Endocrine Flashcards
SIADH clinical manifestations,
Syndrome of Inappropriate Antidiuretic hormone
too much adh
so youre not peeing
- low urine output
- inc body weight
early: thirst, dyspnea and fatigue due to hyponatremia
more server hyponatremia: vomiting , abdominal cramping muscle twitching
SIADH diagnosis
Simultaneous measurements of urine & serum osmolality
- serum sodium will be low
- serum osmolity ( how much substance is in blood)much lower than urine osmolarity shows that the body is inappropriately excreting concentrated urine
osmolarity - solute particles per liter of water
- specific gravity of urine would be high , urine is denser than water
SIADH management
I’s/O’s
Weights
Physical Assessment
Lung Sounds
watch closely with meds for ADH release because that can cause additional sodium excretion (diruretics)
demethocycline to block effect of adh on the renal tubuals
SEVERE:
IV 3% NS
vasopressor receptor antagonist
- Seizure precautions (rails up, lose close, o2 and suction present, etc typical room precautions)
- Fall precautions
types of DI - diabetes insidious
lots of digressing
Central (neurogenic) - results from an interference with ADH synthesis, transport, or release in the posterior pituitary.
ex: brain, tumor, head injury, brain surgery, CNS infections
Nephrogenic DI - Results from inadequate renal response to ADH despite presence of adequate ADH
ex: renal damage , hereditary renal disease
Primary DI - Result from excessive water intake
ex: structural lesion in the thirst center
DI Clinical manifestation
- polydipsia (thirsty)
- poly uria
- excretion of large amount of urine ( low specific gravity, urine osmolarity and serum osmolity is high ) , theres a pure water loss
- nocturne - getting up in the night to pee
- generalized weakness
- dehydration
DI management
Central
hydration
- IV (hypotonic)
- hormone replacement therapy
Desmopressin
Aqueous vasopressin (ADH)
Thirst control:
-Chlorpemide
- Carbamazepine
Nephrogenic
- HORMONE THERAPY HAVE LITTLE AFFECT, THE KDNEYS ARENT RESPONDING BABES
- low sodium diet
- diuretics
- Indomethacin (when diuretics and low sodium aren’t working, help inc renal responsiveness to adh)
Goiter: etiology, management
enlarged thyroid gland, so the cells are stimulated to grow
etiology -
worldwide: lock of iodine in diet
US:
- over or underproduction of thyroid hormones
- nodules (growth of abdnormal tissue)
- goitrogens (food or drug containing iodine inhibiting things)
management -
- diet with iodine
-thyroid hormone
- surgery to remove the goiter itself
Thyroiditis: etiology & management;
the inflammation of the thyroid gland
etiology:
- subacute: viral (abrupt, painful)
- acute: bacterial, fungal
management: treat the underlining cause with saids, corticosteroids or antibiotics
silent painless thyroiditis
- post partum ( mother reacting to fetus)
Hashimotos thyroiditis
- chronic and autoimmune t3 and t4 are low
- most common cause of hypothyroid goiters
; Graves’ Disease: clinical manifestations, diagnosis, management e.g. know class of drugs and what they do (do not need to know specific drug names
causes hyperthyroidism (most common cause of hyperthyroidism)
autoimmune disease
etiology: insufficient iodine supply, smoking, infection, stress , genetics because it is autoimmune
clinical manifestations:
- inc metabolism
- inc tissue sensitivity to SNS stimulation
- Goiter
- Opthalmopathy (inflammation of eyes, double vision)
- Exopthalmos (protrusion of eyeballs)
- Multisystem impact
- Pneumonic - THYROID-IS-ME
tremor, high hr, yawning, restlessness, oglimenuria, irritability, diarrhea, sweating, muscle wasting, exopthamlmos
Diagnosis:
- low or detectable TSH levels ( antibodies latching on to the thyroid receptor sights , your body doesnt think it needs to make TSH)
- Elevated T4 levels
- radioactive iodine
Management:
- block adv effects of excessive thyroid hormones
- suppress over secretion
- prevent complications
- antithyroid medication
- iodine
- beta blockers
- radioactive iodine therapy
post-op complications of thyroidectomy;
remove thyroid
- damage to parathyroid gland causing hypocalcimia (it over works?)
- hemorraghe
- injury to laryngeal nerves
- hypothyroidism
- infection
Acute Thyrotoxicosis: cause, manifestations, and management;
hyperthyroid complication
syndrome of hyper metabolism
elevated T3 & T4 Levels
manifestations:
- tachycardia, heart failure, shock, hyperthermia
- delirium, seizures, coma
- vomiting, diarrhea
Manament: aggressive treatment
- propythiouracil
- beta blockers
- iv fluids
- cardiac monitoring
Hypothyroidism: manifestations, diagnostics, management (know drug names);
slowing of metabolic rate
Primary
- thyroid tissue destruction
- defective hormone synthesis
Secondary
- dec tsh
- hypothalamic dysfunction , dec in trh
manifestations:
- slowing of body process
- fatigue
- weight gain
- palor (cool skin)
- constipation
- SOB
- dec HR
- Mixed edema
Diagnostic: TSH Levels, Free t4 , History & Physical
Management:
return to euthyroid state
Drug Therapy;
levothyroxine (makes the thyroid make the issuing hormones)
liotrix (used in acute 4)
low calorie diet
watch cardiac labs
life long therapy
Myxedema coma—clinical manifestations & management;
complication of hypothyroidism
medical emergency
manifestation: subnormal temp, hypotension, hypoventilation, CV collapse can occur
management: ABCs, BLS, IV thyroid replacement therapy (treating underlining. cause)
labs in hypo & hyperthyroidism;
sodium / electrolytes
TSH, T3, T4
role of parathyroid gland in electrolyte regulation
gets calcium back into the blood
stimulates vitamin D synthesis
hyper causes hypercalcemia and hypophatemia
clinical manifestations: loss of appetite, fatigue, muscle weaknesses,
treatments: remove full or partial pth
hypoparathyroid -
clinical manifestations: paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizures
- iv calcium
