DI/SIADH/CSW

Question 1

TOO much ADH hormone

Answer 1

SIADH

Question 2

deficient ADH

Answer 2

DI

Question 3

Sx of SIADH:

Answer 3

Dilutional Hyponatremia is hallmark
decreased urine output:

Presentation: hyponatremia, decreased serum osmolarity 200

Question 4

Formula for fluid volume deficit

Answer 4

10 ml/kg for each % dehydrated

ie: 4.9 kg kid is 15% dehydrated :

10(4.9)=49

49(15)= 735 ml

Question 5

Sx of DI

Answer 5

characterized by large volumes of dilute urine. Nephrogenic is a result of renal disease- no treatment

Presentation: poluria, polydipsia, low urine osmolarity

Question 6

Labs in CSW

Answer 6

SALT and WATER wasting 
serum sodium:  80
Urine osmo > 200 
SG >1010
UO: 2-3 ml/kg/hr

THESE are messed up.. my info is NOT saving!???

Question 7

Labs in SIADH

Answer 7

serum Na 30
Urine Osmo > 200
SG >1020 ( concentrated)
UO: less than or equal to 1 ml/kg.hr

Question 8

Labs in DI

Answer 8

serum Na >145
Serum Osmo: >295
Urine Na

Question 9

Tx for SIADH

Answer 9

FLUID restriction ( this pt is overloaded- may need lasix) 
Sodium restrict, monitor lytes and I/Os
replace NA slowley ( 3-9% NS)

Question 10

Tx for DI

Answer 10

Volume resuscitate if needed with NS ( pt can be in shock)
Vasopressin or DDAVP
Fluid replacement- slow
monitor fluid and elytes

Question 11

Tx for CSW

Answer 11

replace volume and salt ( pt is dehydrated and hyponatrmic)

Treat underlying problem
replace NA slowly, maintain fluid intake, monitor lytes

Question 12

4-2-1

Answer 12

4 for first 10 kg
2 for second 10 kg
1 for remaining

Question 13

Hyponatremia, dehydration, and hyperkalemia

Answer 13

Congenital adrenal hyperplasia

Question 14

SX of hyperthyroid

Answer 14

nervousness, irritability, emotional liability tremor, excessive appetite, wt loss, smooth skin, increased perspiration, heat INTOLERANCE, diarrhea, tachycardia

PE: goiter, exopthalmos, tachycardia, widened pulse pressure

Dx: low TSH, elevated T4

Tx: radioactive idoine of tx fail

Question 15

Hypothyroidism

Answer 15

growth retardation, diminished OR, impaired tissue perfusion, constipation, thick tongue poor muscle tone, hoarseness, anemia, and intellectual retardation

Dx: elevated TSH low T4

tx: synthroid.

Question 16

Graves disease

Answer 16

hyperthyroid- seen in adolescent women

Question 17

hasimotos

Answer 17

hypothyroid

Question 18

Signs of adrenal crisis

Answer 18

hypo tension, fatigue, vomiting, muscle pain, anorexia, wt loss,

Question 19

Tx for adrenal crisis

Answer 19

gluco-corticoids: cortisol

hydro cortisone

Question 20

Tx for thyroid storm

Answer 20

Propanolol - per harriet

Question 21

What is the cause of a thyroid storm

Answer 21

untreated hyperthyroid:

Causes: tachycardia, HTN, sweating, LOC changes
even CHF and Pulmonary edema..can lead to death

Question 22

Hyper K: most common ekg change

Answer 22

Peaked t wave, absent p wave

Question 23

Congenital adrenal hyperplasia presentation

Answer 23

in the NB period: with salt wasting and shock, get reduced cortisol and aldosterone production, get: hyperkalemia, hyponatremia, and dehydration

Dx: seruem lytes, ACTH stim test ( should cause cortisol to increased), cortisol levels ( in AM: 8 am), newborn screen

Tx: manage fluid and electrolytes, cortisol and hydro cortisone.. MUST stress does before stressful event ( surgery, trauma, dance..)

Question 24

Lab values in primary adrenal insufficiency

Answer 24

low cortisol, high ACTH ( ADRENAL problem*)

Question 25

lab values in secondary adrenal insufficiency

Answer 25

low cortisol, low ACTH ( pituitary problem*)

Question 26

HPA access

Answer 26

Hypothalamus–>makes CRH, stimulates the Pituitary to release–> ACTH, which stimulates the adrenals to release–> glucocorticoids ( cortisol, androgens, aldosterone)

Question 27

Precocious puberty

Answer 27

signs for puberty younger than age 8 in girls and 9 in boys..

• elevated gonadotropins: FSH and LH ( makes it different than partial precious puberty)

Cause: idiopathic vs CNS tumor
Tx: GnRH analog- lupron

Question 28

Cushings

Answer 28

Buffalo hump- dt TOO much cortisol..send 24 hour urine cortisol.