Endocrine Disorders (Part 2) - Unit 3

Question 1

What increases ADH Secretion?

Answer 1

osmoreceptors in hypothalamus respond to changes in serum osmolality

Question 2

What is diabetes insipidus?

Answer 2

NOT ENOUGH ADH

Question 3

DI - kidney’s cannot reabsorb water, cannot concentrate urine, and they have concentrated blood. T/F?

Answer 3

True

Question 4

What are the 3 types of DI?

Answer 4

central (not enough ADH) and nephrogenic (lack of renal response to adh), dipsogenic (oral intake of large amounts of water suppresses release of ADH)

Question 5

Central DI - what causes it?

Answer 5

head injury, neurosurgery, tumor, hypoxic injuries, infection (meningitis, encephalitis), congenital CNS defects

Question 6

What causes nephrogenic DI?

Answer 6

drug toxicity (amphotericin, gentamicin, lasix), electrolyte disturbances, sickle cell disease, renal disease

Question 7

Dipsogenic - more than likely psych T/F?

Answer 7

TRUE

Question 8

Dipsogenic - might also be because we fead an infant what?

Answer 8

Water. do not do that until they’re about 6 months old / can hold a sippy cup.

Question 9

What are some manifestations of DI?

Answer 9

dehydration, increased plasma osmolality >295, hypernatremia, decreased urine osmolality, decreased urine Na5ml/kg/hr, SG

Question 10

What is hypernatremia and what does it indicate?

Answer 10

serum sodium greater than 145, indicates dehydration

Question 11

What are some signs of dehydration?

Answer 11

Dry mucus membranes, irritability, lethargy, headache, seizures

Question 12

How do we manage central DI?

Answer 12

Rapid volume expansion with isotonic fluids if in shock, slowly decrease Na by 1-2 mew/hr over 24 hours, hypotonic fluid replacement, DDAVP (spray in nose), vasopressin, NS/LR

Question 13

What are the goals of UO and SG in managing central DI?

Answer 13

UO = 1.010

Question 14

what is SIADH?

Answer 14

Syndrome of inappropriate antidiuretic hormone secretion - aka, TOO MUCH ADH

Question 15

SIADH - excessive reabsorption of water, hypervolemia, hyponatremia, etc. T/F?

Answer 15

True

Question 16

What are some causes of SIADH?

Answer 16

Pulmonary conditions (infection, asthma, pneumothorax, positive pressure ventilation — increased pressure), CNS conditions (infections, trauma and hypoxic injuries, hydrocephalus, vascular abnormalities), medications (vasopessin, antidepressants antianxiety, antipsychotic, seizure meds, DDAVP, narcotics, chemo, barbituates), post-operative patients

Question 17

SIADH - may have increased vasopressin for 3-4 days post-op. T/F?

Answer 17

True

Question 18

What are some manifestations of SIADH?

Answer 18

Decreased urine output 20, low serum osmolality

Question 19

What are some manifestations of hyponatremia?

Answer 19

headache, nausea/vomiting, confusion, seizures, muscle twitching, cerebral edema

Question 20

How do we treat SIADH?

Answer 20

eliminate excess water, increase serum osmolality, fluid restriction (30-75% of maintenance!!), hypertonic saline for SEVERE cases, loop diuretics

Question 21

For treating SIADH, what’s the initial goal for severe cases?

Answer 21

Initial goal 125-230 then Na should rise by 0.5 meq/l every hour - - risk of cerebral demyelination.

Question 22

Fill in the info!

Answer 22

Bingo

Question 23

How many children in the US have DM Type 1 + 2?

Answer 23

216,000, with AA’s and Hispanics at greater risk.

Question 24

When’s the typical age of onset for Type 1? (Hint, 2 sets!)

Answer 24

4-6

10-14

Question 25

Type 1 Dm - info?

Answer 25

Insulin-producing cells in the pancreas are destroyed, cells starve to death so glucose in unable to enter the cell and remains in the bloodstream.

Question 26

Dm Type 1 tends to affect males more than females - T/F?

Answer 26

True

Question 27

How do we diagnose DM Type 1?

Answer 27

may mimic severe case of flu, ketosis, weight loss, vomiting, polydipsia, polyuria, polyphagia, malaise, coma, random plasma glucose \>126, 2 hr pplasma glucose \>200 during an OGTT

Question 28

how do we manage Type 1?

Answer 28

insulin therapy, glucose monitoring (goal range 80-120), lab measurement of AIC, urine testing for ketones

Question 29

do we always test for ketones?

Answer 29

No - tested every 3 hours during illness and whenever glucose is \>240 when illness not present.

Question 30

Hypoglycemia - symptoms?

Answer 30

Cold and clammy, needs some candy! Hunger, shakiness, weakness, paleness, blurry vision, sleepiness, sweating, anxiety, dilated pupils, dazed appearance, restlessness, seizures, etc.

Question 31

severe hypoglycemia episodes may result in permanent cognitive development, especially under age 5. T/F?

Answer 31

True

Question 32

How do we treat hypoglycemia?

Answer 32

15 grams of carbs - like apple juice, orange juce.. THEN cheese, etc.

Question 33

What is glucagon used for?

Answer 33

Emergency injection for unconscious person - stimulates liver to releasea stored glucose. However, it's icky and makes people feel nasty as fuck!

Question 34

What are some mild symptoms of hyperglycemia? Moderate? Severe?

Answer 34

Mild = lack of concentration, thirst, frequent urination, sweet/fruity breath, thirst. Mod = vomiting, nausea, dry mouth, stomach cramps, Severe = labored breathing (metabolic acidosis), confused, very weak, unconscious. High and dry, my sugar is high!

Question 35

Know this!

Answer 35

Here we go!

Question 36

Insulin pump - needle and catheter changed every 48-72 hours. T/f?

Answer 36

True

Question 37

What's the glucose tragets (premeal) for toddlers/preschool? BS, A1C

Answer 37

BS 100-180, A1C 7.5-8.5

Question 38

What's the glucose tragets (premeal, BS & A1C) for school age kids?

Answer 38

BS 90-180, A1C goal \<8

Question 39

What's the glucose tragets (premeal, BS & A1C) for adolescents?

Answer 39

BS 90-130, A1C goal \<7.5

Question 40

What is ketoacidosis?

Answer 40

Results from progressive deterioration with dehydration, electrolyte imbalance, acidosi, coma..and can cause death!

Question 41

Ketones in blood are strong acids that lower serum pH and produce ketoacidosis - T/F?

Answer 41

True

Question 42

When glucose isn't available, what does the body break down?

Answer 42

Other shit!

Question 43

How do we manage ketoacidosis?

Answer 43

Insulin 0.1u/kg/hr, goal is to decrease glucose by 50-100 mg/dl/hr, dehydration correction with IV fluids

Question 44

We want to get glucose down as quickly as possible. T/F? Dextrose is added once glucose falls to \_\_\_.

Answer 44

FALSE - slowly. 300

Question 45

DM Type 2 - ages? Things about it?

Answer 45

Insulin resistance, ages 10-19, obestiy, heredity, diet, sedentray lifestyle, acanthosis nigricans!!!!!!!!! (dark line around neck)

Question 46

What are some long-term complications of DM type 2?

Answer 46

microvascular complications, especially nephropathy and retinopathy, macrovascular disease, neuropathy