Basic Science

Question 1

In DKA what are the 3 types of Ketones made?

Answer 1

Acetoacetate, Acetone and B-Hydroxybuterate.

• urine dip only tests for the first 2.
• Beta hydroxybuterate is made earlier on in dz, during Rx is converted to acetoacetate. levels therefore initially rise

Question 2

What are the 4 types of hypersensitivity reactions?

Answer 2

1. Type I: IgE antibody mediated. degranulation of mast cells. (Anaphylaxis, urticaria)
2. Type II: Cytotoxic. IgM/IgG antigen interactions. Antibody mediated hypersensitivity (Drug induced thrombocytopenia, transfusion reactions, Rh incompatibility)
3. Type III: IgM, IgG Immune complex mediated hypersensitivity (Serum sickness)
4. Type IV: Delayed type hypersensitivity. Sensitized T cells activated to release cytokines upon binding to antigen (contact dermatitis, rejection of transplants)

Question 3

What is an anaphylactoid reaction?

What are common drugs that can cause this?

Answer 3

Not IgE mediated reaction but substance causes direct release of histamine from mast cells without prior sensitization. Common drugs include:

Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Radiopaque contrast media
Fluorescein
Dextran
Thiamine
Opiates