Chapter 20: Endocrine and Hematologic Emergencies

Question 1

Compare and contrast hyperglycemia and hypoglycemia.

Answer 1

Food Intake: per: Normal or increased food intake, po: Normal or decreased food intake at a normal or “late” time
Insulin dosage: per: normal or decrease insulin dosage (or absent), normal or extra at a normal or “early” time.
Onset: per: Gradual (hours-days), po: Rapid (w/i minutes)
Skin: per: warm and dry po: pale, cool, and moist
Infection: Per: common Po: uncommon
Thirst: Per: intense, Po: absent
Hunger: Per: Present and increasing, Po: absent
Vomiting: Per: Common, Po: Uncommon
Breathing: Per: DKA-kussmaul Po: Normal or becoming shallow/ineffective w/ extensive po and depressed mental status
Odor of breath: Per: DKA-Sweet, fruity Po; Normal
BP: Both: Normal to low
Pulse: Both: rapid, weak Per: thready
Consciousness: Both: Unsteady gait Per: Restlessness, possibly progressing to coma, abnormal or slurred speech Po: Irritability, confusion, seizure, or coma
Response: Per: Gradual 6-12 hrs, Po: Immediate improvement

Question 2

What are the differences between a Type I and Type II diabetic patient?

Answer 2

Type I: unable to produce enough insulin. Hyperglycemic: DKA
Type II: Insulin-resistant cells. Hyperglycemic: HHNS

Question 3

What is DKA?

Answer 3

Diabetic ketoacidosis presenting as generalized illness with abdominal pain, body aches, nausea, vomiting, AMS or unconsciousness.

Question 4

What is HHNS?

Answer 4

Hyperosmotic Hyperglycemic Nonketotic Syndrome: Hyperglycemia, AMS, drowsiness, lethargy, severe dehydration, thirst, dark urine, visual or sensory deficits, partial paralysis or muscle weakness, seizures.

Question 5

What is ketone production the result of?

Answer 5

fat metabolization when glucose unavailable

Question 6

Why do patients with uncontrolled diabetes experience polyuria?

Answer 6

Excess glucose in the blood is excreted by the kidneys