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CCRN Certification > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

what is osmolality

A

how concentrated the blood is… “osmo high, likely dry”

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1
Q

what is a normal osmolality serum

A

275-295 mosL

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2
Q

what are isotonic fluids

A

stays in vasculature

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3
Q

examples of isotonic fluids

A

sodium chloride 0.9%, LR, plasmolyte

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4
Q

what are hypotonic fluids

A

go out into cell (cell hydration)

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5
Q

examples of hypotonic fluids

A

D5W, 0.45% sodium chloride,

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6
Q

what are hypertonic fluids

A

pull from cell to vasculature

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7
Q

examples of hypertonic fluids

A

D5 0.45% sodium chloride, D10 , D5LR, 2 % Na Cl, 3% Na Cl, %% Na Cl

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8
Q

what is diabetes

A

defect in insulin secretion or action or both

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9
Q

what is type 1

A

Beta 1 destruction (do NOT make insulin)

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10
Q

what is type 2

A

insulin secretory deficit, resistance to insulin

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11
Q

what is HgbA1C and normal range

A

average of glucose over 3 months
normal: 4-5.6%
poor control >7%

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12
Q

this puts you at high risk for CV disease and stroke

A

metabolic syndrome

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13
Q

what is required for metabolic syndrome diagnosis

A

2 of the 4 deadly quartet: dyslipidemia, hypertension, hyperglycemia, abdominal obesity

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14
Q
A
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15
Q

what is glucagon

A

anti low glucose (GIVE for hypoglycemia)

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16
Q

what are alpha cells

A

produce insulin

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17
Q

what are beta cells

A

produce insulin (type 1 has a deficiency of beta cells)

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18
Q

what are delta cells

A

produce somatostatin (which inhibits release of glucagon and insulin)

