Endocine 6/7 Flashcards
What can decrease renal perfusion and stimulate renin release?
hemorrhage
PEEP
CHF
liver failure
Sepsis
What ABG abnormality does aldosterone cause?
metabolic alkalosis- holding on too too much water/ buffer
Cortisol production per day, normal serum level, max production, and level during major surgery
15-30mg per day
12mcg/dl normal level
100mg/day max production
50mcg/dl during surgery
What is gluconeogenesis
glucose- new-make
make new glucose
Amino acids are converted to glucose by the liver
increases blood glucose
Cortisol effects
gluconeogenesis
protein catabolism for gluconeogenesis
Fatty acid mobilzation- use fat for energy
Anti inflammatory- stabilize lysosomal membranes, reduce cytokine release, decrease eosiniphils/ lymphocytes
Improve hemodynamics (inotropy) by increasing number and sensitivity to beta receptors in the myocardium
Improves vasoconstriction of catecholamines
Most potent glucocorticoids
1- decadron/ betamethasone- 25x (synthetic)
2- fludro- 10x
3-… (many)
4- cortisol- 1x (first endogenous)
Most potent mineralcorticoids
1- Aldosterone 300x
2- fludrocortisone 250x
3- cortisol 1x
Which steroids have NO mineralcorticoid effects
dexamethasone, betamethasone, triamcinolone
Which drugs have no glucocorticoid effects
aldosterone
Which synthetic steroid is best for addisons disease
prednisone
most closely resembles cortisol
Primary vs secondary hyperaldosteronism causes and renin level
primary- conns syndrome- aldosteronoma, pheo, primary hyperthyroid, aldosterone release from adrenal gland, normal renin
secondary- renovascular htn, aldosterone release from extra renal location, (chf, cirrhosis, nephritis) high renin
Treatment of hyperaldosteronism
removal of tumor
aldosterone blocker- spironalactone/ eplerenone
k supplementation
na restriction
How would hypokalemia affect anesthesia
muscle weakness- more sensitive to NDNMB
U wave
Avoid hyperventilation
What causes cushing’s syndrome
exogenous administration
pituitary tumor, adrenal tumor
glucocorticoid effects of cushings
hyperglycemia
weight gain
increased infection risk
osteoperosis
muscle weakness
mineralcorticoid effects in cushings
htn
hypokalemia
met alkalosis