6. Medical Emergencies: Endocrine Flashcards
Diabetes
• Type 1(____, ____-dependent) –pancreas
does not produce enough insulin
• Type 2 (____-onset) Insulin resistence, also
have insulin deficiency to a lesser extent
• ____
juvenile
insulin
adult
gestational
Insulin therapy
Multiple different types of insulins. He doesn’t expect us to know all the names of insulin! Just know there’s different types of insulin, depending on they ____ of action:
rapid (peak 1 hr), short acting (peak 4hrs), intermediate, long acting (steady state throughout the entire day)
“you can read the graph you don’t have to hear me recite it” Typically patients on a combo of ____ or ____ acting insulin with some shorter or rapid acting insulin for immediate control of their blood sugar after they check their finger stick
duration
intermediate
long
Type 2 Diabetes Management
- ____
- ____
- ____
- ____
- ____ inhibitors
biguanides thiazolidinediones sulfonylureas meglitinides glucosidase
Diabetes • Chronic Complications – \_\_\_\_ – \_\_\_\_ – Impaired \_\_\_\_
macroangiopathy
microangiopathy
immunity
Diabetes
• Acute Complications
– ____
– ____
So if have suspicions of a diabetic having a problem NEVER consider administering insulin. Cuz if they’re ____ and youre wrong, you’ll bottom them out even further. If you have someone hyperglycemic and you think their blood sugar is low and you give them sugar and it goes from 400–> 450 its no big deal, but if you bottom someone out its a BIG problem! REPEATS, he’d never give someone insulin if you thought hyperglycemic, you wanna air on the side of caution!
hyperglycemia
hypoglycemia
hypoglycemic
Risk factors for Hypoglycemia • Intensive \_\_\_\_ therapy • Renal failure • Hypoglycemia unawareness • Alcohol consumption • Gastroparesis • Hypopituitarism • Excessive exercise • Missed or delayed meals • Reduced meal • Medication error • Extremes of age • Illness
MOST COMMON issue- give too much insulin or give their normal dose of insulin but their oral intake is impaired and you for example- tell them not to eat anything because you’re gonna sedate them or not eating that day cuz in pain but took insulin dose.
- Did you take your insulin dose? 2. Is it the regular dose 3. Have you
had anything to eat today 4. when was the last time you ate?
if they say they they took insulin but didn’t eat, be suspicious that their
blood sugar may bottom out in front of you, treat it accordingly ex. give
them some ____ before they start (as long as dont have to be NPO)
insulin
candy
Common Symptoms of Hypoglycemia
• Autonomic – \_\_\_\_ – Trembling – \_\_\_\_ – Anxiety – \_\_\_\_
• Neuroglycopenic – \_\_\_\_ – Confusion – Difficulty \_\_\_\_ – Headache – Inability to \_\_\_\_
• Other – \_\_\_\_ – Weakness – \_\_\_\_ – Blurred vision
sweating
palpitation
nausea
dizziness
speaking
concentrate
drowsiness
hunger
Hypoglycemia Management Conscious Patient
• Ingest ____ orally
• If NPO, can administer via other routes
sugar
Adrenal Gland Function
• Regulates metabolism of
____, fats, ____, water,
and electrolytes
carbohydrates
proteins
Adrenal Gland Hormone Synthesis Adrenal Cortex
• ____
• ____
• ____ Hormones
Adrenal Medulla
• ____
• ____
glucocorticoids
mineral corticoids
sex
epinephrine
norepinephrine
Regulation of ACTH • Circulating \_\_\_\_ • \_\_\_\_ schedule • Stressful stimuli via hypothalamus – \_\_\_\_
cortisol
sleep
corticotropin-releasing factor (CRF)
Regulation of ACTH
you release ACTH from your ____ pit–> adrenal cortex release ____–> if in stress situation you’ll act accordingly or just for homeostasis, circulating cortisol–> feedback ____, not only on ant pituitary but also on ____ further up for feedback inhibition for further release of the ACTH.
if you’re ACTH is LOW, adrenal cortex is ____ so won’t make endogenous cortisol and then there’s less feedback inhibition and this will eventually go up
this is how homeostasis occurs
when stressed (physiologically or psychologically) you will have a stimulus to release ____ from the hypothalamus–> ant pituitary–> release ____–> turn on adrenal cortex–> synthesize and release ____ for stress response
ant
cortisol
inhibition
hypothalamus
inhibited
CRH
ACTH
cortisol
Addison’s Disease
• Primary ____ insufficiency
• Incidence is 1:100,000
• Treated with ____
these people, they’re ant pituitary will release alot of ACTH cuz it wants to see cortisol in the blood, the adrenal cortex is incapable of ____ it so someone w untreated addisons dz will have ____ ACTH level, and as treat them w exogenous steroid therapy then it’ll come back down to normal but they still won’t be able to synthesize steroid on their own!
adrencortical
cortisol
synthesizing
high
Secondary Adrenal Insufficiency
Exogenous Steroid -> Disuse ____ of the adrenal glands
secondary meaning to an outside source (exogenous steroid) you give someone steroids, not for addison’s, rather these people have a normal functioning systems, but you give steroids for lupus or asthma, and that surpasses the secretion of corticotropin releasing factor and ACTH from hypothalamus and ant pit respectively–> ____ ACTH this means normal adrenal cortex is not being stimulated to synthesize cortisol so w time the enzyme levels that synthesize cortisol will diminish so if they get into a stressful situation and they need cortisol, they won’t be able to make it so they will act like they have addisons dz, bp bottoms out and they become comatose
atrophy
low
Adrenal Insufficiency
Predisposing Factors
• Sudden withdrawal of ____ hormones from a patient with adrenal insufficiency (primary or secondary)
- Physiologic or psychologic stress
- ____ adrenalectomy
- Destruction of the ____ gland
- Injury to both adrenal ____
steroid
bilateral
pituitary
glands
Clinical Manifestations of Chronic Adrenal Insufficiency • \_\_\_\_ • Extreme fatigue • We a k n e s s • \_\_\_\_ • Hypotension • \_\_\_\_ • Nausea, vomiting • \_\_\_\_ • Vitiligo
lethargy
hyperkalemia
hypoglycemia
hyperpigmentation
Clinical Manifestations of Acute Adrenal Insufficiency
- Progressive severe ____ confusion
- Intense pain in the ____, lower back, & legs
- ____ collapse
- Loss of consciousness
- Coma
- Death
mental
abdomen
cardiovascular
Normal Daily Cortisol Secretion
• 20 mg on a ____ day
• 300 mg on a ____ day
reads ____mg is the most adrenal cortex can make in one day so if someone you’ll stress surgically and they have adrenal insufficiency, give them equivalent 300mg hydrocortisone a day (100mg 3x a day) to give them that physiologic level of stress response of corticosteroid if they need it where you get in trouble is if someone is taking chronic steroid meds for another dz (lupus, asthma, COPD) and withdraw it or stress them and they need more than dose giving them
often if taking equivalent of 100mg cortical a day, on this day you’ll take the
◦
equivalent of 300 mg of cortisone a day (supplant steroid intake) on the day stress
out, then taper it later on ◦
this is sort of controversial cuz this is “classic teaching”
some people dont supplement, they just double the dose they normally take, so in the
end consult with doctor. if cant give guidance give equivalent of 300mg in a day
nonstressful
stressful
300
