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CCRN Certification > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what is osmolality

A

how concentrated the blood is… “osmo high, likely dry”

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1
Q

what is a normal osmolality serum

A

275-295 mosL

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2
Q

what are isotonic fluids

A

stays in vasculature

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3
Q

examples of isotonic fluids

A

sodium chloride 0.9%, LR, plasmolyte

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4
Q

what are hypotonic fluids

A

go out into cell (cell hydration)

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5
Q

examples of hypotonic fluids

A

D5W, 0.45% sodium chloride,

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6
Q

what are hypertonic fluids

A

pull from cell to vasculature

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7
Q

examples of hypertonic fluids

A

D5 0.45% sodium chloride, D10 , D5LR, 2 % Na Cl, 3% Na Cl, %% Na Cl

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8
Q

what is diabetes

A

defect in insulin secretion or action or both

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9
Q

what is type 1

A

Beta 1 destruction (do NOT make insulin)

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10
Q

what is type 2

A

insulin secretory deficit, resistance to insulin

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11
Q

what is HgbA1C and normal range

A

average of glucose over 3 months
normal: 4-5.6%
poor control >7%

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12
Q

this puts you at high risk for CV disease and stroke

A

metabolic syndrome

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13
Q

what is required for metabolic syndrome diagnosis

A

2 of the 4 deadly quartet: dyslipidemia, hypertension, hyperglycemia, abdominal obesity

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14
Q
A
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15
Q

what is glucagon

A

anti low glucose (GIVE for hypoglycemia)

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16
Q

what are alpha cells

A

produce insulin

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17
Q

what are beta cells

A

produce insulin (type 1 has a deficiency of beta cells)

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18
Q

what are delta cells

A

produce somatostatin (which inhibits release of glucagon and insulin)

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19
Q

what is insulin

A

transports glucose, water and potassium into cells

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20
Q

what is short acting insulin and how fast is the action

A

regular insulin
IV action: 5-10 min
SQ action: 30 min

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21
Q

what is rapid acting insulin and how fast is the action

A

humalog (Lispro)
SQ action: 5-15 min

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22
Q

what is intermediate insulin

A

NPH

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23
Q

what is long acting insulin

A

lantus

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24
Q

what are causes of hypoglycemia

A

too much insulin, N/V, strenuous activity, excessive ETOH, pregnancy

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25
Q

symptoms of hypoglycemia

A

palpitations, tachy HR< diaphoresis, pallor, blurred vision, slurred speech, headache, confusion, fatigue

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26
Q

treatment of hypoglycemia

A

4 oz juice, glucose tabs, 10 - 15 grams carb
1/2 amp of D50 or D5 or D10 IV
IM glucagon

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27
Q

DKA manifestations

A

hyperglycemia, hyper osmolality, anion gap acidosis

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28
Q

causes of DKA

A

stress, infection, meds, diet, trauma, surgery, pancreatitis

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29
Q

what is the #1 treatment for DKA

A

CORRECT FLUID DEFECIT

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30
Q

what is DKA

A

-lack of insulin causes too much circulating glucose
-osmotic diuresis, profound water loss
-leads to glucosuria, dehydration and electrolyte imbalance

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31
Q

what is getting burned up in DKA

A

FAT burning

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32
Q

what are the three Ps of DKA

A

polyuria, polydipsia, polyphagia

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33
Q

symptoms of DKA

A

headache, decreased LOC, visual disturbances, tachycardia, decreased CVP and PAoP, kussmaul breathing, acetone/fruity breath, N/V, pain, weight loss

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34
Q

typical labs for DKA

A
  • low pH (acidosis)
    -low bicarb
    -hyponatremia
    -normal to high K
    -hypophosphatemia
    -elevated ketones in blood and urine
    -elevated urine glucose
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35
Q

typical labs for metabolic acidosis

A

-low pH (if greater than 7 will self correct, if <6.9 needs bicarb)
-anion gap >12 (HIGH)
-bicarb <18 (LOW)

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36
Q

what is ketoacidosis

A

elevated serum and urine ketones (fat burning)

