內分泌新陳代謝科檢查

糖尿病

01  OGTT-for DM diagnosed

-NPO since前一天10PM

-7:50AM check plasma sugar as 0 minute sugar level

-7.5 Amp 的50% G/W(=75g) 稀釋成300 cc, 請病人10 minutes內喝完

-Check plasma sugar at 30, 60, 90, 120 minutes

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低血糖

04  禁食3天試驗 (72hr fasting test) –for hypoglycemia

      1. ----月----日----餐後開始NPO,但可以喝水

      2.check sugar q6h till sugar <60mg/dl , 改 q1h

      3.Sugar <50mg/dl start to check Insulin, C-peptide

        (即suagr <50mg/dl 開始每小時測sugar ,亦同時check Insulin, C-peptide

      4.stop the test if: 1.sugar <45mg/dl

                    2.hypoglycemia symptom & sign

                    3.till 72hrs 

      5.check Insulin, C-peptide, Cortisol, hGH at the end of the test

      6.feed the patient  

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腦下垂體功能測試

22.  Three combined pituitary function test

-          NPO since MN and keep recumbent position until test finish

-          Set 3-way catheter in forearm vein (Heparin locked)

-          早上8:00 抽 plasma Sugar, hGH, Cortisol, TSH, prolactin, LH, FSH 

-          RI 0.15u/kg, TRH 1 Amp, LH-RH 1 Amp (100ug), iv injection at the same time after blood drawing

-          Check plasma Sugar at 15, 30, 60 minutes or presence of hypoglycemia s/s

-        Check TSH at 15, 30, 60 minutes

-          Check (ACTH), cortisol at 30, 60, 90 minutes

-          Check prolactin(=PRL) at 30, 60, 90 minutes

-          Check hGH at 60, 90 minutes

測試項目	抽血	抽血	抽血	抽血
Sugar; TSH	15’	30’	60’
ACTH, cortisol; PRL		30’	60’	90’
hGH			60’	90’

腦下垂體->分泌TSH 功能

12  TRH test-腦下垂體分泌TSH 功能; 腦下垂體-甲狀腺軸問題

-          Check blood TSH at 0 minute

-          TRH (Protirelin) 1 vial (0.5mg) iv push rapidly

-          Check blood TSH at 20, 30, 60, 90, 120 minutes

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11.  TRH test – for growth hormone excess (acromegaly)

-  NPO since MN and keep recumbent position until test finish

-          Check plasma hGH at 0 minute

-          TRH (Protirelin, 0.5mg/1ml/Amp) 1 Amp iv injection

-          Check plasma hGH at 15, 30, 45, 60 minutes

09  Insulin Tolerance Test – for growth retard. (侏儒症)

-          NPO since MN

-          Check hGH, cortisol and sugar at 0 minute

-          RI (0.05-0.1 u/kg) iv push, keep N/S 1BT patent line. 備50% G/W 4 AMP

-          打完RI後, check sugar at 15, 30, 45, 60, 90, 120 minutes

-          Check hGH, at 15, 30, 60, 75, 90, 120 minutes

*若有hypoglycemia symptoms 出現, check sugar, hGH and cortisol, 並立刻終止test

*Prepare IV line for 50% D5W.

08.  Insulin Tolerance Test – for growth hormone deficiency

-          NPO since MN

-          Check GH, cortisol and sugar at 0 minute

-          RI ____u (0.1 u/kg) iv push, keep N/S 1BT patent line. 備50% G/W 4 AMP

-          打完RI後, check sugar at 15, 30, 45, 60, 90, 120 minutes

-          Check GH, cortisol at 30, 45, 60, 90 minutes

-          若有hypoglycemia symptoms 出現, check sugar, GH, ACTH and cortisol, 並立刻終止test

06  Glucagon Test – for growth retard.

-          NPO since MN

-          Check hGH at 0 minute

-          Glucagon 0.03 mg/Kg (max 1mg) IM

-          Check hGH at 30, 60, 90, 120, 150, 180 minutes

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10    LHRH test-for性腺功能不全

-NPO since 12MN

-Check FSH, LH at 0 minutu

-LH-RH (gonadorelin HCL 100ug) 1 Amp iv push

-Check FSH, LH at 15, 30, 45, 60, 90, 120 minutes

-Sperm examinations

-Testosterone, GH, ACTH, Prolactin level

-Thyroid function tests

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Hyperaldosteronism

19.  Saline (2L) loading (infusion) test – for hyper-Aldosteronism

-          NPO since MN and keep recumbent position until test finish

-          Check baseline Aldosterone level at 8:00AM

-          Normal saline infusion at rate of 500 cc /hr for 2hours 

-          Check Aldosterone level at 10:00AM

→ post loading test N/S 2000 ml, plasma aldosterone > 5 ng/dl is positive. (JCEM  91(7):2618–2623, 2006)

29.-糖尿病病人鹽水負荷試驗程序

   1.試驗前一晚8:00解完urine後開始收集urine,禁食,可以喝水,治療照常。

   2.收集完成第一階段urine(8:00pm-8:00am)。

3.於8:00am 開始靜脈注射normal saline ,速度為第一個30分鐘500ml,此後每 

  30分鐘打250ml,亦即在二小時內打完1250ml normal saline 。

4.病人於中午12:00開始正常進食及治療,8:00至12;00am 不要進食、喝水和

  治療 。

5.收集8:00am - 12:00am ; 12:00am - 6:00pm ;6:00pm - 10:00pm

10:00pm - 8:00am 四階段尿液,連同兩項之urine 共五個階段,請記錄每階段urine 總量,收集時段,並取100ml於塑膠瓶內。

   6.於8;00am、12:00am、6:00pm、10:00pm、及隔天8:00am抽血12ml 於特製tube 中。如下列圖表

	8:00am	12:00am	6:00pm	10:00pm	8:00am
Blood
	8pm -8am	8am -12am	12am-6pm	6pm-10pm	10pm-8am
Urine

20.  Dehydration test – for Aldosteronism

-          NPO since MN and keep recumbent position until test finish

-          Check PRA at 7:00AM

-          Lasix 2 Amp iv push immediately

-          Keep upright position and walking for 3 hours

-          Check PRA at 10:00AM