Endocrinological

Question 1

-Kussmaul respirations
-Fruity-smelling breath
-Tachy, thready pulse
-Ortho-hypotension
-Warm, dry skin & mucous membranes
-3 P’s
-Nausea/vomiting
-Abdominal pain
-Weight-loss
-Muscle stiffness or aches
-Being very tired
-Diminished LOC

HX:
-Younger Type 1 Diabetic
-Physical or emotional trauma
-MI/Stroke
-Pancreatitis
-Pregnancy
-Alcohol or drug misuse, particularly cocaine
-Corticosteroids and some diuretics
-Fast Onset

Answer 1

DKA

5-10% mortality
Onset: hours - days

TX:
O2
IV Fluids
Pt’s Insulin
EKG
Rapid transport

Question 2

> 600
-Tachycardia
-Ortho-hypotension
-Shallow/rapid breathing
-ALOC (confusion, delirium, hallucinations)
-Unconsciousness, seizures, coma
-Polydipsia & polyuria
-Blurred vision or loss of vision
-Weakness
-Nausea
-Weight loss
-Fever

HX:
-Usually Older Type 2 Diabetic
-Slow Onset

Answer 2

HHNS

Less common than DKA
40-60% mortality
Onset: days - weeks

TX:
O2
IV Fluids
EKG
Rapid transport

Question 3

-Anxiety & irritability
-Hand tremors
-Rapid or irregular heartbeat (palpitations)
-Sleep disturbance
-Heat sensitivity
-Sweaty or warm, clammy skin
-Weight loss (w/ no changes to diet)
-Enlarged thyroid
-Change in menstrual cycles
-Erectile dysfunction or reduced libido
-Frequent bowel movements
-Bulging eyes
-Fatigue
-Thick, red skin (shins or tops of the feet)

Answer 3

Graves Disease (Hyperthyroidism)

Question 4

-Severe tachycardia
-Dysrhythmias
-Heart failure
-Shock
-Hyperthermia
-Abdominal pain
-Restlessness, agitation, paranoia, delirium
-Coma

HX:
-Hyperthyroidism
-Infection
-Stress
-Surgery manipulation of thyroid gland

Answer 4

Thyroid Storm

Rare, life-threatening condition that happens to Graves disease pt’s

TX:
ABC’s
EKG
Rapid Transport
Solumedrol (call medical control)

Question 5

-Swelling of face (lips, eyelids, tongue)
-Swelling & thickening of skin anywhere on your body (especially lower legs = flaky & red)
-Low systolic, high diastolic BP
-Low HR
-Sparse or brittle hair
-Cold intolerance
-Enlarged thyroid
-Low energy, lethargy, weak
-Weight gain
-Constipation
-Depression

HX:
-Hashimoto’s Disease
-Thyroiditis
-Removal/Radiation of Thyroid
-Iodine Deficiency
-Pituitary Gland/Hypothalamic Dysfunction
-Lupus
-Amiodarone, lithium, interferon alpha, & interleukin-2

Answer 5

Myxedema (Hypothyroidism)

Question 6

-Moon face w/ acne & red cheeks
-Facial & body hair
-Thinning hair
-Buffalo hump & subclavicular fat pads
-Bronze skin w/ bruising & slow wound healing
-Weight gain & abdominal purple stretch marks
-Bone-loss
-Depression, paranoia
-Fatigue & muscle weakness
-Insomnia
-Diabetes
-Hypertension

HX:
-Long-term, high-dose use of the cortisol-like glucocorticoids (Asthma, RA, Lupus)

Answer 6

Cushing syndrome

Overproduction of cortisol & aldosterone

Question 7

-Progressive weakness, weightloss = anorexia
-Skin hyperpigmentation
-Hypotension
-Hyponatremia
-Hyperkalemia
-GI disturbances (nausea, vomiting, diarrhea)

HX:
-Autoimmune Disorders
-Infections
-Type 1 Diabetes
-Tumors

Answer 7

Addison Disease

Cortisol & aldosterone deficiency, slow onset w/ a chronic course

Question 8

-Headache/Dizziness
-Nausea/Vomiting
-ABD/Back/Leg Pain
-Lethargy/ALOC/Syncope
-Hypotension
-Hypoglycemia
-Peaked T waves (Hyperkalemia)

HX:
-Addison’s Disease
-Stress
-Trauma
-Infection

Answer 8

Addisonian Crisis

A life-threatening emergency in which the body cannot increase the amount of cortisol made as a result of stress, which results in:

Hypotension
Hypoglycemia
Hyperkalemia

TX:
ABC’s
IV Fluids
Hydrocortisone 100mg IM or Solumedrol 125mg IV
Monitor BG (Treat hypoglycemia)
EKG