Diabetes, Endocrine and Fluid Therapy Flashcards
What are hormones and how are they transported?
Hormones are chemical messengers released by endocrine glands. They are transported through the bloodstream to target organs, affecting cellular activity.
What is the function of the endocrine system?
Regulates metabolism, growth, reproduction, and stress responses. Maintains homeostasis by controlling hormone levels.
Which gland produces adrenaline, and what is its function?
Adrenal glands produce adrenaline (epinephrine). Adrenaline increases heart rate, contracts blood vessels, and triggers the fight-or-flight response.
What is the difference between endocrine and exocrine glands?
Endocrine glands: Release hormones directly into the bloodstream. Exocrine glands: Release secretions through ducts (e.g., sweat and salivary glands).
Name the major glands of the endocrine system.
Adrenal glands, Thyroid gland, Pancreas, Testes, Ovaries, Pituitary gland.
What is adrenaline also known as?
Adrenaline is also known as epinephrine.
Where is adrenaline produced, and how does it affect the body?
Produced by the adrenal glands (on top of the kidneys). Prepares the body for fight-or-flight by: Increasing heart rate, Dilating airways, Contracting blood vessels.
What are the effects of high adrenaline levels?
Increased heart rate, Sweating, Anxiety, Heightened alertness.
What can low adrenaline levels lead to?
Fatigue, Low blood pressure, Weakness, Difficulty handling stress.
What is epinephrine 1:1000 used for?
Treats anaphylaxis.
What is epinephrine 1:10000 used for?
Administered during cardiac arrest to improve coronary perfusion.
What is thyroxine and where is it produced?
Thyroxine (T4) is produced by the thyroid gland.
What is the primary function of thyroxine?
Controls the metabolic rate of the body by converting oxygen and food into energy.
Where is the thyroid gland located?
Located in the neck, wrapped around the trachea.
What are the symptoms of high thyroxine levels (hyperthyroidism)?
Rapid heartbeat, Weight loss, Nervousness, Heat intolerance.
What are the symptoms of low thyroxine levels (hypothyroidism)?
Fatigue, Weight gain, Cold intolerance, Dry skin and hair loss.
What condition results from excess thyroid hormone production?
Hyperthyroidism.
What condition results from insufficient thyroid hormone production?
Hypothyroidism.
What is the medication used to treat hypothyroidism?
Synthroid (Levothyroxine): Replaces deficient thyroid hormones.
What is the function of insulin?
Lowers blood glucose by allowing glucose to enter cells for energy.
Where is insulin produced?
Produced by the beta cells of the pancreas.
What happens when there is insufficient insulin production?
Results in Type 1 Diabetes (IDDM).
What hormone raises blood sugar levels?
Glucagon raises blood sugar by converting glycogen to glucose.
What is the difference between Type 1 and Type 2 diabetes?
Type 1 Diabetes: No insulin production.
Type 2 Diabetes: Insulin resistance or insufficient insulin production.
How is Type 1 Diabetes managed?
Lifelong insulin therapy.
How is Type 2 Diabetes managed?
Lifestyle changes, oral medications, and sometimes insulin.
What are oral diabetic medications used for?
Lower blood glucose in Type 2 Diabetes.
Name two classes of oral diabetic medications.
Sulfonylureas (Glyburide, Gliclazide): Stimulate insulin release.
Biguanides (Metformin): Reduce glucose production by the liver.
What is the function of sulfonylureas?
Stimulate the beta cells to release insulin.
What is the function of metformin?
Reduces hepatic glucose production and enhances glucose uptake.
What causes Addison’s disease?
Adrenal insufficiency leading to low cortisol and aldosterone production.
What are the symptoms of Addison’s disease?
Abdominal pain
Hypotension
Fatigue
Loss of appetite
What is an adrenal crisis, and how is it treated?
A life-threatening condition treated with hydrocortisone injection.
What is the role of hydrocortisone in treating Addison’s disease?
Replaces deficient cortisol levels and stabilizes the patient.
Why is glucagon often ineffective in adrenal crisis?
Glucagon cannot compensate for cortisol deficiency.
What condition do statins treat?
Hyperlipidemia (high cholesterol levels).
How do statins lower cholesterol?
Block the enzyme responsible for cholesterol production in the liver.
Name three common statins.
Atorvastatin (Lipitor)
Fluvastatin
Simvastatin
What are possible complications of untreated hyperlipidemia?
Angina
Heart attack
Stroke
Why must statins be taken for life?
Cholesterol levels rise again once statins are stopped.
