Endocrine

Question 1

A patient is in DKA. He is on an insulin gtt. You take his blood sugar per protocol and it is 250. What is the next step?

Answer 1

Adjust insulin gtt and call physician for order of D5/45% NS to prevent cerebral edema

Question 2

What should be monitored closely during insulin administration in treatment of DKA?

Answer 2

Potassium

Question 3

HHNKS occurs predominately in patients with what chronic condition?

Answer 3

DM2

Question 4

What 4 things make HHNKS different from DKA?

Answer 4

No ketones in urine
No abdominal pain
No acidity
No kussmauls

Question 5

Compare HHNKS treatment from DKA

Answer 5

HHNKS- 2L NS in an hours followed by fluid replacement
IV insulin at 10u/HR
Monitor K

DKA- 1-2L NS bolus
IV insulin 
Monitor K
BS at 250 give D51/2 NS
Bicarbonate in severe cases

Question 6

Why do DKA individuals have hyperkalemia before treatment?

Answer 6

Because acidity causes K to leave the cell

Question 7

If the BUN and creatinine ratio is

Answer 7

Intrarenal

Question 8

If the BUN/Creatinine ratio is >20:1 then it is what?

Answer 8

Prerenal

Question 9

If the BUN/Creatinine ratio is between 10-20:1 then what is the cause?

Answer 9

It is normal or post renal

Question 10

If urine specific gravity is increases ( > 1.030) then you can expect what?

Answer 10

Dehydration

Question 11

A patient has diabetes insipidis, what would you anticipate with their symptoms, urine specific gravity, NA levels?

Answer 11

Frequent urination
Decreased urine specific gravity
Hypernatremia
Increased urine osmolality 
The patient would be dehydrated

Question 12

SIADH patients labs would show what with their symptoms, urine osmolality, urine specific gravity, NA?

Answer 12

SIASH would show:

NA low
USG- high
Osmolality low

Question 13

Why do vented patients have a change in urinary output?

Answer 13

Vented patients release more ADH causing H20 retention and edema with decreases urinary outputs

Expect decreased BP once patient extubated due to increased urinary outputs

Question 14

A patient would be at increased risk for thrombus and high risk for pulmonary emboli with which of the following?

A. DKA or SIADH
B. HHNKS, DKA, or DI
C. SIADH, DI, or hypoglycemia
D. Neurogenic DI, SIADH, or HHNK

Answer 14

B

The patient is dehydrated so increased viscosity

Question 15

A patient with a traumatic brain injury experiences a change in urinary output over the last 24 hours. If a diagnosis of DI is suspected, which of the following findings would be most likely?

A. Decreased serum and urine osmolality
B. High serum and low urine osmolality
C. Low serum and high urine osmolality
D. Increased serum and urine osmolality

Answer 15

B