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
2
Q
Serum osmolality
A
275-295 mOsm/kg
3
Q
Urine Osmolality
A
500-800 mOsm/kg
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
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
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
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
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.
9
Q
Urine specific gravity
A
1.010-1.020
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
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
12
Q
Cortisol
A
- Stimulates the production of glucose in the liver
- Breakdown fat
- Keeps immune response and inflammation in check
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
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
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