What are diuretics used for?
Reduce fluid buildup in conditions like heart failure and hypertension.
What are the three main types of diuretics?
Loop Diuretics – Furosemide (Lasix)
Thiazide Diuretics – Hydrochlorothiazide (HCTZ)
Potassium-Sparing Diuretics – Spironolactone
How do loop diuretics work?
Block reabsorption of sodium and chloride in the Loop of Henle.
What is the function of thiazide diuretics?
Reduce blood pressure by decreasing fluid volume and relaxing blood vessels.
Why are potassium-sparing diuretics prescribed?
Prevent potassium loss while promoting diuresis.
Which diuretic is commonly prescribed for heart failure?
Furosemide (Lasix).
What is the purpose of fluid therapy?
Maintain intravascular volume and organ perfusion in critically ill patients.
What are the two main types of IV fluids?
Crystalloids: Small molecules that pass easily through membranes.
Colloids: Large molecules that remain in blood vessels.
What is the difference between isotonic, hypotonic, and hypertonic solutions?
Isotonic: Equal solute concentration to body fluids.
Hypotonic: Lower solute concentration, causes water to enter cells.
Hypertonic: Higher solute concentration, causes water to leave cells.
Name an example of an isotonic fluid.
Normal Saline (0.9% NaCl).
What is a fluid bolus, and when is it used?
A rapid infusion of fluid to increase blood volume and cardiac output.
Used in septic and hypovolemic shock.
What formula is used to calculate IV flow rate?
Drops per minute (gtts/min) = Infusion rate (ml/hr) × IV drop factor (gtts/ml) / 60
What is the drop factor for macro and micro IV tubing?
Macro tubing: 10, 15, or 20 gtts/min. Micro tubing: 60 gtts/min.
How do you calculate the infusion rate for 1000 ml over 8 hours?
Infusion rate: 1000 / 8 = 125 ml/hr.
Calculate the drops per minute if 125 ml/hr is administered with a drop factor of 20 gtts/ml.
Drops per minute: (125 × 20) / 60 = 42 gtts/min.
A patient presents with fatigue, weight gain, and cold intolerance. What condition do you suspect?
Hypothyroidism.
You arrive at a scene where a patient has a history of diabetes and is found confused and diaphoretic. What is your initial intervention?
Check blood glucose (CBS) and administer dextrose if low.
A patient on hydrochlorothiazide presents with swollen, waxy lower extremities. What condition is likely?
Fluid overload due to non-compliance with diuretics.
You encounter a patient with chest pain, taking atorvastatin. What condition might this medication be preventing?
Hyperlipidemia, angina, or heart attack.
A patient in adrenal crisis presents with hypotension and confusion. What is the immediate treatment?
Hydrocortisone injection and IV fluids.
What are hormones?
Hormones are chemical messengers produced by endocrine glands and released into the bloodstream.
What processes do hormones regulate?
Hormones regulate metabolism, growth and development, mood and stress response, and sexual function and reproduction.
What is the function of adrenaline?
Adrenaline increases heart rate, dilates air passages, and prepares the body for fight-or-flight response.
What are the effects of high adrenaline?
High adrenaline effects include increased heart rate, sweating, anxiety, and heightened alertness.
What are the effects of low adrenaline?
Low adrenaline effects include fatigue, low blood pressure, weakness, and inability to respond to stress effectively.
What is the medical use of epinephrine?
Epinephrine 1:1000 is used to treat anaphylaxis; Epinephrine 1:10000 is administered during cardiac arrest to increase coronary perfusion.
What is the function of thyroxine (T4)?
Thyroxine controls metabolic rate by converting oxygen and food into energy and regulates body temperature, heart rate, and energy levels.
What are the effects of high thyroxine (hyperthyroidism)?
High thyroxine effects include rapid heartbeat, weight loss, nervousness, and heat intolerance.
What are the effects of low thyroxine (hypothyroidism)?
Low thyroxine effects include fatigue, weight gain, cold intolerance, and dry skin and hair loss.
What is insulin’s function?
Insulin lowers blood glucose by allowing glucose to enter cells.
What is glucagon’s function?
Glucagon increases blood glucose by converting glycogen into glucose.
What is Type 1 Diabetes?
Type 1 Diabetes is characterized by no insulin production and requires lifelong insulin therapy.
What is Type 2 Diabetes?
Type 2 Diabetes involves reduced insulin production or insulin resistance and is managed with diet, oral medications, and sometimes insulin.
