Endocrine Disorders, Immunocompromise (HIV/AIDS, oncology/chemotherapy, transplant patient), Renal Failure

Question 1

d/t conditions that decrease blood flow to the kidney (hypovolemia, decreased CO, decreased vascular resistance, obstruction of blood flow into the renal vascular system)

tx- fluids, vasopressors, inotropes

Answer 1

pre-renal AKI

Question 2

d/t damage to the renal tubules (ATN), nephrotoxic agents or disease that damage the vascular or interstitial tissue (htn, dm, lupus, infectious processes)

tx - withdraw nephrotoxins, diuretics

Answer 2

intra renal AKI

Question 3

ahminoglycosides, NSAIDs, contrast dye, crush injury, and rhabdo

Answer 3

nephrotoxic agents

Question 4

d/t obstruction after the kidney (calculi, prostatic hypertrophy, tumors, structures, neurogenic bladder)

tx - relieve obstruction, urinary catheterizations

Answer 4

post renal AKI

Question 5

fever often first sign (external cooling, Tylenol)

increased CO, SV and contractility leading to hypotension w/ widened pulse pressure (give BB, IVF)
n/v/, jaundice
agitation, seizures

tx: PTU or methimazole (tapazole, thiamazole)

Answer 5

thyroid storm (elevated thyroid levels)

Question 6

inhibits thyroid synthesis

Answer 6

methimazole (tapazole, thiamazole)

Question 7

decrease thyroid hormone release

Answer 7

iodine (sodium iodide, lugol sodium)

Question 8

prevent conversion of T4 to T3

Answer 8

glucocorticoids

Question 9

decreased temp w/o shivering (passive rewarming)

bradycardia, hypotension, SBP < 100 (vasopressors given w/ IV levothyroxine)

hypoventilation, upper airway obstruction (d/t glottic edema) and pleural effusion (O2, mechanical ventilation)

decreased LOC

Answer 9

hypothyroidism

Question 10

profound dehydration, no acidosis, type II diabetics, BS > 800, minimal ketones, onset days-weeks, BUN extremely elevated

Answer 10

HHS

Question 11

less profound dehydration, acidosis, type I diabetics, BS < 800, positive ketones, onset hours-days, BUN mildly elevated

Answer 11

DKA

Question 12

BS 60-80

marked by epinephrine release

sweating, tachycardia, pallor, anxiety, restlessness, palpitations, shaking, hunger, tingling of lips

Answer 12

mild hypoglycemia

Question 13

BS 40-60

marked by neuroglycemic symptoms

behavioral changes, irritability, confusion, drowsiness, weakness, h/a, staggering gait, blurred vision

Answer 13

moderate hypoglycemia

Question 14

BS < 40

seizures, coma, permanent neurological damage

Answer 14

profound hypoglycemia

Question 15

early signs of hypoglycemia may be absent, patient may have LOC or seizures w/o signs of mild hypoglycemia

more common in patients with longstanding diabetes, on beta blockers and alcoholics

Answer 15

hypoglycemic unawareness

Question 16

decreased BS, NA and fluid balances
increased K

hypotension (unresponsive to pressors), abd pain, n/v

Answer 16

Addisons (Adrenal) crisis

Question 17

increased BS, NA and fluid balances
decreased K

cushingoid appearance, immunocompromise, poor wound healing

Answer 17

cushings disease