Endocrine and GI Flashcards
What can stimulate the liver to produce more glucose?
Increase hormone production
Cortisol
Glucagon
Epinephrine
Number 1 cause of dka
Infection
What meds put u at risk for hhs?
Glucocorticoid Diuretics Phenytoin (Dilantin) Propranolol Calcium channel blockers
Med conditions that put u at risk for hhs
Mi
Cerebral vascular injury
Sepsis
Which will cause myoclonus jerking, seizures, and reversible paralysis? DKA OR HHS
HHA
DKA GLucose
⬆️300
HHS glucose
⬆️600
HHS
Osmolarity ⬆️320
Monitor glucose every hour
What is goal glucose?
⬇️200
Correcting acidosis too fast can do what to k
Hypok
How often should old people check glucose when sick?
1-4 hrs
Hhs osmolarity
Above 320
Notify provider if glucose is above
240
Severe acidotic state
PH less than 7.15
What kind of fluid replacement is the gold?
To replace half the estimated fluid deficit over the first eight hours
The second half of fluid replacement is given over how many hours
The next 16 hours that way within the first 24 hours of treatment fluid deficit should be corrected
What is the order of fluids given in DKA and HHS?
- 9% normal saline
- 45% normal saline
5% dextrose (when glucose becomes 200 to prevent hypoglycemia and resolve ketosis)
What should potassium be before insulin administration?
At least 3.3
Difference in primary and secondary adrenal insufficiency
Primary
#⃣ deficient in both glucocorticoids in mineralocorticoids
Secondary
#⃣deficient in glucocorticoids alone
What is the first sign of hypoglycemia
Change in mental status
Counterregulatory hormones with the sympathetic nervous system response and hypoglycemia
Glucagon, epinephrine, cortisol, and growth hormone
What is the best clinical indicator of effective treatment for hypoglycemia?
Neurological status
Cortisol level in adrenal crisis
⬇️10 mg/dL
What is cosyntropin
Synthetic ACTH
Standard dose of cosyntropin
250 mcg (with a result of an increase in cortisol level of 7 to 9 from baseline)
ACTH stimulates this glucocorticoid to release
Cortisol
I’ll dust around is a mineralocorticoid that has what effect
It’s made in the adrenal Cortex and regulates the bodies electrolyte and water balance in the renal tubules
Adrenal crisis lab value of glucose
Less than 50
Adrenal crisis lab value of cortisol
Less than 10
Adrenal lab value of potassium
Either greater than 6.6
Or less than 3.0
Adrenal crisis lab value for sodium
Greater than 150 or less then 130
Adrenal crisis BUN value
Greater than 20
Adrenal crisis pH value
Less than 7.3
What fluid is given initially in adrenal crisis until signs and symptoms of hypovolemia stabilize?
5% dextrose and normal saline
The patient may need how much of this fluid in the first 12 to 24 hours of adrenal insufficiency?
As much as 5 L
How is hyperkalemia treated in adrenal crisis?
With fluid and glucocorticoid replacement, it may not have to be treated specifically
What drug can be given IV push before the cortisol test is done
Dexamethasone phosphate (Decadron) 4 mg every eight hours until cosyntropin test has been done
What do thyroid hormones bind to
Globulin, T4 binding pre-albumin, and albumin
What is the relationship between T4 and T3
95% of thyroid hormones in the body or T4,T4 converts into T3, T3 is more potent than T4
Peak times
Insulin
