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14 Cards in this Set
- Front
- Back
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risk factors for hypoglycemia
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long hx of DM1, intensive insulin therapy, extremes of ages, inappropriate timing of meals and insulin dosing, drug-induced hypoglycemia
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what is the most common cause of hypoglycemia?
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inappropriate timing of meals and insulin dosing
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what are some meds involved in drug-induced hypoglycemia?
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*** most common is sulfonylureas(esp with 1st generation agents)
-insulin -ethanol -pentamicline |
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treatment of an unconscious pt with hypoglycemia
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-parenteral glucagon::stimulates hepatic glyconeogenolysis to raise blood glucose
-dependent on adequate supply of hepatic glycogen; little to no activity in starvation, adrenal insufficiency, or chronic hypoglycemia |
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treatment of severe hypoglycemia
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-should respond within 10-15 min; once they regain consciousness, 20-40g of supplemental carbohydrate should be consumed to restore hepatic glycogen and prevent secondary hypoglycemia
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other pharmacological actions of glucagon
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-smooth muscle relaxant in GIT; diagnostic aid in the radiologic examination of the stomach, duodenum, small bowel, and colon
-enhances warfarin anticoagulant effect |
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tx of hospitalized adults with hypoglycemia
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give IV 50mL of D50W
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clinical presentation of DKA
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-high serum glucose concentrations
-increased serum osmolality -glycosuria; osmotic diuresis -dehydration and intravascular volume depletion -ketone production:odor of acetone on breath -metabolic acidosis |
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Treatment of DKA
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-fluids
-sodium::replaced with NS -potassium -insulin::loading dose and IV infusion -sodium bicarbonate::reserve for pts with severe acidosis or in shock |
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During the treatment of DKA; what is the dosing requirements for the fluids
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-NS:: 0.9%NaCl for hypotension or Na<140mEq/L
-if perfusion adequate and Na>150mEqu/L use 1/2 NS |
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what are the specifications regarding potassium replacement in DKA pts?
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-total body K+ is always depleted, but serum K+ may be high, low, or normal, depending on degree of volume depletion
-initially low serum K+ with severe acidosis requires aggressive replacement therapy |
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Use of sodium bicarbonate in treatment of DKA?
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-reservefor pts with severe acidosis or those in shock
-routine use is discouraged; fluid and insulin therapy will correct acidosis |
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drugs that induce hyperglycemia (5 types)
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-diazoxide
-thiazide and loop diuretics -glucocorticoids -pentamidine -protease inhibitors |
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what is the mechanism of petamidine in drug-induced hyperglycemia?
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-beta-cell toxinthe produces a cytolytic-induced release of insulin, resulting initially in hypoglycemia
-followed by a beta-cell destruction and insulin deficiency, resulting in drug-induced hyperglycemia |