What are oral hypoglycemic agents (OHA)?
OHAs lower blood glucose levels by different mechanisms.
What are examples of sulfonylureas?
Examples include Glyburide and Gliclazide, which trigger beta cells to release insulin.
What is the function of glucagon?
Glucagon is administered intramuscularly if IV access is unavailable and converts liver glycogen into glucose to raise blood sugar.
What is Addison’s Disease?
Addison’s Disease is caused by insufficient production of adrenal hormones (cortisol and aldosterone).
What are symptoms of Addison’s Disease?
Symptoms include abdominal pain, hypotension, fatigue, and electrolyte imbalance.
What is the treatment for Addison’s Disease?
Hydrocortisone injection can resolve adrenal crisis within 1 hour; ongoing steroid replacement therapy is required.
What do statins do?
Statins block an enzyme in the liver that produces cholesterol and reduce LDL cholesterol.
What are examples of statins?
Examples include Atorvastatin (Lipitor), Fluvastatin, Lovastatin, Pravastatin, and Simvastatin.
What is the purpose of diuretics?
Diuretics manage fluid balance by promoting diuresis.
What are loop diuretics?
Loop diuretics block reabsorption of sodium and chloride in the Loop of Henle; most common is Furosemide (Lasix).
What is the IV flow rate formula?
Drops per minute (gtts/min) = Infusion rate (ml/hr) × IV drop factor (gtts/ml) / 60.
What is an example of an IV flow rate calculation?
For 1000 ml of Normal Saline over 8 hours using macro tubing with a drop factor of 20 gtts/min, the flow rate is 42 gtts/min.
What are key takeaways about hormones?
Hormones regulate key body functions such as metabolism, growth, and stress responses; insulin and glucagon control blood sugar levels.
What is the next intervention for a 45-year-old male in cardiac arrest with asystole?
Continue high-quality CPR.
Administer epinephrine 1:10,000 IV/IO every 3-5 minutes. Reassess rhythm after 2 minutes of CPR.
What medication and dose should be administered for a 35-year-old female experiencing anaphylaxis?
Epinephrine 1:1000 IM (0.3 mg for adults, 0.01 mg/kg for pediatrics).
Consider additional doses every 5-15 minutes if symptoms persist.
What is the next step for a patient in pulseless ventricular tachycardia (pVT) who has received one shock?
Administer epinephrine 1:10,000 IV/IO (1 mg every 3-5 minutes).
Continue CPR and reassess after 2 minutes.
What is the next course of action for a 60-year-old male with pulseless electrical activity (PEA)?
Continue CPR.
Administer epinephrine 1:10,000 IV/IO every 3-5 minutes. Identify and treat reversible causes (e.g., hypoxia, hypovolemia).
What condition do you suspect in a 50-year-old woman with palpitations, tremors, and weight loss?
Hyperthyroidism (high thyroxine levels).
Consider beta-blockers to control symptoms and refer for further evaluation.
What is the likely cause of symptoms in a 65-year-old male with hypothyroidism who has not taken his medication?
Low thyroxine levels (hypothyroidism).
Resume Synthroid (levothyroxine) to correct thyroid hormone deficiency.
What life-threatening condition should be considered in a 72-year-old female with confusion and hypothermia?
Myxedema coma.
Administer IV levothyroxine and hydrocortisone immediately.
What condition is concerning for a 48-year-old male with hyperthyroidism presenting with fever and agitation?
Thyroid storm (life-threatening hyperthyroidism).
Administer beta-blockers, antithyroid medications, and supportive care.
What is the immediate intervention for a 15-year-old male with Type 1 Diabetes and a blood glucose of 42 mg/dL?
Administer Dextrose 25-50 mL of D50 IV push if IV access is available.
If no IV access, administer 1 mg glucagon IM.
What condition is suspected in a 67-year-old diabetic female with a blood glucose of 580 mg/dL?
Diabetic ketoacidosis (DKA).
Initiate IV fluids, insulin infusion, and electrolyte management.
What is the most likely diagnosis for a 72-year-old male with Type 2 Diabetes and a blood glucose level of 850 mg/dL?
Hyperosmolar Hyperglycemic State (HHS).
Treatment: IV fluids, insulin infusion, and correction of electrolyte imbalances.
What is the appropriate intervention for a 55-year-old male with a blood glucose of 60 mg/dL who is conscious?
Administer oral glucose (15-20 g) and reassess after 15 minutes.
What medication can be administered for persistent hypoglycemia despite multiple doses of dextrose?
