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Endocrinology - Coggle Diagram

- - - - excess GnRH
      - long bones fuse early
    - - stunted growth
  - - - GH deficiency
    - - normal size babies
      - short as children
  - - - excess GH due to a pituitary tumour before epiphyseal plates fuse
    - - excess growth
  - - - excess GH due to a pituitary tumour after epiphyseal plates fuse
    - - enlarged hands
      - enlarged feet
      - prominent jaw
      - deformed skull
      - prominent orbital ridge
      - enlarged organs
      - bitemporal hemianopia
      - osteoarthritis
  - - - loss of permissive effect of TH on GH
    - - TH supplementation
    - - infantile features
        
        facial features
        
        fat distribution
      - stunted growth
      - severely impaired cognitive function
      - appear normal at birth
  - - - large baby
- - - - diabetic ketoacidosis
        
        presentation
        
        N&V
        
        abdo pain
        
        sweet smelling, ketotic, pear-drop breath
        
        drowsiness
        
        rapid, deep sighing respiration (Kussmaul)
        
        increased RR with good sats due to metabolic acidosis
        
        coma
        
        polyuria
        
        polydipsia
        
        weight loss
        
        weakness
        
        dry mucous membranes
        
        sunken eyes
        
        tachycardia
        
        hypotension
        
        hypothermia
        
        management
        
        ABC
        
        1st hr
        
        1L/hr 0.9% saline
        
        actrapid 6 units/hr
        
        2nd hr
        
        BG < 14
        
        10% dextrose with KCl
        
        reduce insulin to 3U/hr
        
        adjust insulin to maintain BG 9–14mmol/l
        
        at end
        
        lab glucose
        
        U&Es
        
        bicarbonate
        
        3rd & 4th hrs
        
        500ml/hr 0.9% saline
        
        review potassium
        
        supplement if <5 & passing urine (KCl)
        
        until discharge
        
        reduce rate of saline
        
        bicarbonate normal, E&D
        
        restart s/c insulin regimen
        
        30 mins later
        
        1 more item...
        
        DVT prophylaxis?
        
        central line?
        
        catheter?
        
        investigations
        
        glucose
        
        VBG
        
        urinalysis/blood ketones
        
        U&Es, FBC
        
        blood/urine culture
        
        ECG (within 30 mins) & cardiac monitor
        
        consider CXR
        
        consider MSSU
        
        complications
        
        hyperkalaemia
        
        hypokalaemia
        
        hypoglycaemia
        
        rebound ketosis
        
        arrhythmias
        
        acute brain injury
        
        cerebral oedema (esp. in children)
        
        aspiration pneumonia
        
        thromboembolism
        
        arterial
        
        venous
        
        ARDS
      - microvascular disease
      - nephropathy
      - CVD
      - foot complications
      - eye complications
      - adverse pregnancy outcomes
      - hypoglycaemia
        
        classification
        
        mild
        
        can self treat
        
        severe
        
        needs 3rd party intervention
        
        causes
        
        too much insulin
        
        inappropriate insulin timing
        
        injection site problems
        
        inadequate food CHO
        
        exercise
        
        alcohol
        
        risk factors
        
        tight glycaemic control
        
        impaired hypo awareness
        
        cognitive impairment
        
        extremes of age
        
        malabsorption/gastroparesis
        
        hypoadrenalism/abrupt steroid withdrawal
        
        renal/hepatic impairment
        
        renal/hepatic impairment
        
        pancreatectomy
        
        management
        
        mild
        
        15–20g quick acting carbohydrate (5–7 Dextrosol tablets, 4–5 Glucotabs, 60ml Glucojuice, 150–200ml pure fruit juice)
        
        10–15 mins later
        
        recheck BG
        
        1 more item...
        
        deteriorating
        
        moderate (able to swallow, but confused/disorientated/aggressive)
        
        if possible
        
        if patient can swallow
        
        1.5–2 tubes glucose gel between teeth & gums
        
        severe (patient can't take anything by mouth)
        
        ABC
        
        contact doctor urgently
        
        stop IV insulin
        
        10 mins later
        
        recheck BG
        
        1 more item...
        
        IV glucose over 10–15 mins (75ml 20% glucose, 150ml 10% glucose or 1mg glucagon IM)
        
        definition
        
        BG < 4mmol/L
        
        presentation
        
        sweating heavily
        
        anxiety
        
        pallor
        
        trembling/shaking
        
        palpitations
        
        lips tingling
        
        hunger
    - - Thirsty
      - Thinner
      - Tired
      - using the Toilet more
    - - finger prick capillary glucose
        
        more than 11 mmol/l
        
        contact specialist for same day review
      - blood ketones
    - - basal long acting insulin bd/od as background, then rapid/short bolus acting insulin at meals, 1 unit per 10g CHO
        
        Levemir (long acting analogue, 22 hrs) bd & rapid acting analogue (Novorapid, Humalog, Apidra)
      - inject insulin into lower abdomen, lateral thighs or buttocks
      - rapid acting mixed with intermediate acting (Humalog Mix or Novomix) BB & BT
      - rapid acting mixed with intermediate acting BB, rapid acting BT & intermediate acting (Insulatard, Humulin I, Insuman Basal) BBed
      - short acting BB, BL & BT; intermediate BBed or long acting (Lantus/Levemir) at fixed time
      - test BG prior to driving
      - CGM
        
        intermittent scanning CGM (isCGM)
        
        flash
        
        real time CGM (rtCGM)
        
        Freestyle Libre
        
        can link with insulin pump
      - carb counting
      - exercise
      - screening
        
        foot/eye/kidney complications
      - manage CVS risk factors (smoking, cholesterol)
      - optimise BP control
      - sick day rules
        
        don't stop insulin
        
        check BG
        
        check ketones
        
        <0.6 mmol/l: normal
        
        repeat after 2 hrs
        
        0.6–1.4 mmol/l: risk of DKA
        
        drink plenty of sugar free fluids
        
        correction dose of insulin
        
        retest BG & ketones 1–2 hrly
        
        1.5–2.9 mmol/l: risk of DKA
        
        contact medical team for advice
        
        3.0 or above
        
        DKA
        
        phone for urgent medical advice