Endocrine Flashcards
what causes keto acidosis
Type 1 diabetes,
or type 2 with neglect, illness stress
It is from lack of insulin
MEtabolic acidosis 8
HA, hyper k, mm twitching, warm flushed skin, NV, decreased mm tone, decreased reflexes, kussumal
MEtabolic acidosis 8 why?
HA, hyper k, mm twitching, warm flushed skin, NV, decreased mm tone, decreased reflexes, kussumal
DKA
what causes signs and symptoms of DKA
5
Metabolic acidosis, dehydration, glucose. metabolic, hypo electrolytes
What labs would you want for DKA
anion gap, BMP-Glucose,electro,kideney, art gas,BP, Serum osmolality, urine stuff, cbc
Can DKA be outpatient
yes if they do not have an infection and no serious s/s
how do we treat right away for DKA?
O2, then IV- 0.45-0.9 NS, add dextrose if below 250-SLOWWW, short acting insulin, and k+ because of insulin at 0.1 units and increased output, possibly bicarb, Cardiac monitor, labs
What is hyperosmolar hyperglycemia
Its an emergency with 600+ BG levels, and severe osmotic diuresis caused by infection or newly diagnosed DM11
What are we concerned about hypersomolar hyperglycemia
What can that lead to
Hypovolemia, Hypoelectrolytes, dehydration, Hemoconcentraition, renal perfussion, tissue anoxia (Lactic levels increased)
Seizure, shock, coma, death
S/s of hyperos hypergly
Hypovolemia s/s, dehydration s/s, shock s/s, high urine output to low urine output, seizure, high bg, stroke- similarities. LOV issues, s/s of hypoglycemia- mimic alcohol.
Management of Hyperos hypergly
Similar to DKA, more fluid, might need a foley, breath sounds, IV- normal half normal, add dextrose at 250, insulin electrolytes, watch cardiac, renal, Mental status.
What is the number for hypoglycemia
less than 70
s/s for hypoglycemia
what happens if you dont get help?
Shaky, palp, nervous, diaphoretic, hunger pallor
Neuroglycopenia- Diff speaking, visual disturbances, stupor, confusion, coma
loss of c. seizures, coma, death
What is the rule of 15?
and 2 things to remember
2 pharm interventions
take 15g of simple carbs or gels or tabs, check in 15, repeat. If no change in 2-3 times call HCP No foods with fat-slows glucose Don't over do it 20-50ml 50% DEXTROSE Glucogon
To remember about diabetic care
A1c Every 3 months, Stop smoking- circulation, check for dry skin or callus, use lotion but not in-between toes.
causes of SIADH and what is it and more common in
Its over production of ADH
sm lung cancer, brain trauma, brain surg, Drugs, ICP
males
How do we diagnose SIADH 3
High consentrated urine so increased Special gravity, Low serum osmolality, and hypona+
S/s
6 OF SIADH
Low urine output 10/ml.hr or less, increased circulating volume THiRST, Increased GFR, Hypona+ s/s, sudden weight gain without edema,
S/S Of hypona+
mm cramps, irritablity, fatigue, HA, Twitching, mm weak, cerebral edema vomiting, confusion, seizures, coma,
What are we focused on with SIADH how do we do that? 6
Dilutional Na+- Seizure and fall precautions, watch s/s give 3% if supper low very slow too fast causes permanent brain nerve damage
FVOL-Heart and lung sounds, Is and OS, daily weights, BP, fluid restriction maybe 500 skin, rom, loops( watch K)
watching neurofunction
Thirst- Ice chips gum oral care tin drugs
Dont increase ADH- no drugs- vassopressin, DDAVP flat bed
decrease ADH- Vassopressin antag demecylocine
Types of DI and about them
Central- Interference with ADH production tumors, infections, brain surgery
Neph-kidneys wont respond- Lith, renal damage
primary- Thirst issues
Manifestations of di 5 causes with with r/t s/s
polydipsia, polyuria,- 2-20 l a day with low SG
Increased plasma osmolality
Sleepy from nocturia
dehydration-thirst, hypo, tachy, shock
Hyperna+ irritable, mental dullness, coma
DI and three things to watch for one thing to teach
Specific tx for neph and central-
Hyperna+-Watch s/s, hypotonic solutions, dextrose-watch glucose and its diuretic effect.
