endocrine Flashcards
testing to dx DM
blood glucose >= 126 fasting on more than one occasion
A1C >= 6.5
somogyi effect
nocturnal hypoglycemia
patient is hypoglycemia at 0300 but rebound with an elevated BS @ 0700
what is GAD-65
glutamic acid decarboxylase found in 80% of patient with type I DM
when do ketone usually develop
type I DM
along with weight loss
tx for somogyi effect
reduce or omit the at bedtime dose of insulin
dawn phenomenon
blood glucose becomes progressively elevated throughout the night resulted in elevated blood glucose at 0700 (the dawn is rising)
tx for dawn phenomenon
add or increase the at bedtime dose insulin
metabolic syndrome
BP 130/85
waist circumference: Men >= 40 “ ; women >=35 “
FBG: >130
Triglycerides >= 150
HDL: men <40 and <50 in women
must have 3 to dx
pt present with recurrent vaginitis upon assessment you discover she is also having blurred vision and pruritus . what do you test and dx
ketones in urine/blood
DM II
what is the starter drug for Type II DM
biguamide (Metformin, glucophage, glumetza)
black box warning: lactic acidosis c/o muscle pain
this medication can increase risk of thyroid cancer and is part of REMS
GLP-1 agonists
trulicity, betta, Victoza, ozemic, semaglutide
REMS - risk and evaluation and mitigation streagegy: pancreatitis
how do you determine if pt is having dawn effect or somogyi effect
test 0300 BS - if pt is hypoglycemic it is somogyi effect
s/s of DKA
kussmaul breathing
fruity breath
glucose > 300
ketonemia
glycosuria
low bicarb HCO3
low CO2
hyperkalcemia
hyperosomolality
tx of DKA
fluid
0.1 u/kg regular insulin IV bolus following by 0.1 u/kg/hr - if glucose does not fall by at least 10% in first hour repeat bolus
s/s of HHS
change in LOC
greatly elevated glucose > 1000
hyperosmolality
relatively normal ph
normal anion gap
tx of HHS
0.1 u/kg regular insulin IV bolus followed by 0.1 u/kg/hr infusion . repeat bolus if glucose doesn’t fall by 10% in first hour
elevated TSH and decreased T3 and T4
hypothyroidism
most common presentation of hyperthyroidism
graves disease
pt presents with increased appetite, weight loss, palpitation and exophthalmos what do you test and dx
TSH - elevated
t3 & t4 - decreased
hyperthyroidism
what is a common disease associated with hypothyroidism
hashimotos thyroiditis
s/s of hypothyroidism
cold intolerance
muscle fatigue
puffy eyes
edema of hands and face
elevated TSH and decreased t4
hypothyroidism
mtg of hypothyroidism
levothyroxine
mtg of hyperthyroidism
propranolol for symptoms
thiourea drugs for mild cases, goiters - methimazole, propylthiouracil
tx of thyroid crisis
over drive of hyperthyroidism
propylthiouracil 150-250 q 6
methimazole 15-25 mg q 6
AVOID ASA/NSAIDs
complication of hypothyroidism and mtg
myxedema coma
protect airway
fluid replace prn
levothyroxine 400mcg IV x1 then 100mcg daily
slow rewarming with blankets-avoid circulatory collapse
labs associated with Cushing syndrome
hyperglycemia
hypernatremia
hypokalemia
elevated ACTH
test performed for cushing
dexamethasone suppression test to detremne cause- administer dexamethasone and cortical is still elevated
s/s of cushign dx
central obesity
moon face with buffalo hump
acne
hirustism
HTN
hyper secretion of ACTH by pituitary
Cushing syndrome
deficiency in cortisol, androgen and aldosterone
addisons disease
s/s of addisons disease
hyperpigmentation in buccal mucosa and skin teases
diffuse tanning /freckles
scant axially and pubic hair
hypotension
labs associated with addisons disease
hypoglycemia
hyponatremia
hyperkalemia
plasma cortisol < 5mcg/dl @ 0800
what test do you administer to determine Addison disease
cosyntropin (synthetic ACTH) stimulation test
mtg of Addison disease
replace glucocorticoid and mineralocorticoid - hydrocortisone and fludrocortisone acetate (Florinef)
disease of water retention and increased release of ADH
SIADH -syndrome of inappropriate antidiuretic hormone
s/s of SIADH
change in LOC r/t hyponatremia
seizure, coma
decreased DRTs
labs associated with SIADH
hyponatremia , decreased serum osmolarity
increased urine osmolality (thick urine )
increased urine sodium > 20
mtg of SIADH
NA >120 - restrict fluid, 1000ml/day
NS <110 or neuro s/s : replace with hypertonic or isotonic saline and lasix
goal 1-2 mEq/h increase per hour
mtg of DI
serum Na >150- administer D5W to replace fluid loss over 12-24 hours
serum Na <150, administer 1/2 NS or 0.9 NS
DDAVP 1-4mcg IV or Sq q 12-24 hours
maintenance dose of DDAVP is intransally
decrease ADH resulting in volume depletion and inability to concentrate urine
diabetes insipidus (DI)
s/s of DI
increased thrifty
polyuria
labs r/t DI
hypernatremia - increased serum osmolarity
decreased urine osmolality (thin urine)
hypokalemia
test administered with DI
desmopression challenge - determine if central DI if positive
excess catecholamine releases with paroxysmal HTN
pheochromocytoma
almost always due to tumor of adrenal medulla
pt presents with palpitations, weight loss, labile BP what test do you order and dx
TSH.-will be normal
pheochromocytoma
labs/DX of pheochromocytoma
TSH normal
Plasma-free metanephrines in blood
24 hour urine: catecholamines, metanephrines, vanillylmandelic acid (VMA), and creatine
CT used to confirm
MTG and monitoring of pheochromocytoma
surgical removal of tumor
monitor for Hypotension (depleted catecholamines), adrenal insufficiency , hemorrhage