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19
Q

what is insulin

A

transports glucose, water and potassium into cells

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20
Q

what is short acting insulin and how fast is the action

A

regular insulin
IV action: 5-10 min
SQ action: 30 min

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21
Q

what is rapid acting insulin and how fast is the action

A

humalog (Lispro)
SQ action: 5-15 min

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22
Q

what is intermediate insulin

A

NPH

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23
Q

what is long acting insulin

A

lantus

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24
what are causes of hypoglycemia
too much insulin, N/V, strenuous activity, excessive ETOH, pregnancy
25
symptoms of hypoglycemia
palpitations, tachy HR< diaphoresis, pallor, blurred vision, slurred speech, headache, confusion, fatigue
26
treatment of hypoglycemia
4 oz juice, glucose tabs, 10 - 15 grams carb 1/2 amp of D50 or D5 or D10 IV IM glucagon
27
DKA manifestations
hyperglycemia, hyper osmolality, anion gap acidosis
28
causes of DKA
stress, infection, meds, diet, trauma, surgery, pancreatitis
29
what is the #1 treatment for DKA
CORRECT FLUID DEFECIT
30
what is DKA
-lack of insulin causes too much circulating glucose -osmotic diuresis, profound water loss -leads to glucosuria, dehydration and electrolyte imbalance
31
what is getting burned up in DKA
FAT burning
32
what are the three Ps of DKA
polyuria, polydipsia, polyphagia
33
symptoms of DKA
headache, decreased LOC, visual disturbances, tachycardia, decreased CVP and PAoP, kussmaul breathing, acetone/fruity breath, N/V, pain, weight loss
34
typical labs for DKA
- low pH (acidosis) -low bicarb -hyponatremia -normal to high K -hypophosphatemia -elevated ketones in blood and urine -elevated urine glucose
35
typical labs for metabolic acidosis
-low pH (if greater than 7 will self correct, if <6.9 needs bicarb) -anion gap >12 (HIGH) -bicarb <18 (LOW)
36
what is ketoacidosis
elevated serum and urine ketones (fat burning)
37
normal anion gap
11-12
38
cause of metabolic acidosis
"MUD PILES" Methanol, Uremia, DKA, Propylene glycol, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
39
what is the fluid replacement protocol for DKA
-initial isotonic (0.9% or LR), add dextrose when BG reaches 250 (D5 1/2) to prevent hypoglycemia -then 0.45% saline for cellular hydration or drink water if able (water is hypotonic)
40
what is the typical fluid deficit for DKA patients
about 5 l behind at start of DKA *spread fluid replacement out over 8 hrs
41
what is the insulin management of DKA
-DO NOT drop BG too quickly -start with IV then transition to SQ -must have overlap of IV and SQ otherwise they can go back to ketoacidosis
42
what is the relationship of K and pH
INVERSE RELATIONSHIP for every 0.1 drop in pH, 0.6 increase in K
43
what is hyperosmolar hyperglycemic syndrome (HHS)
-AKA nonketoic hyperglycemia -usually type 2 DM -causes are the same as DKA -BG >600 -can take days to weeks to develop
44
what is one major difference between HHS and DKA
HHS has ABSENCE of ketones there is enough endogenous insulin to prevent ketosis
45
what is the urine in HHS
-osmotic diuresis, osmo >330 -polyuria THEN oliguria/concentrated urine once dehydrated
46
what is a cardinal sign of DKA
AMS and hyperglycemia
47
what are typical HHS labs:pH, Na, K, mag, phos, hct/hgb, and urine glucose
ph normal/mild acidosis Na high K low and mag low (go together) phos low hct/hgb elevated d/t dehydration urine glucose HIGH
48
HHS treatment
*volume replacement (isotonic fluids, once BG 250 add dextrose, then 0.45% saline then oral hydration) -insulin (regular IV infusion)
49
what is ADH
it's purpose is fluid balance formed in the hypothalamus has vasopressor qualities
50
what is SIADH
"Swimming in ADH" = too much ADH severe dilutional hyponatremia (dilutes sodium)
51
what is serum and urine osmos in SIADH
serum <280 urine (concentrated), high osmo >100 d/t decreased urine production
52
causes of SIADH
infection, pneumonia, COPD, PE, CVA, head trauma, cancer, recent surgery
53
complications of SIADH
severe dilutional hyponatremia cerebral edema seizure activity
54
treatment of SIADH
fluid restriction, treat problem, diuretic or hypertonic saline
55
how do you correct sodium in SIADH
VERY SLOWLY if too quickly permanent nerve damage can occur
56
what is diabetes insipidus
opposite of SIADH "SIP because you're Pissing" **Lack of ADH failure of ADH to release from the posterior pituitary
57
what is the serum osmo in DI
elevated serum osmo >295
58
what is the water balance in DI
water loss up to 20 L/day
59
causes of DI
TBI, anoxic encephalopathy, meningitis, brain death, Dilantin (phenytoin), tumors
60
symptoms of DI
polyuria, serum osmo elevated, dilute urine, low urine specific gravity, low urine osmo polydipsia, hypernatremia, elevated BUN, low ADH
61
treatment of DI
-give ADH and treat cause ie/ desmopressin (DDAVP) -calculate and replace free water deficit (correct slowly over 2-3 days to prevent cerebral edema)
62
what does the thyroid function on
a negative feedback loop (if working normally) ie/ when T3 and T4 are low, TSH production is high ie/ when T3 and T4 are high, TSH production is low
63
what organs help to keep hormones in balance other than thyroid
hypothalamus and pituitary gland
64
what does the hypothalamus detect
low levels of thyroid hormones
65
what is thyroid storm
*severe hypometabolism -sudden release of thyroid hormone -decrease in TSH, increase in T3 and T4
66
what labs indicate thyroid health
T3, T4 and TSH
67
what is the most reliable measure of thyroid function
TSH normal is 0.3 to 4.5
68
main hormone secreted by thyroid
T4 normal is 0.8 to 1.8
69
symptoms of thyroid storm
*palpitations, tachycardia, heat intolerance -fever, diaphoresis, afib, SOB, HTN, hyperexia, diarrhea, confusion
70
treatment of thyroid storm
hydrocortisone and propythiouracil "the 5 Bs" Block synthesis: antithyroid drugs (methimazole) Block release: iodine Block T3 and T4 conversion: propanolol or corticosteroid Betablocker: treat symptoms Block enterohepatic circulation
71
what is hyperthyroidism and what are the labs
producing too much thyroxine hormone *thyroid storm is the most severe form -TSH low -T3 and T4 high
72
causes of hyperthyroidism
Grave's disease (autoimmune), toxic nodular goiter, hyperfunctioning thyroid adenoma
73
symptoms of hyperthyroidism
tachycardia, heat intolerance, weight loss, palpitations, anxiety, insomnia, afib, agitation, sympathetic overstimulation of muscles that control eye movement
74
chronic hyperthyroidism can cause what
high CO and HF (CHF), osteoporosis
75
treatment of hyperthyroidism
BB (propranolol or methimazole), radioiodine therapy, thyroidectomy
76
what is hypothyroidism
inadequate output of thyroid gland
77
s/s of hypothyroidism
**cold intolerance, weight gain, fatigue -constipation, fluid retention, hair loss/dry skin, decreased libido
78
causes of hypothyroidism
Hashimotos (autoimmune inflammation of thyroid), thyroidectomy, amiodarone, lithium, radioiodine, treatment of hyperthyroid
79
what are the labs of hypothyroidism
high TSH, low T4 often feedback loop is not working so TSH, T3 or T4 can also be low if pituitary gland tumor
80
treatment of hypothyroidism
oral levothyroxine (synthetic T4) requires long term monthly TSH levels (if TSH high, dose too low: if TSH low, dose too high)
81
what is addison's disease
adrenal glands not producing enough hormones -DECREASE/DEFICIT3 in the S's: sugar (cortisone), salt (aldosterone), and sex steroids
82
what is aldosterone
sodium and water reabsorption potassium excretion maintains BP
83
what is cortisol
stimulates glucogenesis (BG) lipolysis depresses immune response decreases inflammation
84
s/s of addison's disease
fatigue, weight loss, muscle weakness, abd pain, diarrhea, hypoglycemia, hypotension, crave salt, hyperpigmentation, orthostatic hypotension
85
labs in addison's disease
LOW cortisol <3 mg (cortisol stimulation test low <19) Low blood glucose ACTH levels elevated anemia
86
treatment of addison's
prednisone to increase cortisol level and fludrocortisone to increase aldosterone level
87
what is an adrenal crisis
sudden severe adrenal insufficiency
88
treatment of adrenal crisis
ADD iv glucocorticoids and IV fluid dextrose
89
what is cushings disease
EXCESS of 3 S's (increase cortisol levels)
90
how do you diagnose cushings
measure free cortisol for 24 hr urine dexamethasone suppression test
91
causes of cushings
exogenous: medications and long term steroid use endogenous: pituitary adenoma or carcinoma
92
treatment of cushings
control cause, surgery if pituitary tumor
93
symptoms of cushings
high BP, buffalo hump, moon face, red face, big, round, hairy, slow wound healing

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