CCFP EM - Endocrine and Metabolic Already Verified A+
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CCFP EM - Already Verified
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CCFP EM - Already Verified
CCFP EM - Endocrine and Metabolic Already Verified A+
Overall management of thyroid storm.
Supportive care
* order of therapy is important
Inhibition of new hormone synthesis (PTU propylthiouracil 10000 mg PO loading dose or methimazole)
*give before iodine therapy
Inhibition of thyroid...
CCFP EM - Endocrine and Metabolic Already Verified A+
Overall management of thyroid storm.
Supportive care
* order of therapy is important
Inhibition of new hormone synthesis (PTU propylthiouracil 10000 mg PO loading dose or methimazole)
*give before iodine therapy
Inhibition of thyroid hormone release (potassium iodine or lugol solution)
Peripheral β-adrenergic receptor blockade (Propranolol IV)
Preventing peripheral conversion of thyroxine to triiodothyronine (hydrocortisone)
- can add anion exchanger (cholestyramine) - help prevent reabsorption of thyroid hormone from the
enterohepatic circulation
why is propranolol preferred in thyroid storm?
at high doses inhibits T4-->T3
6 potential causes of DKA.
Omission
Pump failure
Infection
Pregnancy
Hormonal dysfunction (hyperthyroid, pheochromocytoma, Cushing's)
Medications
Infarction
GIB
Pancreatitis
Major trauma
Surgery
What 2 criteria do you have to check before starting insulin in DKA?
, Serum Potassium > 3.0
Wait 1 hour after fluid resuscitation prior to initiating insulin infusion
What are 4 risk factors for Cerebral Edema in the Pediatric Population in terms of DKA?
Younger age (<5 years)
Greater acidosis (lower pCO2, lower pH)
New onset diabetes
Longer duration of symptoms
Sick appearance
More severe evidence of dehydration (increased hematocrit, increased urea)
Name 2 medical interventions to avoid that could increase the risk of cerebral edema in peds DKA.
IV Insulin Bolus
Sodium Barcarboante
Early Insulin infusion (within 1st hour of administration of IV fluids)
Name 1 bedside maneuver and 1 other treatment for Cerebral Edema.
Elevate Head of Bed to 30º
3% NaCl (5ml/kg IV over 10 minutes)
Mannitol 0.5-1.0g/kg IV over 15 minutes)
2 major complications of DKA
ARDS
cerebral edema (especially in youth)
List 3 Common Complications with Insulin Pumps that may precipitate DKA
Disconnection
Empty tank
Kinking
Priming error
Battery dies
Rapid insulin use, malfunction, rapid formation of DKA
risk factors for euglycemic DKA?
- just received insulin
- Young T1DMs vomiting
- Patient’s with impaired gluconeogenesis (liver failure, EtOH use disorder, starvation)
dx - normal glu, acidosis, HCO3 low, serum ketones
how do you manage euglycemic DKA?
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