Poo Poo Help Flashcards
Hyperglycaemia and raised ketones in the absence of acidosis is known as what?
Diabetic ketosis
How would you manage diabetic ketosis?
(Random blood glucose of above 11.1mmol/L is sugggestive of new diagnosis)
Subcutaneous insulin and fluids and careful monitoring of blood glucose and ketones
Normal blood ketone level?
<0.6 mmol/L
Initial management of those with diabetic ketoacidosis with evidence of hypotension is to
bolus 500ml 0.9% sodium chloride (slains)
What does bolus mean
an intravenous injection of a single dose of a drug over a short period.
Headache , drop in consciousness, (rise in blood pressure, drop in pulse and seizures) complication of DKA in a children is what
Cerebral oedema or swelling of brain parenchyma
When would you give only oral fluids and subcutaneous fluids in DKA, Vs IV 0.9% sodium chloride?
Mild DKA in children
Alert
Not nauseous
Not vomiting
No signs of dehydration
Man with diabetes. Blood glucose low- all other parameters in normal range. Symptoms of confusion and clammy. Do what
Give sugary drink. This isn’t DKA you doink.
U&Es investigation for DKA when? Vs capillary blood gas and capillary blood ketones?
Latter is first as to find out pH and bicarbonate and glucose and ketone levels: assesses severity and CONFIRMs diagnosis.
THEN you would do U&Es for potassium levels once diagnosis is confirmed to check for dehydration and electrolyte disturbance
adrenal gland is at what level
T12
I know that zona reticularis secretes sex hormones, what specific example can you think of
DHEA
I know the adrenal medulla secretes catecholamines… what 3 ( >3< mind you) can you think of
epinephrine
dopamine
norepinephrine
When is the peak of cortisol secretion
6-9am
what is the most common cause of congenital adrenal hyperplasia
21-hydroxylase hyperplasia, as there is lack of negative feedback on CRH and ACTH, patients keep pumping out CRH and ACTH and stimulate adrenal gland therefore hyperplasia and sex hormones
95% of cortisol is bound to what
cortisol binding globulin
what is cortisol diabetogenic?
suppression of insulin
lack of cortisol can lead to
hypoglycaemia
affect of cortisol on glucagon
permissive- helps increase blood glucose
affect on bones with cortisol
osteoporosis via stimulation of bone resorption
this is not the same as absorption.
it’s the opposite. Cortisol wants to free the amino acids. etc.
is Cushing’s disease associated with hypertension or hypotension
Cushing’s disease = excess cortisol.
cortisol is produced in the adrenal glands due to the presence of ACTH. This stimulation of the adrenal glands = hypertension.
This is due to the permission of norepinephrine! Nothing to do with aldosterone.
Apart from cushings disease of the pituitary gland = ACTH dependant, what is the most common cause of Cushing’s syndrome?
iatrogenic i.e. too many steroids
How do you screen for cushing’s?
24 hour urinary free from cortisol
How do you diagnose Cushing’s?
dexamethasone suppression test.
Too much cortisol- where is it coming from?
low dose given (like 1mg), if that blocks therefore low cortisol in normal person. or if cushings then it remains elevated. Measure in the morning cuz it will be overnight.
But
high dose 8mg, that’ll be enough for -ve feedback to suppress CRH therefore ACTH in the pituitary.
Addison’s diagnosis is via what test
Short Synacthen
so.
Addison’s is not enough cortisol.
so if you give ACTH then if increases, not Addison’s? Should double in an hour.
why hypotension with Addison’s
due to hypovolaemia
how do we treat Addison’s. Obviously we replace… but what with?
glucocorticoids with prednisolone, hydrocortisone or dexamethasone
replacement of mineral corticoids which is aldosterone. So we replace that with fludrocortisone
Someone with Addison’s is pretty ill. What do we do to their dose???
Double the gluco ones. So double the dexamethasone, or prednisolone, or whatever it is, but keep the f the same.
Think- in illness, we NEED to double the sugar.
what do we do when confronted with Addisonian crises?
Give the glucocorticoids but as IV. IV hydrocortisone
What’s the actual issue when you encountering Addisonian crises?
Hypoglycaemia and therefore hypotension
what’s the triad for phaeochromocytoma?
tremor
sweating
palpitations
hypertension
how do we diagnose the phaeochromocytoma?
24 hour urine collection to check levels of epinephrine and norapinephrine etc.
adrenal hypersecretion hormone levels please for primary, secondary, tertiary…
Cortisol, ACTH, CRH
cortisol, acth, crh
high low low
high high low
high high high
Conn’s syndrome is too much aldosterone. (hypertension??) How do we check if it’s primary or secondary?
Renin to aldosterone level. If above 20 = primary. Because Conn’s syndrome = too much aldosterone, which can be primary at the adrenal gland. OR it can be because there is too much angiotensin 2 stimulating release of aldosterone. That would mean too much renin. And that’s because the juxtaglomerular cells sense the hypovolaemia.
Conn’s on sodium and potassium levels
Conn’s would mean you have too much serum sodium, and not enough k
what’s normal calcium level?
2.2-2.6mmol/l
is tetany hypocalcaemia or hyper?
hypo
hypertension or hypotension for hypocalcaemia?
hypotension
diarrhoea with hypocalcaemia or hypercalcaemia?
hypo
explain Trousseau’s sign, and what it represents
when you inflate the blood pressure cuff and the hand spasms = hypocalcaemia
hypocalcaemia in alkalosis or acidosis? What condition may lead to this?
In alkalosis
imagine sour milk- milk is acidic
hypothyroidism
what if it seems like hypothyroidism, but calcium levels remain high, and PTH levels are also high?
guess it just means that the levels are high but organs are unresponsive, pseudo
when would you administer IV calcium gluconate?
severe hypocalcaemia where the patient is symptomatic
mild hypocalcaemia?
oral calcium tablets and replace vitamin D
You have vomiting and nausea with hypercalcaemia. Which endocrine condition would you associate it with?
hyPERthyroidism.
is secondary or primary hyperthyroidism low calcium levels?
Secondary. Its hyper to counteract the low calcium levels. Low calcium levels to do with CKD
