Endocrine Flashcards
What is DKA
Condition from no insulin in body so serum glucose > 500mg/dL causes body to use fat for energy causing too much ketones which spill over to urine production, and causes acidotic pH (metabolic acidosis) and leading to azotemia (^ BUN)
Causes of DKA
Infection, stress, non-compliance by pts with insulin regimen or a new onset type 1 diabetes diagnosis
S&S of DKA
Tachypnea-> kusssmaul respirations Hypotension Tachycardia Dry mucous membranes r/t dehydration Decreased LOC Hyperkalemia (increased serum potassium)
Treatment of DKA
Insulin drip
Fluid replacement start with 0.9% saline then to D5W
Continue until metabolic acidosis resolved then subq insulin
Can give sodium bicarbonate for severe acidosis
**Do not try to reduce K+!!! It will correct as acidosis is corrected
What is Hyper-osmolar hyperglycemic noketonic syndrome/coma (HHS/HHNK)
Primarily in type 2 diabetics (there is still insulin production)
A state of SEVERE hyperglycemia that creates a hyper-osmolar state in which no ketones are produced –therefore there’s no acidosis
Causes of HHS/HHNK
Infection, stress, however less rapid than DKA
Pts w/non-compliance with diet/meds/insulin regimen, steroids, pancreatitis, TPN use,
(Overal more rare than DKA)
Criteria for HHNK
Serum glucose > 800mg/dL High osmolality (>than 350) NO ketones in urine pH > 7.3 Azotemia (increased BUN)
S&S of HHS/HHNK
Tachypnea -> rapid+shallow respirations
Profound hypotension
Tachycardia(beta-blockers might mask this)
Dry mucous membranes r/t severe dehydration
Hyperkalemia but may not be as significant as w/DKA
Treat HHNK
Insulin drip
Fluid replacement 0.9% NS
What is Diabetic Insipidus (DI)?
Not enough anti-diuretic hormone (ADH) or ADH is present however the kidneys aren’t able to respond which causes abnormal water regulation in the body by the kidneys
S&S of DI
Fluid-deficit dehydration -> polydipsia Polyuria Hypotension, even hypovolemic shock Low urine specific gravity < 1.005 (dilute urine) Low urine osmolality <250 Hypernatremia (hi serum sodium levels) Increased serum osmolality> 295
DI causes 2 categories
1) Neurogenic DI or Central: head; trauma, hypoxia, ischemic, tumors, surgery, autoimmune
- —> lack of ADH production from alterations in the ability of posterior pituitary gland or hypothalamus
- ) Nephrogenic DI: kidney; drugs/meds (osmotic agents), osmotic states, decreased osmotic pressure, kidney failure (called high output renal failure, pregnancy (homone-related)
- —> the kidneys are not abe to respond, thus kidneys cannot retain or reabsorb water
Treatment for DI
Nephrogenic– give thiazide diuretic (may help block sodium reabsorption thus correcting Na levels and therefore osmolality abnormalities reducing osmotic diuresis of nephrogenic DI
Neurogenic or Central DI-> replace ADH (vasopressin, DDAVP: desmopressin)
Monitor urine output and specific gravity
What is SIADH symptom of inappropriate anti-diuretic hormone?
Too much ADH (too much anti-diuretic hormone) causing water retention in the kidneys -> causes drop in serum sodium and thus serum osmolality
* Referred to dilutional hyponatremia or water intoxication
S&S of SIADH
Excess ADH
Hyponatremia (dilutional) can cause seizures
Decreased serum osmolality
Decreased urinary output
Increased urine specific gravity> 1.030 (concentrated urine)
Weight gain
Edema