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37
Q

normal anion gap

A

11-12

38
Q

cause of metabolic acidosis

A

“MUD PILES”
Methanol, Uremia, DKA, Propylene glycol, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

39
Q

what is the fluid replacement protocol for DKA

A

-initial isotonic (0.9% or LR), add dextrose when BG reaches 250 (D5 1/2) to prevent hypoglycemia
-then 0.45% saline for cellular hydration or drink water if able (water is hypotonic)

40
Q

what is the typical fluid deficit for DKA patients

A

about 5 l behind at start of DKA
*spread fluid replacement out over 8 hrs

41
Q

what is the insulin management of DKA

A

-DO NOT drop BG too quickly
-start with IV then transition to SQ
-must have overlap of IV and SQ otherwise they can go back to ketoacidosis

42
Q

what is the relationship of K and pH

A

INVERSE RELATIONSHIP
for every 0.1 drop in pH, 0.6 increase in K

43
Q

what is hyperosmolar hyperglycemic syndrome (HHS)

A

-AKA nonketoic hyperglycemia
-usually type 2 DM
-causes are the same as DKA
-BG >600
-can take days to weeks to develop

44
Q

what is one major difference between HHS and DKA

A

HHS has ABSENCE of ketones
there is enough endogenous insulin to prevent ketosis

45
Q

what is the urine in HHS

A

-osmotic diuresis, osmo >330
-polyuria THEN oliguria/concentrated urine once dehydrated

46
Q

what is a cardinal sign of DKA

A

AMS and hyperglycemia

47
Q

what are typical HHS labs:pH, Na, K, mag, phos, hct/hgb, and urine glucose

A

ph normal/mild acidosis
Na high
K low and mag low (go together)
phos low
hct/hgb elevated d/t dehydration
urine glucose HIGH

48
Q

HHS treatment

A

*volume replacement (isotonic fluids, once BG 250 add dextrose, then 0.45% saline then oral hydration)
-insulin (regular IV infusion)

49
Q

what is ADH

A

it’s purpose is fluid balance
formed in the hypothalamus
has vasopressor qualities

50
Q

what is SIADH

A

“Swimming in ADH” = too much ADH
severe dilutional hyponatremia (dilutes sodium)

51
Q

what is serum and urine osmos in SIADH

A

serum <280
urine (concentrated), high osmo >100 d/t decreased urine production

52
Q

causes of SIADH

A

infection, pneumonia, COPD, PE, CVA, head trauma, cancer, recent surgery

53
Q

complications of SIADH

A

severe dilutional hyponatremia
cerebral edema
seizure activity

54
Q

treatment of SIADH

A

fluid restriction, treat problem, diuretic or hypertonic saline

55
Q

how do you correct sodium in SIADH

A

VERY SLOWLY
if too quickly permanent nerve damage can occur

56
Q

what is diabetes insipidus

A

opposite of SIADH
“SIP because you’re Pissing”
**Lack of ADH
failure of ADH to release from the posterior pituitary

57
Q

what is the serum osmo in DI

A

elevated serum osmo >295

58
Q

what is the water balance in DI

A

water loss up to 20 L/day

59
Q

causes of DI

A

TBI, anoxic encephalopathy, meningitis, brain death, Dilantin (phenytoin), tumors

60
Q

symptoms of DI

A

polyuria, serum osmo elevated, dilute urine, low urine specific gravity, low urine osmo
polydipsia, hypernatremia, elevated BUN, low ADH

61
Q

treatment of DI

A

-give ADH and treat cause ie/ desmopressin (DDAVP)
-calculate and replace free water deficit (correct slowly over 2-3 days to prevent cerebral edema)

62
Q

what does the thyroid function on

A

a negative feedback loop (if working normally)
ie/ when T3 and T4 are low, TSH production is high
ie/ when T3 and T4 are high, TSH production is low

63
Q

what organs help to keep hormones in balance other than thyroid

A

hypothalamus and pituitary gland

64
Q

what does the hypothalamus detect

A

low levels of thyroid hormones

65
Q

what is thyroid storm

A

*severe hypometabolism
-sudden release of thyroid hormone
-decrease in TSH, increase in T3 and T4

