Endocrine Flashcards
What are common GU complications associated with diabetes?
nephropathy
glomerulonephritis
chronic renal failure
What are some common GI symptoms associated with diabetes?
gastroparesis
nocturnal diarrhea
What are some common CNS complications of diabetes?
strokes
paresthesias
autonomic and peripheral neuropathy
What are some common CV complications related to diabetes?
HTN
CAD
cardiomyopathy
retinopathy
What are some common miscellaneous complications associated with diabetes?
*hint: musculoskeletal and immune
joint stiffness and infections
What are some signs and symptoms of autonomic neuropathy?
resting tachycardia loss of HR variability orthostatic hypotension altered regulation of breathing sudden death syndrome
Why might it be useful to obtain a hemoglobin A1C level?
glucose binds to an RBC for its lifespan and so results of this lab test may tell you about average glucose control over the last 90 days in a patient who has labile blood sugars currently
Why might “stiff joint syndrome” pose a difficulty to the anesthesia provider?
TMJ, atlanto-axial joint, other cervical spine joints, etc. may all be affected and could create a difficult airway
How can the CRNA assess for stiff joint syndrome in a Type 1 diabetic?
ask the patient to attempt “prayers sign”. if they cannot completely close their hands together, it may be a sign of cervical spine immobility and would possibly require an awake fiberoptic intubation
What are some questions the CRNA could ask about insulin use?
have you taken your oral hypoglycemic or insulin the day of surgery?
how often do you check your blood sugar?
will the patient require an insulin drip during the procedure?
should we have a glucose containing IV solution hanging?
how will the blood sugar be managed post-op?
do you have an insulin pump?
What are the signs and symptoms of DKA?
N/V, lethargy, dehydration, abdominal pain, fruity breath, kussmaul’s breathing, coma
What are the signs and symptoms of cushing’s disease?
thickening of facial fat moon face hump on back increased body hair hyperglycemia hypertension decreased libido amenorrhea skeletal muscle wasting depression
What are the anesthetic considerations for managing a patient with Cushing’s disease?
manage HTN intra op and plan for blood loss (get type and screen)
careful with fluid overload r/t activation of RAA
may be treated with lasix so monitor K+ levels
careful control of hyperglycemia intra op
monitor for metabolic alkalosis and electrolyte changes
What are the signs and symptoms of Addison’s disease?
tan skin hyperkalemia, hyponatremia hypovolemia hypotension weight loss muscle weakness abdominal and back pain hypoglycemia
What are the anesthetic considerations when managing a patient with Addison’s disease?
carefully monitor for hypotension
plan to give exogenous steroids, and should take home dose the day of the procedure.
What are some common clinical manifestations of diabetes?
polydypsia polyuria polyphagia weight loss recurrent infections visual changes paresthesias lethargy and fatigue
What is an example of a stress steroid dose?
minor surgery - 25 mg hydrocortisone
major surgery - 100 mg hydrocortisone q8h x 3
What are the CRNAs concerns when caring for a patient with Conn’s disease?
severe systemic HTN with diastolic BPs over 100 which may be resistant to treatment
hypokalemia and muscle weakness are other symptoms that may warrant close monitoring of electrolytes and a lowered dose of NMB.
What are the symptoms of a pheochromocytoma?
headache, diaphoresis, palpitations
*also associated with anxiety, tremor, pallor, chest pain, epigastric pain, flushing, etc.
How can you treat a patient with a pheochromocytoma?
combined alpha and beta block (alpha 1st to prevent CV collapse)
restore fluid volume
restore insulin release with an alpha block
Give examples of some of the drugs that you may use to treat pheochromocytoma patients?
alpha block - phentolamine, phenoxybenzamine, prazosin
beta block - propranolol, atenolol, esmolol
alpha + beta blocker - labetalol
How is primary hyperparathyroidism diagnosed?
serum calcium greater than 5.5, often presents as kidney stones
*high Ca++ > 7.5 mEq/L is usually indicative of cancer
What are the signs and symptoms of hyperparathyroidism?
skeletal muscle weakness, polyuria and polydipsia, anemia, prolonged PR interval, short QT interval, systemic HTN, vomiting, abd pain, pathologic fractures, decreased pain sensation
Describe the medical management for hypercalcemia associated with hyperparathyroid.
NS infusion at 150 mL/hr
loop diuretics to inhibit Ca++ reabsorption
biphosphonates - prevent osteoclast action
hemodialysis for life threatening Ca++ increase
mithramycin - inhibits osteoclasts but can cause thrombocytopenia and renal toxicity
How is hypoparathyroidism diagnosed?
serum calcium less than 4.5 or ionized calcium less than 2
What are the signs and symptoms of acute hypoparathyroidism?
oral parasthesias restlessness neuromuscular irritability Chovstek and Trousseau's sign airway stridor
What are the signs and symptoms of chronic hypoparathyroidism?
fatigue muscle cramps prolonged QT interval lethargy personality changes
What is Chvosteks sign?
tapping on the facial nerve and eliciting a muscle twitch when the patient has hypocalcemia
What is trousseau’s sign?
compression of the forearm in a patient with neuromuscular irritability associated with low Ca++ will cause muscle spasm in the hand and wrist
What is the treatment of hypoparathyroidism?
10% calcium gluconate until neuromuscular irritability dissipates
thiazide diuretics to increase serum Ca++ concentration
What are some lab abnormalities that might be present in a patient with hyperthyroid disease?
elevated T4, elevated T3, decreased or normal TSH
What are the signs and symptoms of hyperthyroid disease?
anxiety, fatigue, muscle weakness, weight loss, diarrhea, heat intolerance, diaphoresis, tachyarrhythmias, exophthalmos, goiter
What are the three cardinal treatments for hyperthyroid disease?
beta blockers - symptom management
antithyroid drugs - to lower T4 and T3 levels
iodide containing compounds - lugol’s solution, etc.
What are common causes of hypothyroidism?
destruction of the thyroid gland due to chronic thyroiditis (hashimoto’s), surgical removal, radioiodine therapy, irradiation of the neck
also may be due to hormone deficiency associated with antithyroid drugs, excess iodine or dietary iodine deficiency
What are the causes of secondary hypothyroidism?
hypothalamic dysfunction or anterior pituitary dysfunction
What are the signs and symptoms of hypothyroidism?
enlarged thyroid gland, decreased metabolic activity, lethargy, cold intolerance, cardiac changes, decreased cortisol leading to atrophy of the adrenal cortex
How do you treat hypothyroid?
exogenous oral T4!
What are the cardiac consequences of chronic hypothyroidism? How can you manage or prepare for this?
bradycardia, decreased CO, SV and contractility - Echo and EKG
increased SVR and HTN - slow to respond to treatments so start early
increased circulating catecholamines
decreased EKG voltage and prolonged PR, QRS and QT intervals
potential for pericardial effusion and conduction abnormalities
What are the respiratory consequences of hypothyroidism?
decreased surfactant
decreased response to hypoxia and hypercapnia - get a baseline O2 sat
What are the renal consequences of hypothyroidism?
inappropriate secretion of antidiuretic hormone – CHECK ELECTROLYTES because hyponatremia is common
