I want a pt. on a tight control glucose regimen. 

1)  How do I decide how fast to run my insuling drip (in units per hour?)

2)What are the ranges that Marty gave us to remember?

3) How often do I check  Blood sugar?

1) divide pts blood sugar by 150 to get a relative rate in units per hour. 

2) However:  Marty gave this equation but then gave the following ranges (which do not necessarily calculate out)

100-200 = 1U/ Hour

200-250 = 2U/ Hour

250-300 = 3U/Hour

350-400 = 4U/Hour

3) 1-2 hours

Fill in the blanks regarding preparing a glucose drip for management in the O.R:

You can place ____a____ units of insulin in _____b___ mls of normal saline and run at a rate of 5 to _____c_____ m/hr and adjust to maintain desired blood glucose level.

a) 100

b) 1000

c) 20

1) Manage fluids with .9 NS (especially with induction)

2) Administer 100-200 cc/hr of a 5% dextrose solution hourly

3) Document peripheral neuropathies.

Answer True or false to the following statements regarding hypoglycemia under anesthesia.   If false explain why they are false:

1) Hypoglycemia is dangerous.

2) If the pt has been well controlled with long acting hypoglycemics blood sugar monitoring is not necessary.

3) Renal insufficiency decreases the duration of insulin and oral hypoglycemics

4) Diabetics can exhibit hypoglycemia with blood sugars greater than 50 mg/dl

1) True

2) False.  Judicious blood sugar monitoring is necessary especially if the patient has taken long acting hypoglycemics.

3) False.  Renal insufficiency increases duration of insulin and oral hypoglycemics

4) True

-Tachycardia

-Lacrimation

-diaphoresis

-HTN

(Think: What's my pt's blood sugar?)

Fill in the blanks (hah hah!)

Hyperglycemia ____1_____ the risk of infection and augments the damage from _____2_____ ischemia.

1) increases

2) Cerebral

1)If I have a blood sugar greater than 600 in a Type II diabetic what can occur?

2) What do you need to do if this occurs?

1) non-ketotic, hyperosmolar hyperglycemic coma can occur. 

2) Volume and insulin replacement is necessary (not too rapidly or cerebral edema can occur)

1) What is an insuloma?

2) What are you going to do about it whilst they try to remove the angry insuloma?

1)  insulin secreting tumor that needs to be surgically removed.

2) come at it like a spider monkey:

- Maintain glucose above symptomatic level

-frequent glucose monitoring

(if blood sugar doesn't rise after the tumor is removed, some tumor may still be left)

- diazoxide/hyperstat may be given to suppress the tumor's insulin release

- Aldosterone (mineralocorticoid)

-Cortisol (glucocorticoid)

I'm a hormone. 

I am the most potent mineralocorticoid produced by the adrenal cortex. 

My production manager is the renin-angiotensin system

I look fabulous in a Members Only jacket and parachute pants........ Who am I?

ALDOSTERONE!!!!!!

SUUUUUPEEEERRRRRRR!!!

(You silly little freaks)

What is the syndrome associated with hypersecretion of aldosterone?

(could be from: adrenal adenoma, hyperplasia, carcinoma)

- HTN

-Hypokalemia

-Muscle Weakness

-Alkalemia

-Urine K > 40 meq per 24 hours

-Headache

-retinopathy

-cardiomegaly

-hypomagnesemia

What are some lab findings you might have with Conn's Syndrome?

Answer True or False:

1) Hyperkalemic alkalosis

2) Sodium elevations

3) Decrease in Bicarb levels

4) Increased plasma aldosterone

5) Increased plasma renin activity

1) False- Hypokalemic alkalosis

2) True

3) False- bicarbonate elevations

4) True

5) False- Decreased plasma renin level activity

1) Correct the potassium

2) Restore Volume

3) Correct HTN with spironolactone (aldosterone antagonist-potassium sparing diuretic)

4) Less B/P lability with inhalation anesthetic

5) May see  HTN with postioning or manipulation of the tumor.

6) May see hypotension when the tumor is removed.

Answer True or False to the following comments regarding Cushing's Disease: 

1) Underproduction of cortisol by the adrenal cortex

2) Increased susceptibility to infections.

3) The treatment is to punch Nate in the nads.

4) Spironolactone causes retention of fluid and causes a decrease in potassium

5) Careful postioning is important.

1) False: Overproduction of cortisol by adrenal cortex

2) True

3) False: adrenalectomy is the treatment

4) False: Diuresis with spironolactone will mobilize fluid and normalize potassium

5) True:  Of course positioning is important.  Seriously- What fucking lecture did we get that ever stated "Hey don't worry about positioning."????  Seriously.  These slides are gay.