Endocrine Flashcards
what do ketones represent
increased lipolysis in the context of absent glucose
causes of hypoglycemia
-meds: insulin, oral hypoglycemics
-decreased oral intake in DM with insulin
-critical illness: sepsis, liver failure
-EtOH
-malnourishment,
-cortisol deficiency
- pancreatic tumours (insulin secreting)
threshold value for adult hypoglycemia
3.9 aka 4
Tx of hypoglycemia
25 g of glucose carbs or 25 g or IV dextrose 50mL of D50 is 1 amp, then run infusion usually
when is glucagon not effective, what is the dose
in elderly or alcoholics, dose= 1 mg IM
dextrose is always better choice
4 I’s that cause DKA
-insulin (lack of)
-infection
-ischemia
-illicit drugs (cocaine)
3 criteria for dx fo DKA
hyperglycemia, ketosis, WAGMA
why can bicarb sometimes be normal in DKA
concurrent metabolic alkalosis from vomiting
walk through DKA mgmt
-rehydrate with 1-2 L NS
-once initial bolus done, consider switching to 1/2 NS once hyponatremia is corrected
- replace K if needed, if less than 3.5 add 40 meq/L, if 3.5-5 add 20 meq/L
-start insulin and after K > 3.5 at 0.1U/kg/hr
-continue insulin until gap closed, once glucose < 14 switch to D5 1/2NS.
when to give bicarb in DKA?
consider if pH < 6.9, evidence of impending CV collapse, or life-threatening hyperK
how to spot cerebral edema?
HA, AMS, vomitting. usually occurs 6-10 hrs after tx started.
tx= reducing IVF rate and giving mannitol.
difference of HHS vs DKA
slower process than DKA, higher glucose, higher osmolality, more volume depletion, normal pH
criteria for HHS dx
glc >33
osmolality >315
bicarb >15
pH > 7.3
may or may not have ketones
Tx of HHS
- basically same as DKA except they they need ++ fluid (often 8-12 L light)
give 2L over first 1 hr, continue intil hemodynamically stable then insulin/potassium is same as DKA
typical HHS pt
elderly, weak, T2DM, with limited oral intake
33% have no previous dx of DM
anterior and posterior pituitary hormones are:
post: oxytocin, ADH
ant: GLFTAP
causes of hypopituitarism
pituitary tumour (most common, can be benign or malignant)
pituitary apoplexy (hemm)
sheehan syndrome (post partum hypoperfusion of pituitary)
other: infection, trauma, radiation, surgery, infiltrative dz
treatment of hypopit
supportive, give steroids and thyroid hormone (if deficient), NEED to give steroids before Synthroid as it will cause adrenal crisis if dont
3 ways parathyroid hormone increases Ca
increased kidney resorption
increase osteoclasts
increase GI resorption
signs of myxedema coma?
hypothermia, AMS is characteristic
other findgins:
bradycardia, hypotension, resp failure,
edema, low ECG voltage, hypoglycemia, hyponatremia
often precipitated by major illness, cardiac or neuro event
treatment of myxedema coma?
-supportive care
-empiric replacement of steroid (hydro cort 100 mg IV)
-then levothyroxine 500 ug IV
precipitants of thyroid storm
infection, DKA, iodine load, stroke, ACS, PE, trauma, surgery
clinical features of thyroid storm
tachycardia
hyperthermia
HF
CNS effects
GI/hepatic dysfunction
scoring system for thyroid storm
Burch-Wartofsky
looks at temp, CNS, GI, HR, ?afib, CHF and precipitating event
mgmt of thyroid storm
supportive care
propranolol
methimazole or PTU
steroid (dex or HC), will decrease t4 to t3 conversion
can also give inorganic iodine, 1 hr after PTU
1 common drug for inducing hypo and hyper thyroidism
hypo: Lithium
hyper: amiodarone
3 hormones released by adrenals
cortisol, aldosterone, catecholamine
pheochromocytoma, what is it, what are symtpoms
adrenal tumor that causes release of catecholamine. classic triad: HA, sweating, tachycardia.. + other symptoms of epi/norepi excess
adrenal insufficiency, what is it
decreased cortisol or aldosterone or both
if primary it will be both as issue is wiht gland, if secondary will just be cortisol as ACTH decreaed from pituitary
how to know if adrenal insufficiency involves aldo deficiency too?
they will be hyperK
adrenal crisis s/s? causes?
life threatning, refractory hypotension, hypoglyecmia, (hypoNa and hyperK if primary insufficiency)
tx of acute adrenal crisis
hydrocortisone 100 mg IV if primary as it will replace both cortisol and aldo
if no hypoNa or hyper K and no known dx of adrenal insufficiency give dexamethasone 6 mg IV as it wont interfere with ACTH stim test
waterhouse-Friedrichson syndrome
bilat adrenal hemm due to infection, often meningococcal.
causes of adrenal insufficiency
primary: autoimmune, infectios, infiltrative, drugs, waterhouse-Friedrichson syndrome
secondary: prolonged steroid use, pituitary tumour, basal skull #, ICA stroke or aneurysm
adrenal crisis (aka addison’s crisis) trigger?
acute physiologic stress, pituitary apoplexy, withdrawl of chronic steroids
