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20 Cards in this Set
- Front
- Back
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What are precipitating factors for DKA?
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INADEQUATE INSULIN
infection infarction trauma pregnancy alcohol steroids |
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What labs should you check to confirm DKA?
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blood glucose >200
anion gap + serum bicarb <18 hyponatremic urine ketones + |
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How do you correct sodium for hyperglycemia?
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1.6 per 100 of glucose, starting at 200;
some authorities recommend 2.4 per 100. |
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What is the tx for DKA?
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IV fluids NS 2 L over 4 hours
Insulin drip 100 U at 0.1 U/kg/h Check K, if hyperkalemic start to replace when down to 5.4 Switch insulin to SQ when glucose is down to 250 MUST give basal insulin 4 hours before stopping IV insulin (dose: avg drip x 20 = dose of basal) |
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What is the tx for HNK?
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IV fluids NS
When BP stabilizes, consider half normal saline Insulin drip when hemodynamically stable Add dextrose 5% when glucose is < 250 |
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What are some signs of adrenal insufficiency?
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hyperpigmentation (primary) - see palm creases or lines in buccal mucosa
hypotensive shock N/V, abdominal pain ORTHOSTASIS OTHER AUTOIMMUNE DISEASES like DM, Hashimoto's, pernicious anemia |
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Where can you see hyperpigmentation in adrenal insufficiency?
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see palm creases or lines in buccal mucosa
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T/F Primary adrenal insufficiency is more likely to produce shock than secondary or tertiary.
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true
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Describe the terms of an ACTH stim test.
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1. Get baseline cortisol and ACTH.
2. 250 mcg of IV/IM cosyntropin. 3. wait 60 minutes. 4. Measure cortisol. 5. > 18 normal; below 18 adrenal insufficiency. |
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What if patient is having severe adrenal crisis? What about the stim test then?
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You can give dexamethasone, which won't show up in the assay, and go ahead with the stim test.
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T/F Potassium is only elevated in primary ACTH stim test
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true
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Tx for adrenal insufficiency
(crisis and maintenance) |
crisis: IV fluids
hydrocortisone 100 me IV q8 maintenance: glucocorticoid 2/3 in AM, 1/3 in evening (e.g., 15/5 of hydrocortisone) + a mineralocorticoid like fludrocortisone 0.1 mg/day. --Monitor renin level you only have to give the mineralocorticoid at lower maintenance doses; hydrocortisone provides some mineralocortocoid action at high doses given for crisis. |
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Tx for thyroid storm
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4 aspects
1. PTU or methimazole (block iodination 2. steroid: hydrocortisone 100 mg IV q8 3. Propranolol for sx and to block conversion of T4 to t3 4. SSKI or Lugol's: prevents iodination. Use cautiously, only use after PTU DO NOT use CT scan dye without blocking with PTU first! |
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Where does T4 get converted to T3?
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liver
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Which is the major thyroid hormone, T4 or T3?
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T3
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Profound, dangerous hypothyroid is ?
What are telltale signs? |
myxedema coma
"free water excess" : effusions, edema hypotension, REPEATED ORTHOSTASIS hypothermia delayed relaxation of reflexes thick tongue distant heart sounds |
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Tx of myxedema coma
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corticosteroid IV
eg hydrocortisone 100 mg IV q8h or dexamethasone levothyroxine IV 300-500 mcg x 1 then 75-100 mcg QD |
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workup for pheo
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are there signs of MEN II syndrome?
parathyroid / medually thyroid ca / pheo 24 hour urine for VMA, metanephrines can getn serum metanephrine as well can image if labs are + |
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tx of pheo
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alpha blockade:
phenoxybenzamine 10 mg PO BID phentolamine (can be IV) then beta blockade and hydration plan surgery 1-2 weeks after alpha blocker |
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tx of hypercalcemia
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Normal saline main tx
IV bisphosphonate calcitonin plicamycin Lasix once pt is volume resuscitated |
