endocrine Flashcards
type 1 diabetes
DM peaks at age 10-15 yrs
75% of cases diagnosed prior to 18 yrs of age
DMI: destruction of pancreatic beta cells
ketoacidosis
Dehydration
Electrolyte imbalance, acidosis
Coma
Death
long term complications of diabetes
Microvascular and macrovascular complications
Primary microvascular:
Nephropathy
Retinopathy
Neuropathy
Tight glycemic control diminishes longterm effects of the disease
diabetes insipidus
Underproduction or under secretion of antidiuretic hormone
Results in fluid and electrolyte imbalances
May be transient or lifelong condition
Patients may feel weak and tired due to nocturia
Characterized by polydipsia (thirst) and polyuria (increased urination)
Typical urine output for DI: 5L-20L
Serum osmolality elevated (>300 mmol/kg) due to water loss through kidneys
Very low specific gravity (<1.005)***
diabetes insipidus water deprivation test
Water deprivation test (positive for central DI)
No fluids for 8-16 hrs
Hourly monitoring of BP, weight and urine osmolality
Test stopped when orthostatic hypotension develops, weight loss of 3%, or urine osmolality stabilizes
main treatment goal for diabetes insipidus
fluid and electrolyte balance
DDAVP used as a hormone replacement
Vasopressin utilized as ADH replacement
nephrogenic diabetes insipidus
Kidney does not respond to ADH
Treatment
Low Na diet
Thiazide diuretics
(slows the GFR and allows more water reabsorption in the Loop of Henle and distal tubules)
Indocin may also be prescribed (increases renal responsiveness to AHD)
syndrome of inappropriate antidiuretic hormone (SIADH)
Typical population: older adults
Results from abnormal production of ADH
Caused by: small cell lung cancer (chronic) Head trauma or medications (self limiting) Characterized by: fluid retention serum hypo-osmolality Dilutional hyponatremia Hypochloremia Concentrated urine with increase intravascular volume Normal renal function
effects and treatment of SIADH
Effects: Muscle cramping Nausea and vomiting Muscle twitching Seizures
Diagnosed by: Urine specific gravity >1.005 Serum osmolality<28 mmol/L Serum sodium <134mmol/L Treatment: Limit fluids to 800-100ml/day for mild Limit fluids to 500/day for severe
Severe hyponatremia may be treated with hypertonic saline administered very slowly
hypo/hyperthyroidism
TSH (controlled by anterior pituitary)(hypothalamus controls thyrotropin-releasing factor)
(issue may be organ defect or secretion issues)
T3
T4
Calcitonin
TREATMENT:
TSH replacement: synthroid
hypothyroidism medications
Desiccated thyroid Natural preparation Source: cattle and pigs Synthetic preparations: Levothyroxine (Synthroid ) T4 Liothyronine T3 Labs required: TSH, T4, T3 Dosing based on lab values Pregnancy: dosage may change q4 weeks
hypothyroidism medications contraindications
Known drug allergy Recent MI Adrenal insufficiency Hyperthyroidism Caution: the fillers often contain starch—may cause problems (gluten intolerant individuals or celiacs)
hypothyroidism medications adverse effects
Cardiac dysrhythmias
Tachycardia, palpitations, angina, hypertension
Insomnia, tremors, headache, anxiety
Nausea, diarrhea, cramps
Menstrual irregularities, weight loss, sweating, heat intolerance, fever
hypothyroidism medications interactions
Enhances oral anticoagulants (dose may need to be lowered of anticoagulant
Lower digoxin serum levels (digoxin dose may need to be increased)
Cholestyramine :absorption of both medications may be decreased
Diabetics: hypoglycemic medications may need to be increased
graves disease
antithyroid medications
radioactive iodine
Surgery
Graves’ disease is most often treated with the anti-thyroid drug methimazole (Tapazole, generic versions).