66
Q

what labs indicate thyroid health

A

T3, T4 and TSH

67
Q

what is the most reliable measure of thyroid function

A

TSH
normal is 0.3 to 4.5

68
Q

main hormone secreted by thyroid

A

T4
normal is 0.8 to 1.8

69
Q

symptoms of thyroid storm

A

*palpitations, tachycardia, heat intolerance
-fever, diaphoresis, afib, SOB, HTN, hyperexia, diarrhea, confusion

70
Q

treatment of thyroid storm

A

hydrocortisone and propythiouracil
“the 5 Bs”
Block synthesis: antithyroid drugs (methimazole)
Block release: iodine
Block T3 and T4 conversion: propanolol or corticosteroid
Betablocker: treat symptoms
Block enterohepatic circulation

71
Q

what is hyperthyroidism and what are the labs

A

producing too much thyroxine hormone
*thyroid storm is the most severe form
-TSH low
-T3 and T4 high

72
Q

causes of hyperthyroidism

A

Grave’s disease (autoimmune), toxic nodular goiter, hyperfunctioning thyroid adenoma

73
Q

symptoms of hyperthyroidism

A

tachycardia, heat intolerance, weight loss, palpitations, anxiety, insomnia, afib, agitation, sympathetic overstimulation of muscles that control eye movement

74
Q

chronic hyperthyroidism can cause what

A

high CO and HF (CHF), osteoporosis

75
Q

treatment of hyperthyroidism

A

BB (propranolol or methimazole), radioiodine therapy, thyroidectomy

76
Q

what is hypothyroidism

A

inadequate output of thyroid gland

77
Q

s/s of hypothyroidism

A

**cold intolerance, weight gain, fatigue
-constipation, fluid retention, hair loss/dry skin, decreased libido

78
Q

causes of hypothyroidism

A

Hashimotos (autoimmune inflammation of thyroid), thyroidectomy, amiodarone, lithium, radioiodine, treatment of hyperthyroid

79
Q

what are the labs of hypothyroidism

A

high TSH, low T4
often feedback loop is not working so TSH, T3 or T4 can also be low if pituitary gland tumor

80
Q

treatment of hypothyroidism

A

oral levothyroxine (synthetic T4)
requires long term monthly TSH levels (if TSH high, dose too low: if TSH low, dose too high)

81
Q

what is addison’s disease

A

adrenal glands not producing enough hormones
-DECREASE/DEFICIT3 in the S’s: sugar (cortisone), salt (aldosterone), and sex steroids

82
Q

what is aldosterone

A

sodium and water reabsorption
potassium excretion
maintains BP

83
Q

what is cortisol

A

stimulates glucogenesis (BG)
lipolysis
depresses immune response
decreases inflammation

84
Q

s/s of addison’s disease

A

fatigue, weight loss, muscle weakness, abd pain, diarrhea, hypoglycemia, hypotension, crave salt, hyperpigmentation, orthostatic hypotension

85
Q

labs in addison’s disease

A

LOW cortisol <3 mg (cortisol stimulation test low <19)
Low blood glucose
ACTH levels elevated
anemia

86
Q

treatment of addison’s

A

prednisone to increase cortisol level and fludrocortisone to increase aldosterone level

87
Q

what is an adrenal crisis

A

sudden severe adrenal insufficiency

88
Q

treatment of adrenal crisis

A

ADD iv glucocorticoids and IV fluid dextrose

89
Q

what is cushings disease

A

EXCESS of 3 S’s (increase cortisol levels)

90
Q

how do you diagnose cushings

A

measure free cortisol for 24 hr urine
dexamethasone suppression test

91
Q

causes of cushings

A

exogenous: medications and long term steroid use
endogenous: pituitary adenoma or carcinoma

92
Q

treatment of cushings

A

control cause, surgery if pituitary tumor

93
Q

symptoms of cushings

A

high BP, buffalo hump, moon face, red face, big, round, hairy, slow wound healing

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