Endocrine Flashcards

1
Q

Diabetic ketoacidosis

A
  • more common in younger<65 & T1DM
  • Rapid onset <24 hours
  • Hyperglycemia (Serum glucose 300-800)
  • Anion gap acidosis (pH<7.3, anion gap >20 mEq/L) - serum bicarb is usually severely low
  • Ketonemia from lipolysis
  • Urine losses >5L
  • Hyperglycemic s/s: polyuria, polydipsia, polyphagia, osmotic diuresis, profound dehydration, tachycardia, hypotension
  • DKA specific s/s: N/V, abdominal pain, compensatory Kussmaul respiratory to breathe off the excess acid
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2
Q

Serum osmolality

A

275-295 mOsm/kg

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3
Q

Urine Osmolality

A

500-800 mOsm/kg

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4
Q

Hyperosmolar Hyperglycemic State (HHS)

A
  • Enough endogenous insulin, minimal or no ketoacid accumulation
  • Slow onset - several days
  • Hyper mortalilty
    -Common in older >65 and T2DM
  • Severely elevated blood glucose >1000 mg/dL
  • Hyperosmolality >320 mOsm/kg
  • low to normal pH>7.3
  • Urine loss >9 L/day
  • HHS specific s/s: neuro change, HA, lethargic, obtundation, coma
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5
Q

DKA/HHS Treatment

A
  • Replace lost fluid & electrolytes (isotonic crystalloids - NS/LR)
  • Correct blood sugar
  • Check ABGs, BUN/Cr, electrolytes q4h
  • BG check q1h
  • If K<3.3, replace before IV insulin to void hypokalemia!!
  • Start insulin infusion at 0.1 units/kg/hr and titrate per protocol
  • Change IVF to D51/2Ns once BG <250mg/dL and serum sodium normalizes
  • Tx to SQ insulin once BG <200
  • Continue IV insulin for 2-4 hours after to avoid hyperglycemia recurrence
  • Resume PO diet
  • Replace Na, Ca, Phos
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6
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A
  • Impairment of negative feedback mechanism and causes inability to suppress ADH secretion so the body holds on to too much water and can’t excrete in the urine
  • Causes: CNS disorder (stroke, hemorrhage, infection, trauma, psychosis), tumors from small cell carcinoma in the lung can cause an ectopic production of ADH, pulmonary disorders (i.e., pneumonia), pituitary surgery
  • Dx: Low sodium <130 (dilutional hyponatremia), low serum osmolality <275, high urine osmolality >100, high urine sodium >40 (normal 20), urine output - low and concentrated <0.5 ml/kg/hr
  • Tx: fluid restriction <1L/day, Iv hypertonic saline, correct sodium level slowly to prevent osmotic demyelination syndrome
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7
Q

Antidiuretic hormone (ADH)

A
  • Vasopressin formed in the hypothalamus and released from the posterior pituitary gland in response to increased serum sodium levels
  • ADH stimulates kidneys to reabsorb water, concentrate urine, correct the serum osmolality, negative feedback mechanism
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8
Q

Diabetes insipidus

A
  • Insufficient secretion of ADH
  • Cause: Neurogenic/central DI: insufficient ADH secretion, nephrogenic DI - kidneys don’t respond to ADH, Phenytoin (Dilantin)
  • Dx: Polyuria r/t lack of ADH (5-15L/day), dilute urine, low urine osmolality <200 mOsm/kg, low specific gravity <1.005, high serum sodium >145, high serum osmolality >295, polydipsia
  • Tx: replace ongoing fluid losses (replace 1/2 of free water over 1st 24hours, then slowly over next 2-3 days to prevent cerebral edema), replace ADH - Desmopressin (DDAVP), sodium-restricted diet closely monitor UO and serum Na and notify if UO>200 ml/hr x2.
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9
Q

Urine specific gravity

A

1.010-1.020

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10
Q

Adrenal Insufficiency (Addison’s Disease)

A
  • Rare disorder where autoimmune destruction of the adrenal glands results in insufficient production of hormones that the body needs (aldosterone and cortisol)
  • S/S: fatigue, weight loss, syncope, depression, hyperpigmentation of the skin
  • Dx: hyponatremia from sodium loss and water retention, hyperkalemia d/t inability to excrete potassium in the urine, hypoglycemia
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11
Q

Aldosterone

A
  • Stimulates kidneys to hold on to sodium and water in response to low blood pressure
  • Regulates potassium levels
  • Promotes the excretion of potassium in the urine
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12
Q

Cortisol

A
  • Stimulates the production of glucose in the liver
  • Breakdown fat
  • Keeps immune response and inflammation in check
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13
Q

Adrenal crisis

A
  • Peripheral vascular collapse and vasodilatory shock, - A life-threatening emergency
  • Check electrolytes, glucose, cortisol, and ACTH
  • Rapid infusion of 2-3L of NS or D5NS to support BP and hypoglycemia
  • Hydrocortisone 100mg IV bolus, followed by 50mg IV q6h until VS stabilize
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14
Q

Hyperthyroidism

A
  • Excess production of thyroid hormones
  • Causes: Grave’s disease (most common) - an autoimmune disorder
  • S/S: a diffuse palpable goiter, sinus tachycardia, arrhythmias, afib, HTN, tremors, palpitations, fatigue, weight loss despite increased appetite, excess perspiration and heat intolerance, exophthalmos, periorbital edema
  • Dx: TSH low, T3/T4 high
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15
Q

Thyroid storm

A
  • Life-threatening manifestation of hyperthyroidism
  • Severe hypermetabolism
  • Tachycardia >140, arrhythmia progressing to CHF (CV collapse and hypotension leading to cardiogenic shock), hyperpyrexia (hyperthermia) w/ temp >104, altered mentation
  • Agitated, anxious, delirious, psychosis, stupor, coma
  • Tx: Beta-blockers (propanolol, esmolol) to reduce adrenergic tone and reduce serum T3 levels; Propylthiouracil (PTU) and iodine to stop the production and block the release of thyroid hormones; glucocorticoids (IV hydrocortisone) to suppress autoimmune process and reduce T3
  • Supportive: reverse hyperthermia with cooling measures and Tylenol, IVF to correct fluid losses and BP, monitor hemodynamic w/ CHF, in severe cases possible ventilation
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16
Q

Hypothyroidism

A
  • Lack of production of thyroid hormones especially T4
  • Causes: Hashimoto’s Disease (an autoimmune disorder that destroys thyroid tissue), iodine deficiency, amiodarone (high contents of iodine contributes to hypothyroidism)
  • S/S: decreased mental status, fatigue, cold intolerance, bradycardia, hypotension, ascites, edema
17
Q

Myxedema Coma

A
  • Severe form of untreated hypothyroidism
  • S/S: altered mental status, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, hypoventilation
  • Tx: replace thyroxine T4 (Levothyroxine), T3

-Supportive: mechanical ventilation, fluids, pressors, passive rewarming, IV dextrose, close monitoring for arrhythmias

18
Q

Metabolic syndrome

A
  • High risk for developing CV disease & stroke
  • Dyslipidemia (TG>150 mg/dL, low HDL <40-50)
  • HTN (SBP >130, DBP >85)
  • Hyperglycemia (FBG >100, dx T2DM)
  • Abdominal obesity (waistline >40 male >35 female)
19
Q
A