Glucagon IM/IV to stimulate glycogenolysis and increase blood glucose.
What is the immediate treatment for a 40-year-old male with Addison’s disease presenting with severe abdominal pain?
Administer hydrocortisone IV immediately.
Provide IV fluids and glucose for supportive care.
What condition is suspected in an unconscious patient with adrenal insufficiency and hypotension?
Adrenal crisis.
Treat with IV hydrocortisone and aggressive fluid resuscitation.
What should be done for a 35-year-old female with Addison’s disease who missed her hydrocortisone dose?
Administer hydrocortisone injection and transport for further evaluation.
Why might glucagon be ineffective in raising blood sugar during an adrenal crisis?
Without cortisol, the body cannot effectively mobilize glucose in response to glucagon.
What medication should be initiated for a 52-year-old male with high cholesterol despite lifestyle changes?
Statins such as atorvastatin (Lipitor) to lower LDL cholesterol.
What condition should be suspected in a patient taking statins who reports muscle pain and weakness?
Statin-induced myopathy.
Consider discontinuing the statin and checking creatine kinase (CK) levels.
What is the consequence of untreated hyperlipidemia for a patient refusing statin therapy?
Increased risk of angina, heart attack, stroke, and peripheral artery disease.
What lab values are likely elevated in a patient non-compliant with their statin therapy?
LDL cholesterol and total cholesterol.
What class of medication is indicated for a 70-year-old male with heart failure and worsening dyspnea?
Loop diuretics such as furosemide (Lasix) to reduce fluid overload.
What is the primary mechanism of hydrochlorothiazide in hypertension management?
Reduces blood pressure by decreasing fluid volume and relaxing blood vessels.
Why did a patient on spironolactone develop hyperkalemia?
Potassium-sparing diuretics like spironolactone prevent potassium excretion, leading to hyperkalemia.
What type of diuretic might be added for a patient on furosemide who develops hypokalemia?
Potassium-sparing diuretics such as spironolactone to maintain potassium balance.
What type of fluid is most appropriate for a 72-year-old patient in septic shock requiring fluid resuscitation?
Isotonic crystalloids such as Normal Saline (0.9% NaCl) or Lactated Ringer’s.
What is the difference between crystalloid and colloid fluids?
Crystalloids: Small molecules that pass easily through cell membranes.
Colloids: Large molecules that stay within blood vessels to expand volume.
What is the mechanism of action for hypertonic solutions in cerebral edema?
Hypertonic solutions draw fluid out of cells, reducing intracranial pressure.
What is the primary goal during fluid bolus therapy?
Increase venous return, cardiac output, and organ perfusion.
What is the initial fluid therapy for a 65-year-old female with severe diarrhea and hypovolemic shock?
Normal Saline (0.9% NaCl) or Ringer’s Lactate for volume replacement.
How do you calculate the drops per minute for 1000 mL of Normal Saline over 8 hours using macro tubing?
Infusion rate: 1000 mL / 8 hours = 125 mL/hr.
Drops per minute: 125 × 20 / 60 = 42 gtts/min.
How do you calculate the flow rate for 500 mL of D5W over 4 hours using micro tubing?
Infusion rate: 500 mL / 4 hours = 125 mL/hr.
Drops per minute: 125 × 60 / 60 = 125 gtts/min.
How do you calculate the flow rate for 250 mL of Normal Saline over 2 hours using macro tubing?
Infusion rate: 250 mL / 2 hours = 125 mL/hr.
Drops per minute: 125 × 15 / 60 = 31 gtts/min.
How do you calculate the flow rate for infusing 1 L of Lactated Ringer’s over 5 hours?
Infusion rate: 1000 mL / 5 hours = 200 mL/hr.
Drops per minute: 200 × 10 / 60 = 33 gtts/min.
What is the next step in management for a patient with septic shock not responding to fluid boluses?
Consider starting vasopressors (norepinephrine or dopamine) to maintain perfusion.
What electrolyte imbalance should be suspected in a patient receiving furosemide who develops ventricular arrhythmias?
Hypokalemia due to potassium loss from diuretics.
What medication can be used to control heart rate in a patient with thyroid storm?
Beta-blockers (e.g., propranolol) to control sympathetic overactivity.
What is the priority intervention for a diabetic patient found unconscious with a blood glucose of 38 mg/dL?
Administer Dextrose 50% IV push immediately.
What immediate intervention should be performed for a patient with Addison’s disease who collapses due to an adrenal crisis?
Hydrocortisone IV injection and fluid resuscitation.
