Topic 7 - Endocrine

Question 1

Hypoglycemia - Autonomic features

Answer 1

• Diaphoresis
• Hunger
• Tingling in the mouth
• Tremor
• Tachycardia
• Pallor
• Palpitations
• Anxiety

Question 2

Hypoglycemia - neurological features

Answer 2

• Lethargy, behavioural changes, headache, visual disturbance, slurred speech, dizziness, ALOC, seizures, coma
• NOTE - chronic poorly controlled diabetics may be relatively hypoglycemic despite having a BGL >4mmol/L

Question 3

Hyperglycemia - DKA characteristics

Answer 3

• Hyperglycemia
• Ketosis
• Metabolic acidosis

Question 4

Hyperglycemic hyperosmolar syndrome characteristics

Answer 4

• Hyperglycemia
• Hyperosmolarity
• Severe dehydration

Question 5

HHS versus DKA

Answer 5

HHS is caused by relative insulin deficiency whereby sufficient insulin is produced to limit ketone production. It is most commonly seen in older patients with type II diabetes,

Question 6

Hyper/poglycemia causes

Answer 6

6 I’s:

• Ignorance
• Infection
• Ischemia (cardiac)
• Infarct (cerebral)
• Intoxication
• Impantation

Question 7

Hyperglycemia management

Answer 7

• 12-lead
• IV access
• IV fluids
• O2

If hyperkalemia is indicated by ECG consider:

• Calcium gluconate
• Sodium bicarbonate
• Salbutamol

Question 8

Glucagon (pharmacology)

Answer 8

• Mobilizes hepatic glycogen and releases as glucose in systemic circulation

Question 9

Glucagon (Indications)

Answer 9

• Symptomatic hypoglycemia (with inability to administer oral glucose)

Question 10

Glucagon (Contraindications)

Answer 10

• KSAR or hyposensitivity to glucagon

Question 11

Glucagon (Precautions)

Answer 11

• Nil

Question 12

Glucagon (Side effects)

Answer 12

• None

Question 13

Glucagon (Onset and half-life)

Answer 13

Onset: 4-7 minutes

Half-life: 3-5 minutes

Question 14

Glucose gel (Indcations)

Answer 14

• Symptomatic hypoglycemia

Question 15

Glucose Gel (Contraindications)

Answer 15

• Unconcious
• Difficulty swallowing
• Patients <2 years

Question 16

Glucose gel (Precautions)

Answer 16

• Nil

Question 17

Glucose gel (Side effects)

Answer 17

• Nausea and/or vomiting
• Diarrhoea

Question 18

Glucose gel (Onset)

Answer 18

• around 10 minutes

Question 19

Glucose 10% (Indications)

Answer 19

• Symptomatic hypoglycemia with inabillity to administer oral glucose

Question 20

Glucose 10% (Contraindications)

Answer 20

• Nil

Question 21

Glucose 10% (Precautions)

Answer 21

• Tissu and vascular necrosis secondary to extravasation

Question 22

Glucose 10% (Side effects)

Answer 22

• Nil