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119 Terms

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T3 and T4

Both T3 and T4 are 99.5% bound to plasma proteins, mainly thyroid-binding globulin and albumin.

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T3 activity

T3 activity is 5-10x greater than T4 activity.

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T4

T4 is the main negative feedback hormone.

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Central diabetes insipidus

An ADH deficiency leads to the condition known as central diabetes insipidus, characterized by polyuria, polydipsia, headaches, and other symptoms.

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Polyuria

Increased urine production.

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Polydipsia

Increased thirst.

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Headache

A symptom of central diabetes insipidus.

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Increased plasma osmolarity

A consequence of central diabetes insipidus.

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Seizures

Can occur due to central diabetes insipidus.

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Hormones working together

Hormones typically work in concert to produce a desired effect or physiologic outcome.

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Exponential response

Hormones working together can produce effects 5x greater than what they would alone.

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IGF-1

Most of the effects of GH are mediated by the production of IGF-1, which is produced after GH binds the GH receptor on the cell membranes of liver cells.

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GH

Growth hormone.

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IGF-1

Insulin-like growth factor 1, mediated by STH.

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Estrogen

Estrogen is the dominant hormone in the follicular phase of the menstrual cycle, inhibiting FSH release, promoting endometrial thickening, and promoting the LH surge.

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FSH

FSH levels increase during the follicular phase for growth/development.

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LH surge

Estrogen promotes the LH surge during ovulation, necessary for follicular maturation and ovulation.

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Corpus luteum

Estrogen is secreted by the corpus luteum in the luteal phase, but progesterone is the main hormone secreted by the corpus luteum in the luteal phase.

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Insulin in liver

Insulin in the liver increases glucose uptake, lipogenesis, glycogenesis, and decreases glucose output, gluconeogenesis, and glycogenolysis.

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Insulin resistance

Insulin resistance is the failure of normal amounts of insulin to elicit the expected response.

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Sulfonylureas

Sulfonylureas act on SUR to inhibit ATP-sensitive K+ channels and stimulate insulin secretion from pancreatic β-cells.

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GLP-1 receptor agonists

Long-acting GLP-1 receptor agonists act on incretin receptors on pancreatic β-cells to increase cAMP levels and stimulate insulin secretion.

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DPP-4 inhibitors

DPP-4 inhibitors inhibit the enzyme DPP-4, increasing GLP-1 levels in type 2 diabetes.

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Prandial state

In the prandial state, pancreatic β-cells secrete insulin, promoting glucose uptake, glycogenesis, and lipogenesis.

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Metformin

The main clinical benefit of metformin is reduced glucose production by the liver, inhibiting gluconeogenesis and improving insulin sensitivity.

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Vitamin D metabolism

In CKD, the kidneys are unable to convert inactive vitamin D to active vitamin D, leading to deficiency.

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Myxedema coma

Pharmacological management of myxedema coma includes IV glucocorticoid, levothyroxine ± liothyronine IV, and supportive care.

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Vascular access techniques

Native arteriovenous (AV) fistula, synthetic AV graft, and venous catheters are used for hemodialysis, each with different longevity and complications.

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Overflow incontinence

Medications that exacerbate overflow incontinence include alpha-adrenergic agonists and anticholinergics.

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Intradialytic hypotension

Intradialytic hypotension is treated and prevented through patient positioning, fluid and electrolyte administration, changing dialysis settings, and the use of midodrine.

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Prerenal, intrinsic, and postrenal AKI

Differentiate between prerenal, intrinsic, and postrenal acute kidney injury based on the underlying causes.

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Medications to discontinue in AKI with low blood pressure

ACEI/ARBs, NSAIDs/COX-2 inhibitors, and diuretics should be discontinued in patients with AKI and low blood pressure.

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Medications needing dose reduction in renal impairment

Various medications, including antimicrobials, acyclovir, chemotherapy drugs, NSAIDs, and immunosuppressants, require dose reduction in renal impairment.

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Supportive measures in AKI

Supportive measures in AKI include assessing volume status, using crystalloids for volume depletion and loop diure

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Hyperglycemic crisis treatment categories:

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Treatment with isotonic saline bolus followed by infusion.

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Treatment for DKA to correct acidosis, indicated if pH

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IV administration, important but fluids are more pressing, weight-based dosing.

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Patient-specific based on deficiencies.

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Sliding scale insulin:

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Inpatient glycemic control goal:

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Basal insulin initiation for Type 2 DM:

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10 units/day or 0.1-0.2 units/kg/day.

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Electrolyte disorders and mineral bone disease in CKD:

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Uremia in CKD:

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Anemia in CKD:

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Nephrotic syndrome in uncontrolled diabetic nephropathy:

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Regulation of glomerular filtration in the glomerulus:

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Causes of acute renal failure (ARF)/acute kidney injury:

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Decrease in blood flow to the kidneys.

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Damage directly to kidney tubules or parenchyma.

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Obstruction of the renal artery.

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Drug-induced nephrotoxicity:

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Acid-base disorders:

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Acute and chronic causes.

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Acute and chronic causes.

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Causes mnemonic "MUD PILES."

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Causes mnemonic "USED CAR."

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Causes include vomiting and diuretic use.

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Hyponatremia:

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Hypovolemic, euvolemic, and hypervolemic causes.

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Typically caused by hyperglycemia.

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ADA guidelines for glucose goals:

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Diagnosis of Diabetes:

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