endocrine Flashcards
DM s/s
polys: dipsia, phagia, uria
need BGL
DM: ANS neuropathy symptoms 7
Cardiac: resting tachy, dec variability to HR, arrhythmias, orthostatic hypotension
GI: gastroparesis
peripheral neuropathies
altered regulation of breathing
Labs and test for DM
*BGL!!!!!!! even if have one on labs
HbA1c
intraop BGL control: ask…
intra op stuff needed
ask: take insulin day of? PO hypoglycemic? need glucometer, how often monitored fluid with glucose insulin gtt how managed post- op
Labs and test for DM
Elytes–GLUCOSE
BUN/cr
ECG
(HbA1c)
Cushings
High cortisol
s/s: wt gain, Moon face, buffalo hump, HTN, gluc intolerance, hypoK, hyperNa
Addisions
s/s: wt loss, hypotension, hypoglycemic, weakness, abd and back pain, hypERk, hypOna
Addisions steroids
25mg for minor surg
major: 25mg + 100mg IV over 24hrs
100mg q8 or pre intra post op
Pheochromocytoma
catecholamine releasing tumor: in adrenal medulla
in kids adrenal and multiple sites
s/s: HA, diaphoresis, palpitation, anxiety, CP
episodes: frequency (daily to month), duration (~1hr)
touch tumor and INC INC SNS release–INC BP
Pheochromocytoma tx
**inc BP test alpha block before OR alpha block restores insulin release **must alpha block first then beta block if beta first lose compensation for inc SVR beta for persistent tachy DRUGS: phentolamine, phenoyxbenzamine, esmolol
DM acute complications
HYPOGLYCEMIA: worse than hyper
under anesthesia symptoms are masked
DKA: don’t take to OR: kussmals, Inc BGL, lethargic, dehydrated
Parathyroid dx asmt
hyperCa >7.5mEq/L most likely CA MSK: muscle weakness, fx, GU:kidney stones, polyuria, dec GFR CV: HTN, prolonged PR GI: Vomiting, abd pain, PUD, pancreatitis Anemia
Parathyroid mgmt/test
**avoid nephrotoxic drugs
dec dose NMB
RSI-vomiting
labs: H&H, ECG, 5 lead during
Med mgmt hyperCa
Saline: 150ml/hr
Lasix
Bisphosphonates-life threatening hyperCa–inhibits osteoclasts
Mithramycin -also inhibits osteoclasts
Hypoparathyroid
low Ca
Hypoparathyroid tx
infusion of Ca gluconate 10ml of 10% until neuromuscular irritability dissipates
HCTZ- deletion of K and Na get Inc Ca
Chvostek sign
“trastick”
tap facial nerve in front of ear: contraction of eyes, nose, mouth
Trousseau
“trueso”
compression of FA leads to spasm of head and wrist, adduction and bunching fingers, wrist flexed
Thyroid chart review
VS, labs, Meds, endocrinologist
Hyperthyroid
hypermetabolic: anxiety, tachydysrhythmias, wt loss, diarrhea-elyte changes, heat intolerance, diaphoresis, exophthalmos, goiter
labs inc T3T4, dec or n TSH
meds: bblockers,
antithyroid-methimaxole, carbimazole, PTU,
Iodine containing compounds- lugols solution
PREOP concerns: eyes and airway
Hypothyroidism
primary: DESTRUCTION of thyroid: hashimotos, thyroidectomy
secondary: CNS dysfunction, Hypothalamic DYSFUNCTION (TRH deficiency) Anterior pit dyscintion (TH deficieny)
**Dec metabolic activity: cold intolerance, brady, HTN, gastroparesis
Considerations: keep warm, steroids, ECH, give PEEP( lower surfactant) dec response to hypoxia, hypercapnia- don’t give too much narcs
Cardiac: Brady- ecg
Resp: hypoxia, hypercapnia, give PEEP for lower surfactant
Renal: inappropriate ADH- hypoNa- elyte
Chronic hypothyroidism asmt
Cardiac: brady, dec CO, inc SVR, HTN, poss CHF *need ECG
Resp: dec responce to hypoxia abd hypercapnia
Renal: inappropriate ADH– hypoNa *check elytes
Tx: oral admin of T4, if ischemic heart disease may not tolerate so have to give nitro first
ROS for DM 6
CV: HTN, CAD, retinopathy
GU: renal function, nephropathy CRF
GI: delayed gastic emptying: aspiration risk
MSK: Type 1: stiff joints, difficulty airway: prayer sign, can’t get hands together then probably have problems with TMJ and Atlantooccipital joint
CNS: strokes, peripheral neuropathy, visual, ANS neuropathy
*RAVENS: Renal, Aspiration (gi), Vascular, Eyes, Neuropathy, Stiff joint
**ANS neuropathy: affects CV and GI
Cushings asmt
BGL: can control with sm ant insulin
HTN
*NMB doesn’t work as well
*Know fluid status:
inc blood volume bc of Na retention: CHF- can be on diuretics *check K, elytes
m Alkalosis
*blood loss: T&S, T&C major, consider invasive monitoring
Addisions asmt
need volume, keep hydrated
pressors+steroids? invasive monitoring?
BGL-glucose needed?
are the on steroids? if yes take day of. cortisol bridging
Conns
excess production of aldosterone
no specific s/s , some asymptomatic
**HTN: may be resistant to tx, PRBC ready, Aline?
aldosterone induced Na retention..polyuria?
HypoK=muscle cramps and weakness
*low NMB dose
