Endocrine

Question 1

What electrolyte derrangements are common with DKA

Answer 1

1. Hyperglycemia and ketoacidosis
2. Hyperkalemia but decreased total body stores
3. Hyponatremia (salt wasting from diuresis)
4. Wasting of mag and phos

Question 2

What is the initial presentation of up to 1/4 of type 1 diabetes?

Answer 2

DKA

Question 3

How can you differentiate HHS from DKA?

Answer 3

No acidosis with HHS but still very high sugars

Absence of ketones in the urine reliably excludes DKA

Question 4

Fluid deficit in DKA?

Answer 4

5-10 liters

Question 5

Do patients with DKA need long acting insulin?

Answer 5

Not until acidosis resolves

Question 6

Insulin dose for DKA?

Answer 6

0.1 U/kg/h

Question 7

Do patients in DKA need a bolus?

Answer 7

First hour dose commonly given as a bolus but not shown to improve recovery

Question 8

Why do all insulin infusions need an adequate flush?

Answer 8

Binds to plastic IV tubing

Question 9

How should fluids be given in DKA?

Answer 9

1. Reverse shock with NS

2. Then run 1/2 NS at 2-3x maintenance

Question 10

When should K be added to fluids in DKA?

Answer 10

Add potassium once K levels reach the normal range (DON’T FORGET TO CHECK/SUPPLEMENT MAG!)

Question 11

What is a rare but devastating complication of DKA most commonly seen in children?

Answer 11

Cerebral edema but don’t let this fear lead you to undertreating shock

Question 12

What treatments are indicated for maternal thyroid storm?

Answer 12

1. PTU
2. Propranolol
3. Potassium iodide (blocks T3/T4 release)
4. Prednisone (dexamethasone)
5. Phenobarbital for extreme agitation