Endocrine Flashcards
what is osmolality
how concentrated the blood is… “osmo high, likely dry”
what is a normal osmolality serum
275-295 mosL
what are isotonic fluids
stays in vasculature
examples of isotonic fluids
sodium chloride 0.9%, LR, plasmolyte
what are hypotonic fluids
go out into cell (cell hydration)
examples of hypotonic fluids
D5W, 0.45% sodium chloride,
what are hypertonic fluids
pull from cell to vasculature
examples of hypertonic fluids
D5 0.45% sodium chloride, D10 , D5LR, 2 % Na Cl, 3% Na Cl, %% Na Cl
what is diabetes
defect in insulin secretion or action or both
what is type 1
Beta 1 destruction (do NOT make insulin)
what is type 2
insulin secretory deficit, resistance to insulin
what is HgbA1C and normal range
average of glucose over 3 months
normal: 4-5.6%
poor control >7%
this puts you at high risk for CV disease and stroke
metabolic syndrome
what is required for metabolic syndrome diagnosis
2 of the 4 deadly quartet: dyslipidemia, hypertension, hyperglycemia, abdominal obesity
what is glucagon
anti low glucose (GIVE for hypoglycemia)
what are alpha cells
produce insulin
what are beta cells
produce insulin (type 1 has a deficiency of beta cells)
what are delta cells
produce somatostatin (which inhibits release of glucagon and insulin)
what is insulin
transports glucose, water and potassium into cells
what is short acting insulin and how fast is the action
regular insulin
IV action: 5-10 min
SQ action: 30 min
what is rapid acting insulin and how fast is the action
humalog (Lispro)
SQ action: 5-15 min
what is intermediate insulin
NPH
what is long acting insulin
lantus
what are causes of hypoglycemia
too much insulin, N/V, strenuous activity, excessive ETOH, pregnancy
symptoms of hypoglycemia
palpitations, tachy HR< diaphoresis, pallor, blurred vision, slurred speech, headache, confusion, fatigue
treatment of hypoglycemia
4 oz juice, glucose tabs, 10 - 15 grams carb
1/2 amp of D50 or D5 or D10 IV
IM glucagon
DKA manifestations
hyperglycemia, hyper osmolality, anion gap acidosis
causes of DKA
stress, infection, meds, diet, trauma, surgery, pancreatitis
what is the #1 treatment for DKA
CORRECT FLUID DEFECIT
what is DKA
-lack of insulin causes too much circulating glucose
-osmotic diuresis, profound water loss
-leads to glucosuria, dehydration and electrolyte imbalance
what is getting burned up in DKA
FAT burning
what are the three Ps of DKA
polyuria, polydipsia, polyphagia
symptoms of DKA
headache, decreased LOC, visual disturbances, tachycardia, decreased CVP and PAoP, kussmaul breathing, acetone/fruity breath, N/V, pain, weight loss
typical labs for DKA
- low pH (acidosis)
-low bicarb
-hyponatremia
-normal to high K
-hypophosphatemia
-elevated ketones in blood and urine
-elevated urine glucose
typical labs for metabolic acidosis
-low pH (if greater than 7 will self correct, if <6.9 needs bicarb)
-anion gap >12 (HIGH)
-bicarb <18 (LOW)
what is ketoacidosis
elevated serum and urine ketones (fat burning)
normal anion gap
11-12
cause of metabolic acidosis
“MUD PILES”
Methanol, Uremia, DKA, Propylene glycol, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
what is the fluid replacement protocol for DKA
-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)
what is the typical fluid deficit for DKA patients
about 5 l behind at start of DKA
*spread fluid replacement out over 8 hrs
what is the insulin management of DKA
-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
what is the relationship of K and pH
INVERSE RELATIONSHIP
for every 0.1 drop in pH, 0.6 increase in K
what is hyperosmolar hyperglycemic syndrome (HHS)
-AKA nonketoic hyperglycemia
-usually type 2 DM
-causes are the same as DKA
-BG >600
-can take days to weeks to develop
what is one major difference between HHS and DKA
HHS has ABSENCE of ketones
there is enough endogenous insulin to prevent ketosis
what is the urine in HHS
-osmotic diuresis, osmo >330
-polyuria THEN oliguria/concentrated urine once dehydrated
what is a cardinal sign of DKA
AMS and hyperglycemia
what are typical HHS labs:pH, Na, K, mag, phos, hct/hgb, and urine glucose
ph normal/mild acidosis
Na high
K low and mag low (go together)
phos low
hct/hgb elevated d/t dehydration
urine glucose HIGH
HHS treatment
*volume replacement (isotonic fluids, once BG 250 add dextrose, then 0.45% saline then oral hydration)
-insulin (regular IV infusion)
what is ADH
it’s purpose is fluid balance
formed in the hypothalamus
has vasopressor qualities
what is SIADH
“Swimming in ADH” = too much ADH
