Term
| What are the four insulin counterregulatory hormones? |
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Definition
1) Glucagon - Liver - +glycogenolysis, +gluconeogenesis, +ketogenesis.
2) Cortisol - Liver - +glycogenolysis, +gluconeogenesis. Muscle - -FFA uptake, +proteolysis, -insulin action. Adipose - +lipolysis, -insulin action.
3) Growth hormone - Liver - +gluconeogenesis, +IGFs/IGFBP. Muscle - +AA uptake, -glucose uptake. Adipose - +lipolysis, -glucose uptake.
4) Epinephrine - Liver - +glycogenolysis, +gluconeogenesis, +ketogenesis. Muscle - +glycogenolysis, -insulin action. Adipose - +lipolysis, -insulin action. |
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Term
| Most common precipitating factors in DKA? |
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Definition
| 1) INFECTION. 2) Insulin noncompliance or underdosing. |
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Term
| Diagnostic criteria for DKA and HHS |
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Definition
DKA: Triad, 1) Hyperglycemia, 2) Metabolic acidosis, 3) Ketone production.
HHS: 1) Hyperglycemia, 2) Hyperosmolality, 3) Dehydration. NO KETOACIDS |
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Term
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Definition
1) Replete fluid deficit - half over first 24 hrs, next half over next one to two days (might have a 6-12L deficit).
2) Treat with IV insulin. When glucose reaches 200-300mg/dL, add dextrose. Hyperglycemia corrects faster than DKA. OVERLAP INSULIN INFUSION with SUBCUE by 1-2 hrs. to prevent recurrence.
3) Potassium - In acidosis potassium leaves cells inexchange for protons (buffer). Initially HIGH, but then dives when K goes back into cells. MUST GIVE K, monitor for arrythmias.
4) Bicarbonate - GIVE ONLY IN SEVERE ACIDOSIS (<6.9).
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Term
| How do you correct Sodium? |
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Definition
Na + 0.016(glu-100)
Use corrected sodium to calculate water deficit. |
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Term
| How do you calculate serum osmolality? |
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Definition
| Na x 2 + urea/(2.8 + (glucose/18)) |
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Term
| What ketones are measured? |
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Definition
| Only acetoacetic acid is measured. NOT Beta-hydroxybutyrate. |
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Term
| How do you know when DKA resolves? |
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Definition
Glucose <200
bicarb >15
venous pH >7.3
calculate anion gap <12 |
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Term
| Biggest complication of DKA? |
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Definition
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Term
| What is the anion gap formula? |
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Definition
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Term
| What is Winter's formula? |
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Definition
Pco2 = (1.5 x Bicarb) + 8
If measured is higher than calculated, there is also a primary respiratory acidosis.
If measured is lower than calculated, there is also a respiratory alkalosis. |
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Term
| What is the Delta-Delta formula? |
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Definition
Looks at superimposed metabolic acid/base disorders.
ΔBicarb = ΔAnion Gap
If delta bicarb is greater, then there is a concominant non-anion gap acidosis alongside the anion-gap acidosis.
If the delta bicarb is less than the delta anion-gap, then there is a concominant metabolic alkalosis alongside the anion gap acidosis. |
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