Increase fluids-DDAVP and aqueous vassopressin
FVD- Thirst- CLor and carban, I and O, Vitals-esspecially volume rt, Specific gravity, daily weights, flushed skin- sign of FVD
Long term mat
Nephro-Fluids and decrease Na+ no hormones, thiazides, indometh-NSAID and increases kid sensitivity.
Explain test for DI
Water deprivation test before test measure body weight, urine osmo, volume, and sg no water for 8-12 hr Give presser Central-increse urine osmo nephro- no increase in urine osmo
What is thyroidtoxicosis
causes
Thyroid storm, hyperthyroidism, emergency,
Infection, trauma, stress, thyroidectomy-#1 from release of hormones when removing it.
Manifestations of thyrotox 7
Severe Hyperthyroid s.s, heart fail, shock, seizure, delirium, coma, ab pain,
Management with thyrotox-
6 with examples.
Agressive tx
Help heart- beta blockers, monitor, VA ECHMO, Balloon pump
Get thyroid hormone decreased- meds- Iodine, RA iodine, PTU drugs, glucosteroids, IV isotonic with Dex, surg if goiter or unresponsive to meds
Watch for complications-DysR, give 02, Watch dehydration and listen to lungs
diet-Increase cals, prots and fiber, no season, no stimulants
tx exo- prevent cornal injury, tears, no salt, increase HOB. tape, dark glasses, tepez drug
REST
S/S of hyperthyroidism
Edema. Increase activity, menstrual issues, decreased libito, decreased firtility. impotence, dyspnea, warm smooth moist skin, thin brittle nails, hair loss, decreased LDL, cardiac changes, clubbing, red palms, premature grey, fine silky hair, vertigo, into to heat, increased temp,
drugs for hyperthyroidism 4 and about them
Antithyroid meds-zoles,
Iodine-not long term just for surg
beta blockers
Radioactive iodine-not for preg, destroys tissue, can cause hypt, radioactive precautions.
Care for hyperthyroid 5
Surgery, meds, decrease temp, increase fluids, increase cal,
S/s for iodine tox 4
Swelling of bucccal mucosa, and mucus membranes, increase saliva, N/V and skin reactions. STOP TX
Tx for hypothyroidism
Myedexema coma
Long standing hypothyroidism from acculumulation of hydrophilic monopolysacerides, in dermis and tissue
Myedex coma s/s 5
caused by?
Puffy face and peri orbital,
coma-mentally slow, drowsy, lathargic
infection, drugs, cold, trauma, stopping tx
Manifestaions of My coma 4
Subnormal temp, hypotn, hypovolemia, cardiac collapse- hypovent, hypona hypogly lactic acidosis,
Care for myex coma
two drugs
Mechanical respiration, cardiac monitoring, temp, skin care, vitals weights i LOC
IV thyroid hormone vassopressors
Cushings cause
types
Common
Over exposure to corticosteroids, iatrogenic- prednisone, ACTH Secreting pituitary adneoma or adrenal tumor
Ectopic-Tumors somewhere else- lungs and pancreas
women 20-40
Manifestations that you don’t know of chushings
hyperglycemia, mm weak and atrophy, osteoporosis, weak skin, delayed wound healing, hypoK, hypertn, acne, buffalo hump edema, awkward gate, CNS changes, GI increased Acid, bruise and petechiae
How to diagnose cushings
increased serum cort, midnight saliva, 24 hour urine- greater than 80
What tests would you expect with cushings.
