Metabolic Medicine

A

• Alcoholic Ketoacidosis - Recognition, Dextrose, and Thiamine

  Consider in chronic alcohol use with abdominal pain and wide anion gap; give dextrose containing fluids, thiamine before glucose if possible, and correct electrolytes.

D

• Diabetes Sick Day Medication Adjustments with CKD

  Hold metformin and sodium glucose cotransporter 2 inhibitors during acute illness with dehydration risk, adjust insulin, and resume when eating and hydrated.
• Diabetic Ketoacidosis - Sick Day Rules and Outpatient Prevention

  Teach sick day plans with hydration, supplemental insulin, ketone testing, and early contact to prevent progression to DKA and hospitalization.
• Dietary Sodium Restriction - Practical Counseling for Patients

  Provide simple targets, label reading tips, and common food substitutions to reduce sodium intake and improve blood pressure control.

H

• Hyperkalemia - ECG First, Stabilize, Shift, and Remove

  Obtain ECG and stabilize myocardium with calcium for concerning changes, shift potassium intracellularly, and remove with diuretics, binders, or dialysis.
• Hypernatremia - Free Water Deficit and Safe Correction

  Calculate free water deficit, correct chronic hypernatremia slowly, and choose enteral or IV hypotonic fluids with frequent sodium checks.
• Hypertriglyceridemia Pancreatitis - IV Insulin and Adjuncts

  For severe hypertriglyceridemia pancreatitis, initiate insulin infusion with dextrose as needed, consider plasmapheresis in selected cases, and start long term lipid therapy.
• Hypokalemia - Evaluation, Repletion, and ECG Monitoring

  Identify causes including diuretics and GI loss, check magnesium, replete potassium orally when possible, and use cardiac monitoring for severe hypokalemia.

L

• Lactic Acidosis - Causes, Resuscitation, and Workup

  Recognize type A from hypoperfusion and type B from drugs or liver disease; resuscitate shock, stop offending agents, and monitor clearance trends.

M

• Metabolic Acidosis - Anion Gap and Delta Delta Approach

  Use anion gap to classify, calculate delta gap to uncover mixed disorders, and target the cause such as ketoacidosis, lactic acidosis, or toxins.
• Metabolic Syndrome - Diagnosis and Risk Reduction

  Diagnose using simple criteria for central obesity, glucose, lipids, and blood pressure; reduce risk with weight loss, physical activity, and cardiometabolic medications as needed.
• Metformin - Renal and Hepatic Considerations and Lactic Risk

  Use eGFR thresholds to guide dosing, hold during acute illness or contrast exposure when risk is high, and recognize rare lactic acidosis presentations.

N

• Non Gap Metabolic Acidosis - Renal Tubular Causes and Diarrhea

  Distinguish renal acidification defects from gastrointestinal bicarbonate loss using urine studies and clinical context to direct therapy.

O

• Obesity Pharmacotherapy - GLP1 Agents and Dual Agonists

  Use FDA approved anti obesity medications in eligible patients with lifestyle support; discuss expected weight loss, side effects, and monitoring.

R

• Recurrent Hypoglycemia - Evaluation and Counterregulation

  Identify iatrogenic causes, impaired awareness, adrenal or pituitary disease, and insulinoma; adjust therapy and provide rescue plans including glucagon.