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Line 1: + + + + + + − *During vitamin B12 repletion, you should monitor '''serum potassium, which can drop as new RBCs are formed.''' − *Young, normal weight patient, without family history of diabetes presents with symptomatic DKA? '''T1DM''' + + + + + − + − *'''Prolactin-secreting''' pituitary adenomas, including large ones, are first treated with '''oral dopamine antagonists''', whereas other pituitary adenomas are treated with surgery if large enough. Line 17:
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=Missed Concepts=
=Missed Concepts=
*During vitamin B12 repletion, you should monitor '''serum potassium, which can drop as new RBCs are formed.'''
*'''Prolactin-secreting''' pituitary adenomas, including large ones, are first treated with '''oral dopamine antagonists''', whereas other pituitary adenomas are treated with surgery if large enough.
*Congenital Adrenal Hyperplasia is most commonly '''21-hydroxylase deficiency''' (hypotension, low Na, high K, hypoglycemia, ambiguous genitalia in girls), but can also be '''11β-hydroxylase deficiency''' (hypertension, low K, hypoglycemia, ambiguous genitalia in girls) or '''17α-hydroxylase deficiency''' (hypertension, low K, euglycemia, ambiguous genitalia in boys).
*Discontinue metformin prior to surgeries with a high contrast load (e.g. cardiac cath)
=Thyroid=
*Workup of thyroid nodule almost always ends with FNA, the one exception is '''a patient without suspicious US findings or cancer risk factors, a low TSH, and a hot nodule on 123-Iodine scan (toxic adenoma).''' For these patients '''go straight to treatment (Methimazole pretreatment to achieve euthyroid > RF ablation vs. surgery)'''
*Workup of thyroid nodule almost always ends with FNA, the one exception is '''a patient without suspicious US findings or cancer risk factors, a low TSH, and a hot nodule on 123-Iodine scan (toxic adenoma).''' For these patients '''go straight to treatment (Methimazole pretreatment to achieve euthyroid > RF ablation vs. surgery)'''
*Hashimoto thyroiditis can be associated with other autoimmune conditions such as atrophic gastritis (pernicious anemia).
*Hashimoto thyroiditis can be associated with other autoimmune conditions such as atrophic gastritis (pernicious anemia).
*Total T3 and T4 in pregnancy can be 1.5x normal range and still be physiologic. TSH is suppressed. '''There is no role for measuring free T4 in pregnancy'''
*Total T3 and T4 in pregnancy can be 1.5x normal range and still be physiologic. TSH is suppressed. '''There is no role for measuring free T4 in pregnancy'''
*Amiodarone decreases peripheral conversion of T4 to T3, but generally this self resolves in 6-9 months after treatment initiation. Amiodarone has a half-life of 100 days.
*Low T4 and low TSH suggests central hypothyroidism. Measure ACTH levels and get an ACTH stim test as well as AM serum cortisol.
=Glucose Homeostasis=
*One complication of SGLT2 inhibitors is '''euglycemic DKA with BG < 250, but still with an elevated AG and low pH.'''
*Hyperglycemia and catabolic symptoms (weight loss, urinary frequency) are indications for insulin.
*Hyperglycemia and catabolic symptoms (weight loss, urinary frequency) are indications for insulin.
*One complication of SGLT2 inhibitors is '''euglycemic DKA with BG < 250, but still with an elevated AG and low pH.'''
*Young, normal weight patient, without family history of diabetes presents with symptomatic DKA? '''T1DM'''
=Electrolyte Imbalanaces=
=Electrolyte Imbalanaces=
| Sodium || Example || Example
| Sodium || Example || Example
|-
|-
| Potassium || Example || Example
| Potassium || Nausea, vomiting, ECG changes, asystole || Example
|-
|-
| Calcium || Example || Increased DTRs
| Calcium || Example || Usually asymptomatic, but can cause increased DTRs, muscle cramps, convulsions
|-
|-
| Magnesium || Low-absent DTRs || Example
| Magnesium || Low-absent DTRs, flaccid paralysis, apnea || Example
|-
|-
| Phosphorus || Example || Example
| Phosphorus || Example || Example
==Hyponatremia==
==Hyponatremia==
*Moderate to severe hypothyroidism can cause cause mild euvolemic hyponatremia.
*Dx: Correct for Glucose. '''Moderate to severe hypothyroidism''' can cause cause mild euvolemic hyponatremia.
==Hypercalcemia==
==Hypercalcemia==
*Dx: Best initial test is '''PTH'''
*Dx: Best initial test is '''PTH'''
*Tx:
*Tx:
==Hypocalcemia==
*Dx: correct for albumin (Ca + 0.8*[4 - albumin])