Essential Facts on the Go: Internal Medicine (22 page)

• Check serum calcium, ionized calcium, phosphorus, albumin, PTH, PTHrp, vitamin D levels, SPEP/UPEP

Treatment

• Normal saline

• Loop diuretics (only once patient has been fluid resuscitated and is euvolemic)

• Calcitonin (up to 4 doses to avoid tachyphylaxis, works within hours)

• Bisphosphonates (pamidronate/zoledronic acid; caution in AKI/CKD; works within days)

• Steroids (best treatment for vitamin D mediated hypercalcemia)

ENDOCRINE

VI_1_a
Diabetic Ketoacidosis

Diagnosis

Hyperglycemia

Anion gap metabolic acidosis

Evidence of ketogenesis

Urinalysis

Serum ketones

Evaluation

What is the underlying cause of DKA?

Ischemia (?MI – check EKG, troponin)

Infection (?fever, ?WBC count, check blood cx, urine cx, CXR)

Insulin noncompliance

Assess ABC’s