severe dilutional hyponatremia (dilutes sodium)
what is serum and urine osmos in SIADH
serum <280
urine (concentrated), high osmo >100 d/t decreased urine production
causes of SIADH
infection, pneumonia, COPD, PE, CVA, head trauma, cancer, recent surgery
complications of SIADH
severe dilutional hyponatremia
cerebral edema
seizure activity
treatment of SIADH
fluid restriction, treat problem, diuretic or hypertonic saline
how do you correct sodium in SIADH
VERY SLOWLY
if too quickly permanent nerve damage can occur
what is diabetes insipidus
opposite of SIADH
“SIP because you’re Pissing”
**Lack of ADH
failure of ADH to release from the posterior pituitary
what is the serum osmo in DI
elevated serum osmo >295
what is the water balance in DI
water loss up to 20 L/day
causes of DI
TBI, anoxic encephalopathy, meningitis, brain death, Dilantin (phenytoin), tumors
symptoms of DI
polyuria, serum osmo elevated, dilute urine, low urine specific gravity, low urine osmo
polydipsia, hypernatremia, elevated BUN, low ADH
treatment of DI
-give ADH and treat cause ie/ desmopressin (DDAVP)
-calculate and replace free water deficit (correct slowly over 2-3 days to prevent cerebral edema)
what does the thyroid function on
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
what organs help to keep hormones in balance other than thyroid
hypothalamus and pituitary gland
what does the hypothalamus detect
low levels of thyroid hormones
what is thyroid storm
*severe hypometabolism
-sudden release of thyroid hormone
-decrease in TSH, increase in T3 and T4
what labs indicate thyroid health
T3, T4 and TSH
what is the most reliable measure of thyroid function
TSH
normal is 0.3 to 4.5
main hormone secreted by thyroid
T4
normal is 0.8 to 1.8
symptoms of thyroid storm
*palpitations, tachycardia, heat intolerance
-fever, diaphoresis, afib, SOB, HTN, hyperexia, diarrhea, confusion
treatment of thyroid storm
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
what is hyperthyroidism and what are the labs
producing too much thyroxine hormone
*thyroid storm is the most severe form
-TSH low
-T3 and T4 high
causes of hyperthyroidism
Grave’s disease (autoimmune), toxic nodular goiter, hyperfunctioning thyroid adenoma
symptoms of hyperthyroidism
tachycardia, heat intolerance, weight loss, palpitations, anxiety, insomnia, afib, agitation, sympathetic overstimulation of muscles that control eye movement
chronic hyperthyroidism can cause what
high CO and HF (CHF), osteoporosis
treatment of hyperthyroidism
BB (propranolol or methimazole), radioiodine therapy, thyroidectomy
what is hypothyroidism
inadequate output of thyroid gland
s/s of hypothyroidism
**cold intolerance, weight gain, fatigue
-constipation, fluid retention, hair loss/dry skin, decreased libido
causes of hypothyroidism
Hashimotos (autoimmune inflammation of thyroid), thyroidectomy, amiodarone, lithium, radioiodine, treatment of hyperthyroid
what are the labs of hypothyroidism
high TSH, low T4
often feedback loop is not working so TSH, T3 or T4 can also be low if pituitary gland tumor
treatment of hypothyroidism
oral levothyroxine (synthetic T4)
requires long term monthly TSH levels (if TSH high, dose too low: if TSH low, dose too high)
what is addison’s disease
adrenal glands not producing enough hormones
-DECREASE/DEFICIT3 in the S’s: sugar (cortisone), salt (aldosterone), and sex steroids
what is aldosterone
sodium and water reabsorption
potassium excretion
maintains BP
what is cortisol
stimulates glucogenesis (BG)
lipolysis
depresses immune response
decreases inflammation
s/s of addison’s disease
fatigue, weight loss, muscle weakness, abd pain, diarrhea, hypoglycemia, hypotension, crave salt, hyperpigmentation, orthostatic hypotension
labs in addison’s disease
LOW cortisol <3 mg (cortisol stimulation test low <19)
Low blood glucose
ACTH levels elevated
anemia
treatment of addison’s
prednisone to increase cortisol level and fludrocortisone to increase aldosterone level
what is an adrenal crisis
sudden severe adrenal insufficiency
treatment of adrenal crisis
ADD iv glucocorticoids and IV fluid dextrose
what is cushings disease
EXCESS of 3 S’s (increase cortisol levels)
how do you diagnose cushings
measure free cortisol for 24 hr urine
dexamethasone suppression test
causes of cushings
exogenous: medications and long term steroid use
endogenous: pituitary adenoma or carcinoma
treatment of cushings
control cause, surgery if pituitary tumor
symptoms of cushings
high BP, buffalo hump, moon face, red face, big, round, hairy, slow wound healing
