Review - Clinical XIII (Endocrinology)

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[Block 1: Barebones beat. The Rapper flows with a rhythmic, street-poetry cadence. The organ swells slightly on the rhymes.]

Osteoporosis; bisphosphonates, denosumab , raloxifene, teriparatide 
Osteoporosis; bisphosphonates, denosumab , raloxifene, teriparatide

Paget disease can be monostotic (30%), treatment with bisphosphonate. Sarcoma or giant cell tumor may develop Paget Paget

6 months for orchidopexy for cryptorchidism, six, six

[Block 2: The drums strip back to just a rim-click and a kick. The vocals get more intense, acting as the main percussion.]
*Metformin; for patient without cardiovascular or kidney disease. Metformin, in in out
“G.I. side effects are dose-related, often transient”, measure vitamin B12 every few years, “liver injury with cholestasis rare”
“lactic acidosis in patients with risk factors”. Halt on the day of radiocontrast in patients with e.G.F.R. 30–60.
For type I; rapidly acting insulin PLUS  long-acting , rapid and long
Short-acting insulin injected just before, regular insulin before 30–45 min prior
[Block 3: The dark organ shifts to a lower, heavier octave. The Rapper punches in the acronyms aggressively.]

Acidosis, acidosis
D.K.A.; “normal saline” then regular insulin (0.1 unit/kg bolus + 0.1 unit/kg/h “continuously or I.M.”). Bicarbonate for pH ≤ 7
If low K (<3.5), delay insulin until corrected. Measure K, 2 hours after insulin, every 4 hours until the resolution of D.K.A.. Start K.C.l. (after 2-3h of therapy) as soon as the acidosis starts to resolve.
Once the D.K.A. controlled, the patient is awake, can eat then subcutaneous insulin
For Hyperglycemic Hyperosmolar State, “Less insulin (0.05 unit/kg/h without bolus)”, less potassium replacement. If hypotension and oliguria, “normal saline”, otherwise hypotonic

[Block 4: The beat kicks back in fully. The Rapper delivers the final verses with rapid, undeniable authority.]
When to use Statin? Latest guidelines, Go
Statin for “A.S.C.V.D., 1, 90 L.D.L.”, “Age 40–75, diabetes, (regardless of L.D.L.)” “70 L.D.L.  5 percent 10-year  risk
If not enough not enough 
add ezetimibe, alirocumab/Evolocumab, or bempedoic , bempo, pow, pow

[Outro: The drums stop completely. Just the Rapper's raw voice and the echoing organ in the background.]
Fibrates/omega 3 for hypertriglyceridemia (≥500 mg/d.L., don’t use gemfibrozil with statin)
Avoid Avoid 
Avoid in pregnancy and lactation; statin (use only for high-risk), ezetimibe, bempedoic, P.C.S.K.9. Bile acid sequestrants “Safe”

[Ending: A final, lingering minor chord on the organ slowly fades into the vinyl crackle. A single lighter click. Total silence.]

2849/7500

[Intro: 85 BPM. A dusty vinyl crackle. A dark, mournful Hammond organ plays a solitary, minor-key progression. A simple, heavy boom-bap drum loop drops in. The Rapper exhales, stepping up to the mic to deliver the raw facts.] [Block 1: Barebones beat. The Rapper flows with a rhythmic, street-poetry cadence. The organ swells slightly on the rhymes.] Osteoporosis; bisphosphonates, denosumab , raloxifene, teriparatide Osteoporosis; bisphosphonates, denosumab , raloxifene, teriparatide Paget disease can be monostotic (30%), treatment with bisphosphonate. Sarcoma or giant cell tumor may develop Paget Paget 6 months for orchidopexy for cryptorchidism, six, six [Block 2: The drums strip back to just a rim-click and a kick. The vocals get more intense, acting as the main percussion.] *Metformin; for patient without cardiovascular or kidney disease. Metformin, in in out “G.I. side effects are dose-related, often transient”, measure vitamin B12 every few years, “liver injury with cholestasis rare” “lactic acidosis in patients with risk factors”. Halt on the day of radiocontrast in patients with e.G.F.R. 30–60. For type I; rapidly acting insulin PLUS long-acting , rapid and long Short-acting insulin injected just before, regular insulin before 30–45 min prior [Block 3: The dark organ shifts to a lower, heavier octave. The Rapper punches in the acronyms aggressively.] Acidosis, acidosis D.K.A.; “normal saline” then regular insulin (0.1 unit/kg bolus + 0.1 unit/kg/h “continuously or I.M.”). Bicarbonate for pH ≤ 7 If low K (<3.5), delay insulin until corrected. Measure K, 2 hours after insulin, every 4 hours until the resolution of D.K.A.. Start K.C.l. (after 2-3h of therapy) as soon as the acidosis starts to resolve. Once the D.K.A. controlled, the patient is awake, can eat then subcutaneous insulin For Hyperglycemic Hyperosmolar State, “Less insulin (0.05 unit/kg/h without bolus)”, less potassium replacement. If hypotension and oliguria, “normal saline”, otherwise hypotonic [Block 4: The beat kicks back in fully. The Rapper delivers the final verses with rapid, undeniable authority.] When to use Statin? Latest guidelines, Go Statin for “A.S.C.V.D., 1, 90 L.D.L.”, “Age 40–75, diabetes, (regardless of L.D.L.)” “70 L.D.L. 5 percent 10-year risk If not enough not enough add ezetimibe, alirocumab/Evolocumab, or bempedoic , bempo, pow, pow [Outro: The drums stop completely. Just the Rapper's raw voice and the echoing organ in the background.] Fibrates/omega 3 for hypertriglyceridemia (≥500 mg/d.L., don’t use gemfibrozil with statin) Avoid Avoid Avoid in pregnancy and lactation; statin (use only for high-risk), ezetimibe, bempedoic, P.C.S.K.9. Bile acid sequestrants “Safe” [Ending: A final, lingering minor chord on the organ slowly fades into the vinyl crackle. A single lighter click. Total silence.]

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