Wednesday [14/6/23] Flashcards
what is hypoglycaemia? [1]
below 4 BMs
first-line regardless if they are symptomatic? [2]
fast-acting carbohydrates liquid like glucojuice, fruit juice, sugar
what should be avoided first line hypoglycaemia? [2]
choclates and biscuits as they have lower sugar content and high fat might delay stomach emptying
what should be done if BM levels don’t increase after glucojuice? [1]
repeat after 15 minutes up to 3 treatments maximum in total
once recovered, what should be given to patients? [2]
snack providing long-acting carbohydrate should be given to patient -> biscuits/slice of bread etc.
if hypoglycaemia not managed by 3 glucogels what should be done? [2]
IM glucagon or gluocse 10% infusion.
what should be given to a patient who is unconscious or having seizures?
Hypoglycaemia which causes unconsciousness is an emergency. Patients who are unconscious, having seizures, or who are very aggressive, should have any intravenous insulin stopped, and be treated initially with glucagon. If glucagon is unsuitable, or there is no response after 10 minutes, glucose 10% intravenous infusion, or alternatively glucose 20% intravenous infusion should be given
should glucose 50% ever be used in acute setting? [2]
Glucose 50% intravenous infusion is not recommended as it is hypertonic, thus increases the risk of extravasation injury, and is viscous, making administration difficult.
should insulin injection be ommited for unwell patients? [2]
If an insulin injection is due, it should not be omitted; however, a review of the usual insulin regimen may be required. Patients who self-manage their insulin pump may need to adjust their pump infusion rate. If the patient was on intravenous insulin, continue to check blood-glucose concentration every 15 minutes until above 3.5 mmol/litre, then re-start intravenous insulin after review of the dose regimen. Concurrent glucose 10% intravenous infusion should be considered.
how common are renal stones? [2]
Renal tract stones (also termed urolithiasis) are a common condition, affecting around 2-3% of the Western population. They are more common in males and typically affect those <65yrs. They commonly form as renal stones (within the kidney) but can migrate to become ureteric stones (within the ureter).
how often are renal stones made of calcium? [2]
Around 80% of urinary tract stones are made of calcium, as either calcium oxalate (35%), calcium phosphate (10%), or mixed oxalate and phosphate (35%). The remaining stone compositions include struvite stones* (magnesium ammonium phosphate), urate stones (the only radiolucent stones), and cystine stones (typically associated with familial disorders affecting cystine metabolism).
what causes struvite stones? [2]
For struvite stones, also called infection stones, form in alkaline urine in the presence of urease-producing organisms, such as Proteus and Klebisella species. Urease catalyses urea into carbon dioxide and ammonia, which leads to the precipitation of magnesium ammonium phosphate crystals.
what causes urate stones? [2]
For urate stones, high levels of purine in the blood, either from diet (e.g. red meats) or through haematological disorders (such as myeloproliferative disease), results in increase of urate formation and subsequent crystallisation in the urine.
what causes cystine stones/ [2]
For cystine stones, these are typically associated with homocystinuria, an inherited defect that affects the absorption and transport of cystine in the bowel and kidneys; as citrate is a stone inhibitor, hypocitraturia from the condition can thus predispose affected individuals to recurrent stone formation
where are the common places for stones to form? [2]
Pelviureteric Junction (PUJ), where the renal pelvis becomes the ureter
Crossing the pelvic brim, where the iliac vessels travel across the ureter in the pelvis
Vesicoureteric Junction (VUJ), where the ureter enters the bladder
