Endocrine and General Medical Flashcards
Cause of Diabetic Ketoacidosis
Lack of Insulin or Insulin Resistance.
Excess blood sugar causes increased water in body which diuresis fluid, Potassium, and Phosphorus. (Causing Metabolic Acidosis)
Treatment of Diabetic Ketoacidosis
Aggressive fluid hydration K+ and Pho4 replacement Insulin dosing at 0.1 u/kg Consider D5w once CBG <300 mg/dl Do not drop glucose >100 mg/dl/hr
Hyperglycemic Hyperosmolar Non-ketonic Coma (HHNK/HHNC)
Excessive sugar but body is still making and using insulin
Presentation of HHNK
Severe dehydration Hyperglycemia (>800 common) Elevated BUN /Creatine Hypernatremia No Ketones
Treatment of HHNK
Aggressive fluid replacement
Insulin
Anticipate hypokalemia
Cause of Diabetes Insipidus (DI)
Lack of anti-diuretic hormone caused by Head injury or Dilantin
Presentation of Diabetes Insipidus
Extreme urinary output with low osmolarity and specific gravity.
Hypernatremia
Treatment of Diabetes Insipidus
Aggressive fluid replacement
Vasopressin
dDavP
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Excessive production of ADH
Causes of SIADH
Small cell / oat cell carcinoma
Head injury
Presentation of SIADH
Dilutional Hyponatremia
Seizures
Cerebral edema
Elevated Urine osmolarity / specific gravity
Treatment of SIADH
Restrict fluids
Diuresis
Demeclocycline (ADH receptor antagonism)
GI Hemorrhage Treatment
Treat shock with 3:1 Crystalloid/Blood
NG/OG
Octreotide (Sandostatin) 25-50 mcg IVP then drip
Vasopressin
Causes of Grave’s Disease / Thyrotoxicosis (Thyroid storm / Hyperthyroid)
Increased Thyroid production due to surgery Uncontrolled DM
AMI
Toxemia
Presentation of Grave’s Disease (Hyperthyroid)
Any new tachycardia/A Fib in otherwise healthy females
Dramatic weight loss
CP /SOB/ Palpitations
Tremors / Nervousness
Treatment of Grave’s Disease (Hyperthyroid)
Anti-thyroid Meds
Anti-pyretics
Consider Iv glucocorticoids (Dexmethasone)
Fluids / Electrolytes
Thyroid controls _____.
Metabolic rate (Body Idle Speed)
Causes of Hypothyroid / Myxedema Coma
Autoimmune disorder most commonly triggered by infection.
Officially Myxedema Coma upon any change in LOC.
Presentation of Hypothyroid
Primarily women, almost exclusively over age 60.
>90% of cases in winter.
Fatigue, weight gain, deep voice, coarse hair
Treatment of Hypothyroid
Levothyroxine
Supportive care
Cause of Addison’s Disease / Adrenal Insufficiency
Not producing enough steroids caused by Autoimmune disease (Primary Addison’s)
Low levels of ACTH (Secondary Addison’s)
Presentation of Addison’s Disease / adrenal Insufficiency
Poor catecholamine production
Failure to respond to exogenous pressor agents
Inadequate aldosterone, cortisol, and androgens
Treatment of Addison’s Disease / Adrenal Insufficiency
Avoid abrupt discontinuation of chronic glucocorticoids
May need to initiate steroids
Causes of Cushing’s Disease
Producing excessive steroids due to:
Chronic glucocorticoid use with abrupt discontinuation
Pituitary disorders (too much ACTH release)
Oat cell carcinoma (“fake” cortisol)
Adrenal carcinoma (too much produced)
Presentation of Cushing’s Disease
Upper body obesity with thin arms and legs
Rounded face
Buffalo Hump
Fatigue, HTN, Hyperglycemia
Treatment of Cushing’s Disease
Initiate or Reduce Glucocorticoids
Supportive
Surgery
Causes of Pancreatitis
ETOH abuse
Biliary stone disease
Steroids and antibiotics
Infections
Presentation of Pancreatitis
Low Calcium levels
Concomitant Sepsis and ARDS
Renal failure
Cullen’s sign
Treatment of Pancreatitis
Fluid resuscitation NPO with OG/NG Meperidine Antibiotics for sepsis Anticipate worsening progression
Causes of Bowel Obstruction
Post operative adhesions
Malignancy
Crohn’s disease
Hernia’s
Presentation of Bowel Obstruction
Bowel ischemia results in sepsis
Pancreatitis common
Treatment of Bowel Obstruction
NPO with OG/NG
Aggressive fluid and pain control
Anti-emetics
Antibiotics
Causes of Hepatic Encephalopathy
ETOH abuse
Liver Failure
Cirrhosis / Hepatitis (causing ammonia toxicity)
Presentation of Hepatic Encephalopathy
Increased AST, ALT, BUN
“Coarse Muscle Flapping”
Treatment of Hepatic Encephalopathy
Stop GI bleeding
NG / OG for blood evacuation in bowel
Stop protein intake
Correct K+ levels
Cause of Splenic Disease / Rupture
Trauma (Most commonly affected organ in blunt trauma)
Presentation of Splenic Disease / Rupture
Left shoulder pain (Kehr’s sign)
Shock
Treatment of Splenic Disease / Rupture
Supportive care
Aggressive fluid replacement and PRBC’s
Surgery
Brudzinski’s Sign
Flexion of knees on neck flexion
Possible bacterial meningitis (or subarachnoid bleed)
“Chin to chest will cause knees to flex”
Kernig’s Sign
Inability to flex hamstring or leg due to pain. Indicative of Meningitis
Cullen’s Sign
Periumbilical bruising indicative of Pancreatitis
Grey-Turner’s Sign
Flank and groin bruising indicative of Pancreatitis
Kehr’s Sign
Left shoulder pain indicative of Splenic injury
Murphy’s Sign
Pain upon palpitation of RUQ while breathing in indicative of Gallbladder problems
Levine’s Sign
Fist over chest indicative of Cardiac problems
Define Hypertensive Crisis
Extremely elevated blood pressure WITH signs and symptoms of end organ damage
Headache, N/V, Visual changes, creatine/RBC in urine
Treatment of Hypertensive Crisis
Lower BP no more than 25% per hour and no lower than patient’s “normal”
Important dermatomes
T4: Nipples
T10: Umbilicus
C3/4/5: Innervates the diaphragm
Meningitis
Inflammation of meninges
Disease carried in CSF
Triad of neck stiffness, photophobia, and headache
6 P’s of Arterial Occlusion
Pain Pallor Paresthesia Poikilothermia Pulselessness Paralysis
The most definitive assessment of shock is ____.
Lactic Acidosis (Lactate >4)