MRI or CT for tumor, Plasma ACH- low or high, blood penias-white, glucose in urine, hyperca, hypo k and alkolosis
TX for cushings
Radiation- for those who can’t have surg,
surgery
drugs-destroy adrenal-ketoconazole and mitotane
Mifepristone0 for hypergly
TX for cushings
Radiation- for those who can’t have surg,
surgery
drugs-destroy adrenal-ketoconazole and mitotane
Mifepristone0 for hypergly
Change steroid dose
What to watch for with cushings
Thrombolytic event, medical alert bracelet, no extreme temps, may need more steroids for stress, watch for infection and OSHTN
Addisons disease four about it
Not enough corticosteroid
decrease of medula of adrenals
all steroids decreased
usually autoimmune
Addisons causes
TB, amylodisis, fungal infection, AIDS, meta cancer. chemo, ketoconazole, bilat adrenoectomy, Anticoag therapy
secondary addison
Pituitary issues with ACTH
Manifestations of addisons
late diagnosis, all the ab stuff, weak, weight loss, bronze skin hyperpig-primary, HA, ORTHOHTN, Salt craving, joint pain
What is the risk for addisons
Addisonian crisis-
tx-high fluids ds5
Hypotn and shock, curculatory collapse hypo na hyper k hypogly, fever, weak, back pain N/V/D
Diagnosis with ad
ACTH and corts measured, inject iv of ACTh recheck 30 mins, addisons is little to no change and primary has high ACTH levels
One difference between primary and secondary addisons
Primary is all of the steroids and secondary has mineral still
Tx for addisons 8
Usually life long hydrocortisone watch hyperka and hypo everything else women need andregen replacement increase salt to diet give cortisol in divided does They need a medical alert bracelet increases dose for stressful situations any GI upset needs to be reported watch for chushing
Drugs that interact with steroids 5
hypogly, glucosides, contraceptives, anticoag, NSAIDS
pheochromcytoma
Tumor in the medulla affecting chromaffin cells aka catecolamines
pheochromcytoma s/s 7
Severe pounding HA, High BP, tachy, chest pain, diaphoresis ab pain
Causes of pheochromcytoma 10
direct trauma, stress, sex, alcohol, smoking, drugs antihypertensives, opioidsm contrast, tri antidepressants,
tx of pheochromcytoma
Alpha and beta blockers sin and lol surg decrease bp and dysr
watch orthp
Kidney lab values Urine osmo BUN Creatinine GFR Urine output SG
Urine osmo- 300-900 BUN-10-20 Creatinine 0.5-1.1 GFR 125 Urine output 1.5-2ml/kg/hour SG-1.005-1.030
Blood gas O2 CO2 Bicarb pH
80-100
35-45
bi-22-28
7.35-7.45
ANION GAP
(na+-k+)- (Cl+HCO3)
normal 8-10
Normal na k cl ca
na-135-145
K-3.5-5
98-106
9-10.5
Serum osmololity
278-300
Thyroid
TSH
t3
t4
0.5-4.5
5.4-11.5
80-100
Micro vs Macro angiography
Micro- Damage to cap and arterioles
causes thickening Retinopathy, neuropathy, neohropathy
Micro-Cerebro, Cardio, stroke, heart attack, PAD and PVD
What are the risks for angiography 5
obesity, smoking, HTN, increased fat intake, sedentary
Rentinopathy Why? Causes one Types one more risk it causes
Hyperglycemia causing damage to the retina
can cause blindness
2 types
Proli-new blood vessles black and red spots, and retinal detachment
non-prolif-most common weak walls=retinal edema and microanurisms maybe blind
Increased risk fot Cateracts and gluacoma
s/s of retinophaphy 6
one for cateracts and one for glaucoma
Cotton wool spots, hard exudate, hemorrhages, aneurysm, abnormal vessles, black and red spots
Cateracts-cloudy lense
Glaucoma-fluid and damage to optic nerve
tx for retinophathy 6
lasor photo coagulation- destroys ischemia
eye exams
vitectomy-take out fluid and stuff helps with vison issues
manage glucose and hypertn
fluinolone acetonide- implant for 36 moths-steroid
VEGF-watch
Nephropathy 2
4 inducers
blood vessles supply the glumatuli
leading cause of end stage renal
Genetic link with kid disease, hypertn, smoking, hyperglycemia
Nephropathy s/s
Grnular surface, decresed kid finction, sm size, increase urine prots, sclerotic vessles, ischemic pyramids
Nephropathy care 4
watch Albumin and creatinine, bp control ace inhibitors-prill
Neuropathy
nerve damage demylenation of the nerve
sensory-Loss of senses in sensation in lower extremeties Or super sensitive, cramping burning, numb feet
or autonomic - non vol structures
dermaplphys
for neuropathy, red bown spots nothing to worry about
TX for neuropathy
Monofil testing on feet foot care, Empty bladder, Drugs
Dibetic risk for infection
Decreased bf so fewer WBC and inflam cells glucose can go septic fast
neuropathy decreases s/s of infection
