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CCRN > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Steroid made from cholesterol absorbed in the blood

Responsible for 90% of mineralocorticoid activity

A

Aldosterone

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2
Q

Aldosterone

A

⬆️ Na
⬆️ H2O

⬇️ K

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3
Q

Aldosterone increased release when:

A

⬇️ renal perfusion
Dehydration
⬆️ angiotensin II
⬆️ K

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4
Q

Where is pancreas located?

A

In the left upper abdominal quadrant

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5
Q

Two types of pancreatic cells

A

Exocrine - acini cells - secrete enzymes that are important in digestive process

Endocrine - from islets of Langerhans

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6
Q

Three types of endocrine cells

A

Alpha - glucagon: opposite of insulin
Beta - insulin: intra cellular transportation of K
Delta - gastrin and somastostatin

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7
Q

Osmolality formula

A

(Na ✖️ 2) ➕ glucose/18 ➕ BUN/2.8

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8
Q

Normal osmolality values for blood and urine

A

Blood: 280

Urine: 300

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9
Q

What is osmolality?

A

It measures concentration

Fluid flows to areas of high osmolality

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10
Q

Arginine vasopressin
Produced by hypothalamus
Stored in posterior pituitary
Allows renal collecting ducts to become more permeable to water

A

Antidiuretic Hormone (ADH)

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11
Q

ADH

A

⬇️ Diuretic
Water conservation
Urine concentration
⬇️ UO

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12
Q

What increases ADH secretion?

A 
Osmoreceptors in hypothalamus respond to changes in serum osmolality
N/V
Stress
Morphine
Nicotine
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13
Q

Blood glucose

A

Acute hypoglycemia

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14
Q

Three causes of acute hypoglycemia

A

Endogenous - within body
Exogenous - diabetic agent
Functional - use all of insulin - status epilepticus

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15
Q

Hypoglycemia causes stimulation of counterregulatory hormones:

E G G G

A

Epinephrine
Glucagon
Glucocorticoids
Growth hormones

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16
Q

Acute hyperglycemia with acidosis cause by not enough insulin, stress trauma or infection

Hypovolemia due to hypotonic fluid loss

Ketonemia

Anion gap > 14

A

Diabetic ketoacidosis

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17
Q

Normal anion gap and formula

A

Normal: 8

Formula: (Na+K) - (HCO3 + Cl)

18
Q

Pathophysiology of DKA

A

⬆️ blood glucose ➡️ No insulin is released ➡️ without insulin, glucose just not enter cells and accumulates in the blood ➡️ hyperglycemia

19
Q

Why is acidosis present in DKA?

A

The breakdown of lipids lead to ketoacids
Dehydration and shock lead to the formation of lactic acid
Dehydration is caused by osmotic diuresis secondary to hyperosmolality

20
Q

Increased at first due to acidosis and decreased perfusion

Decreased after insulin is replaced

A

Potassium

21
Q

Increase due to sodium chloride infusions and sodium loss

Consider K phosphate or K acetate for replacement fluids

A

Chloride

22
Q

Increased only when severely dehydrated

Usually decreased due to urinary losses and dilution of solutes in extra cellular fluid

If dehydrated and hyper, do not lower too quickly due to risk of cerebral Adema

A

Sodium

23
Q

Decreased due to osmotic diuresis

A

Phosphate and Magnesium

24
Q

Decreased if phosphate replacement was high

Inverse relationship with phosphate

A

Calcium

25
Q

Manifestations of DKA

A

Serum glucose > 300

pH

26
Q

How can cerebral edema be prevented?

A

Reduce glucose and osmolality slowly

Avoid sodium bicarb ➡️ bicarb can lead to cerebral edema and increase CO2 production and worsen acidosis
If needed give slowly (0.5-1 mEq/L) over 1 hr

Rehydrate slowly ➡️ second bolus only if pressure is still dropping and shock still presence

27
Q

Managing DKA

A

Volume replacement
➡️ NS or LR (if Cl is ⬆️)
➡️ If Na > 145 = 0.45% NS
➡️ If Na

28
Q

Dilute urine
Not enough ADH
Not able to concentrate urine

A

Diabetes insipidus (DI)

29
Q

Three causes of DI

A

Central ➡️ not enough ADH
(Head injury, neurosurgery, tumor, infection)

Nephrogenic ➡️ lack of renal response to ADH
(Kidney disorders, drug toxicity, electrolyte disturbances, sickle cell, renal dz)

Dipsogenic ➡️ oral intake of large amounts of water suppresses the release of ADH

30
Q

Manifestations of DI

A 
Dehydration
⬆️ SERUM osmolality > 295
⬆️ SERUM Na > 145
⬆️ BUN and Cr
⬇️ URINE osmolality
31
Q

Management of DI

A

‼️ Slowly decrease Na by 1-2 mEq/hr over 24 hrs ‼️

Rapid volume expansion with isotonic fluids if in shock

Hypertonic fluid replacement

DDAVP (Desmopressin) ➡️ preferred

Goals: UO 1.010

32
Q

Too much ADH
Excessive reabsorption of water
⬆️ volume
⬇️ Na

A

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

33
Q

Causes of SIADH

A

Pulmonary condition ➡️ infection, asthma, pneumothorax, PIP/PEEP (⬆️ pressure in intrathoracic cavity it responds by secreting ADH)

CNS conditions ➡️ infections, drama, hypoxic injuries, hydrocephalus, vascular abnormalities

Medications ➡️ Vasopressin, narcotics, chemo, barbiturates, postop

34
Q

Manifestations of SIADH

A 
⬇️ SERUM osmolality  300
⬆️ URINE Na > 20
⬆️ URINE specific gravity > 1.025
Hypertension 
Dyspnea on exertion
Wt gain without edema
35
Q

Treatment of SIADH

A

‼️ Na should rise by 0.5 mEq/L every hr ‼️

Eliminate excess water
NPO immediately

Increased serum osmolality: loop diuretics

Fluid restriction (30-75% of maintenance)

Hypertonic saline for severe cases
Initial goal 125-130
Risk for cerebral demyelination - tx may tear apart brain tissue

36
Q 
Large class of genetic metabolic diseases
Synthesis or breakdown of fats, carbs, and/or proteins are affected
Most are treatable with modification of the diet
A

Inborn errors of metabolism

37
Q

Pathophysiology of inborn errors of metabolism

A

Usually due to a defect of a single gene that codes for enzyme statuses with the conversion of substances into other products

Symptoms are caused by toxic accumulation of substances

Usually present with a period without symptoms, followed by deterioration

38
Q

Common signs and symptoms of Inborn errors of metabolism

A 
Developmental delay, FTT
Irritability and seizures
‼️ Abnormal odor ‼️
Lethargic and poor feeding
Protein or carbohydrates sensitivities
Temperature regulation difficulties
Apnea/bradycardia
Hepatic encepalopathy 
Hypo or hyperglycemia
39
Q

Management of inborn errors of metabolism

A

Amino acids or enzyme cofactors for metabolic deficiencies ➡️ arginine

Dietary modification

40
Q

What is the purpose of endocrine system?

A 
Maintain body's internal environment
Growth 
Reproduction 
metabolism
Fluid and electrolyte balance
Coordination body's stress response

CCRN (9 decks)

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