Metabolic Flashcards
(9 cards)
Addisons
Endocrine disorder that includes reduced levels of hormone secretion from the adrenal glands. These hormones include cortisol and aldosterone. May lead to adrenal crisis which is a life threatening emergency caused by the inability to produce sufficient cortisol in response to major stress. Can precipitated by significant illness, trauma, stress, infection and or non compliance with medications.
Primary = diseased of the adrenal gland (addisons, congenital adrenal hyperplasia, adrenkleukodystrophy)
Secondary = diseases of the pituitary gland or hypothalamus
Latrogenic = chronic corticosteroid treatment, crohns, juvenile arthritis, asthma etc
Hydrocortisone is life saving do not delay administration
Treatments of addisons
- Hydrocortisone
- 12 lead
- Vascular access
- Fluid therapy
- Consider glucose
- Analgesia
Hyperglycaemia
BGL >22
Diabetic ketoacidosis (type 1)
Hyperosmolar hyperglycaemic state (type 2)
Usually due to illness, infection, stress, excessive carbohydrate, inadequate/non compliant with medication, insulin pump failure and medicines
Presentation:
* Polydipsia
* Polyuria
* Fatigue
* Blurred vision
* Nausea/vomiting
* BGL usually >16mmol
* Ketone breath & kussmaul breathing in dka
* Tachycardia
* Hypotension
* Dehydration, dry skin, sunken eyes
* Altered conscious state
Hyperglycaemia treatment
- Vascular access
- Fluid therapy
- Never assist a drowsy patient to self administer insulin
- Do not administer insulin yourself
Hypoglycaemia
BGL <4, with demonstrated signs or symptoms
Presentation:
* Weakness, trembling, shaking
* Diaphoresis
* Headache
* Abnormal behaviour
* Altered conscious state
* Tachycardia
* Seizure
Treatment of hypoglycaemia
- Glucose gel
- Glucagon
- Glucose 10%
- Encourage complex carbohydrates
Renal dialysis
Management of home haemodialysis emergencies
Presentation:
* Error in connecting dialysis or fault of machine may cause air embolism and can cause stroke, seizure and unresponsiveness
* Haemorrhage
Treatment
* Early disconnect of machine.
* Stop bleed, 25cm from arm to clamp
* Manage seizure
* Fluids
Sepsis red flags
child <5 red flag
* Temp <36 OR >38
* BSL <3
* Don’t wake or rouse
* Appears unwell
* Weak, high pitch or continuous cry
* Tachypnoea <12 months >75breaths, 1-5 years >55 breaths
* Tachycardia <12 months >180bpm, 1-5 years >170bpm
* Bradycardia <3 months <100bpm, 3-12 months <90bpm, 1-5 years <80bpm
* Hypotension <3 months <50 SBP, 3month-5year <60SBP
* Spo2 <88% RA or O2 >10 L/min
* Non blanching rash
* Nasal flaring
* Reduce urine
* Lactate >4 if available
Child 5-11 red flag
* Temp <36 or >38
* Evidence of organ dysfunction
* BSL<3
* Doesn’t wake when roused
* Altered mental state
* Looks unwell
* Tachynoea >50
* Tachycardia >170
* Bradycardia <60
* Hypotension <60
* Spo2 <88
* Non blanching rash
* Reduced urine
Adult 12+
* Altered mental status
* SBP <90 or drop of 40 baseline
* >130bpm
* Temp <35 or >39
* RR >25
* Needs O2 to maintain Spo2
* Rash, mottled, ashen, cyanosis
* Not passing urine in 18 hours
* Recent chemo
* Deterioration in functional ability
* Procedure or trauma in last 8 weeks
* Immunosuppressed
Pregnancy
* Change to mental status
* Deterioration in functional ability
* SBP <90 or drop of 40 of baseline
* >130 bpm
* <35 or >38 temp
* RR >25
* Diabetic
* Contact with step A
* Prolonged rupture of membrane
Treatment of sepsis
- Pre notify if within the red flags and communicate sepsis
- IV access
- Blood sample
- Fluid therapy
- Oxygen
