#Acid&Base/Endocrine Flashcards
(44 cards)
pH & potassium change calculation
pH 0.1 = K 0.6 in opposite direction.
Describe how PaCO2 change will effect pH
PaCO2 change 10 mmHg = pH change 0.08
Opposite Direction.
PaCO2 & K change equation
PaCO2 10 torr = K 0.5 mEq/l (same direction)
To increase serum potassium 1 mEq/L, how much potassium must be given?
100-200 mEQs
- DKA: don’t drop glucose levels faster than:
2. At what bs do you start d5w?
- 100 mg/dL/hr
2. <300 mg/dL
Oat cell carcinoma: mimics which 2 hormones causing which 2 syndromes.
- ADH: SIADH (no urinating)
- cortisol : cushings disease (adrenal overloaed)
(Small cell carcinoma typically in lungs)
Causes of SIADH
(Syndrome of innappropriate Antidiuretic syndrome)
- oat cell carcinoma
- viral pneumonia & TB
- head injury
- opiates, pain, anxiety (temporary)
SIADH presentation
Dilution army hyponatremia
=cerebra edema
=seizures
=elevated urine osmolality / specific gravity
-fluid doesn't get into kidneysTreatment for SIADH
- restrict fluids
- Diuresis: 1st degree loop diuretics
- demeclocycline (tetracycline fam / ADH receptor antagonist)
Thyroid storm aka, presentation, tx
Graves’ disease
Presentation: high idle speed, weight loss, cp, sob, fever, tremors/nervousness, marked tachycardia, AFib.
Tx: anti thyroid meds, antipyretics, electrolytes, fluids, glucocorticoids (dexamethasone= prevents production t4-t3), hr will not respond to digitalis.
Myxedema Coma cause, presentation, tx
Hypothyroidism - autoimmune due to infection
Presentation: women, >60, winter. Fatigue, weight gain, cold intolerance, deep voice, coarse hair. ALOC=coma
Tx: supportive, IV levothyroxine (t4), watch for adrenal insufficiency.
Steroid production pathway
Steroid mechanisms:
CRH (cortical releasing hormone) released from brain. > to anterior pituitary > release of ACTH (adrenal corticotropin hormone) > to adrenals > release of glucocorticoids, androgens, mineralcorticoids.
Management of sugars, breakdown from muscles, fatty tissues, sex hormones, electrolytes, aldosterone levels, alpha/beta receptor response.
Addison’s causes (primary/secondary)
Primary: autoimmune
Secondary: pituitary malfunction = low ACTH
Other: acute glucocorticoid withdraw
Addison’s presentation, tx
Presentation: inadequate aldosterone cortisol, androgens. Fatigue, weakness, low BP, low h2o / Na retention, hypoglycemia, poor catecholamine response.
Tx w/steroids, fluid
Cushings disease causes, presentation, tx
Causes: chronic steroid use w/ abrupt DC, pituitary disorder (high ACTH), oat cell, adrenal carcinoma (high cortisol)
Presentation: upper body obesity, thin arms/legs (muscle wasting), round face, buffalo hump, fatique, HTN, high BS, fatty & amino acids to glucose, pancreatic overload (DMII)’ increase Epi/NE
TX: steroid management, supportive, surgery.
Solu-cortef (low potency), Decadron high potency.
Pancreatitis causes
ETOH, biliary stone, steroids & antibiotics, viral/bacterial infection, bowel obstruction
Pancreatitis presentation (7)
- Low ca
- L base atelectasis = elevation L diaphragm
- Bilateral pleural effusion
- Sepsis & ARDS
- Renal failure
- Cullen’s sign: peri umbilical bruising
- Gray-Turner’s sign: flank & groin bruising
Pancreatitis tx (7)
- Fluid resuscitation
- NPO, NG/OG (stimulate stomach=stimulate pancreas)
- Meperidine (similar to atropine, increased GI motility / relaxation, sphincter if odi relaxation)
- Alternate atropine, Narcan, beta blockers, tetrodotoxin
- Anticipate progression (ARDS, Sepsis, MOzdS, DIC)
- Antibiotics for sepsis
- Surgery
Why is liver failure common w/ GI bleeds?
Body is metabolizing blood proteins
-metabolism of proteins = ammonia production
Liver failure / hepatic encephalopathy presentation
Elevated AST, ALT, SGOT/SPGT,
Elevated BUN (Ammonia coverts to blood urea nitrogen)
Hypokalemia - K follows ammonia as excreted
Kehr’s sign
Splenic - L shoulder pain
Brudzinski vs kernig sign
Brudzinski’s: flex neck, want to bring hamstring up
Kernig: brig up hamstring, want to flex neck.
(Releases tension on hamstrings)
Murphy’s sign
Gall bladder - push on RUQ
- traps gallbladder between hand n liver
- pt cannot take a deep breath.
Venous blood gasses
PH 7.31-7.41 PvCO2 40-50 HCO3 22-26 PvO2 35-40 SvO2 70-75% BE -2 to 2
