Reference values - Own notes! Flashcards
According to American Diabetic Association (ADA) diagnostic criteria for DM,
what is the cut-off value of
1. Fasting plasma glucose
2. 2-hourpost-oral glucose tolerance test plasma glucose
3. HbA1c
4. Random plasma glucose
? (please provide unit)
- <7.0 mmol/L
- <11.1 mmol/L
- <6.5 %
- > 11.1 mmol/L
What is the fasting plasma glucose range that accounts for impaired fasting glucose level?
- 6-7 mmol/L
normal: <5.6
What is the plasma glucose range that accounts for impaired glucose tolerance after OGTT?
7.8 - 11.1 mmol/L
notmal <7.8
How do we differentiate Gestational DM and DM in pregnancy?
OFTT performed at 6-12 weeks postpartum:
- at 0 min, normal <5.1
- Gestational DM: 5.1-6.9; DM in pregnancy: >7 - at 60 minutes (1 hour), normal <10.0
- Gestational DM: >10; DM in pregnancy: – - at 120 minutes: normal <8.5
- Gestational DM: 8.5-11; DM in pregnancy: >11.1
DM in pregnancy should be diagnosed one or more of OGTT criteria are met
What are the therapeutic goals of ADA in diabetes patients?
- Glycemic control (3)
- BP
- Lipid profile (3)
- Glycemic control
- HbA1c <7%
- Pre-prandial BG 5.0-7.2
- Post-prandial BG <10.0 - BP <130/80
- Lipid profile
- TG: <1.7
- LDL-C <1.8 (<2.6 in normal)
- HDL-C >1.1 in M, > 1.3 in female
How is serum osmolality calculated?
Calculated osmolality = 2 x [Na+]+ glucose + urea
What is the definition of hypoglycaemia?
Plasma glycose <2.5 mmol/L by laboratory method
In normal circumstances in normal patient, how should the body respond to a short synacthen test? (correct unit please!)
Cortisol level should rise to >450 nmol/L
In patients with
i) primary adrenal insufficiency
ii) secondary adrenal insufficiency,
how would they react to the short synacthen test?
i) no increase in cortisol, with increased baseline ACTH level
ii) sluggish response in cortisol level, with undetectable ACTH level
What is a glucagon stimulation test?
How would a normal individual respond to a glucagon stimulation test? (2)
- Induce hyperglycaemia thus reactive hypoglycaemia and stress > test both adrenocortical and GH-IGF axis
1. Cortisol during hypoglycaemic attack should increase to >450 nmol/L
2. GH during hypoglycaemic attack should increase to >20 ng/mL
What is the definition of neonate hypoglycaemia?
- Full-term baby
- Pre-term infant
- Full-term baby: plasma glucose <2.0mmol/L
2. Pre-term infant: plasma glucose <1.1 mmol/L
What are the differential diagnosis for hypercortisolism?
- Cushing’s disease - pituitary adenoma secreting ACTH
- Adrenal adenoma (primary)
- Ectopic source of ACTH - e.g. SCLC
- Iatrogenic: treatment with exogenous glucocorticoids
What are the investigations for hypercortisolism?
Describe.
- Overnight dexamethasone depression test
- dexamethasone 1mg at 23:00, then measure cortisol in the next morning - High dose dexamethasone depression test
- 2mg Q6h x 2 days
If the hypercortisolism is due to
- Adrenal cause (primary)
- Pituitary adenoma secreting ACTH
- Ectopic ACTH secretion
, what would you expect in the 2 investigations respectively?
- Primary adrenal cause
ONDST - unchanged
HDDST - unchanged - Pituitary adenoma secreting ACTH
ONDST - unchanged
HDDST - decreased >50% - Ectopic ACTH secretion
ONDST - unchanged
HDDST - unchanged
What test is used to confirm primary hyperaldosteronism? What are the expected results in normal individuals and abnormal?
Salt loading test
- 5 days of NaCl tablet, measure 24 hour urine aldosterone and Na
- 24h urine Na >200 mmol/24h = adequate salt loading
- 24h urine aldosterone >38 mol/24h = lack of aldosterone suppression with intravascular expansion
What is the Free androgen index?
Hyperandrogenemia what level?
T/SHBG x100 (both in nmol/L)
> 5 = hyperandrogenemia
- e.g. CAH, PCOS, androgen-secreting tumors
Respiratory distress syndrome is the absence of surfactant in premature infants <32 weeks.
What can be measured in amniotic fluid?
Lecithin-sphingomyelin ratio (L:S) in amniotic fluid <1.5 –> high risk of RDS.
- Surfactant is mostly lecithin (phospholipid)
- sphingomyelin level is constant in amniotic fluid
What does it mean by a positive result for testing pheochromocytoma? (3)
24 hour urine collection
- NA + A: 2x elevation
- NM + M: 2x elevation
- VMA: 3x elevation
Name 2 endocrine tests that can be tested if you clinically suspect a pheochromocytoma.
State their respective positive results.
- Glucagon stimulation test
- stimulate catecholamine secretion from pheochromocytoma
- Positive: NA peal 2000pg/ml or >3x increase over the baseline - Overnight clonidine suppression test
- clonidine can suppress physiological catecholamine secretion, while autonomous secretion by tumor cannot.
- Clonidine 0.3mg PO at 9pm
- BP at 9pm, 11pm and 7am
- Collect urine for NA, adrenaline, creatinine
- Positive: NA/Cr >60nnol/mmol OR adrenaline/Cr >20nmol/mmol
What are the respective risks for glucagon stimulation test and overnight clonidine suppression test.
How are the risks prevented respectively?
- Glucagon stimulation test:
- hypertensive crisis, since catecholamines are stimulated
- standby phentolamine IV 10mg during the test - Overnight clonidine suppression test:
- hypotensive shock
- subject should remain supine throughout at night
What is the normal lymphocyte count in CSF?
<5/mm3
no neutrophils!
What is the normal
1. protein
2. glucose
levels in CSF?
- Protein: 0.15-0.45g/L
should be <0.7g/L - Glucose: 2.8-4.2 mmol/L
should be >60% of plasma glucose
What is the light’s criteria?
For determining whether pleural fluid is exudate or transudate. It is an exudate if (one is met)
- Pleural/ Serum total protein > 0.5
- Pleural/ Serum LDH >0.6
- Pleural/ Serum LDH > 2/3 ULN of serum LDH
How do we determine the content of ascitic fluid?
- Total protein
Transudate <30g/L
Exudate >30g/L - SAAG (Serum ascites albumin gradient)
Transudate >11g/L
Exudate 11g/L
