endocrine dx

Question 1

SIADH

Answer 1

• overproduction/oversecretion of ADH

- excess ADH=reabsorption of water into circulation=low Na

Question 2

causes of SIADH

Answer 2

• drugs
• head trauma
• Ca
• metabolic dz
• CVA
• SLE
• hypothyroidism
• lung infx

Question 3

s/s of SIADH

Answer 3

• serum hypo osmolarity
• dilutional low Na, low Chl,
• fluid retention, weight gain, cerebral edema
• increased intravascular volume
• concentrated urine
• normal renal function
• muscle cramps and weakness
• fatigue
• thirst
• low UOP
• sz, coma

Question 4

diagnostic studies for SIADH

Answer 4

• urine osmolality
• serum osmolality less than 280
• low Na
• SG greater than 1.005

Question 5

tx for SIADH if Na > 125 mEq/L

Answer 5

• fluid restriction 800-1000mL/24 hours
• hypertonic saline solution 3-5%
• diuretics

Question 6

tx for SIADH if Na less than 120

Answer 6

• fluid restriction 500mL/24 hour
• demeclocycline, lithium
• vasopressin
• ICU or monitored bed

Question 7

positioning for SIADH

Answer 7

• flat

- 10 degree HOB elevation

Question 8

diet for SIADH

Answer 8

supplement Na, K

Question 9

diabetes insipidus

Answer 9

• deficiency of production of ADH

- decreased renal response to ADH

Question 10

central diabetes insipidus

Answer 10

• most common
• neurogenic
• occurs when there is an organic lesion that interferes with ADH synthesis or release
• secondary to intracranial surgery or head trauma

Question 11

nephrogenic diabetes insipidus

Answer 11

adequate but decreased response to ADH by the kidney

Question 12

psychogenic diabetes insipidus

Answer 12

• dispogenic

- associated with excessive water intake

Question 13

causes of diabetes insipidus

Answer 13

• head trauma
• tumors
• surgical ablation or irradiation of pituitary
• infx of CNS
• drugs

Question 14

acute phase of diabetes insipidus

Answer 14

• abrupt onset of polyuria

- 1-5L/hour

Question 15

interphase of diabetes insipidus

Answer 15

• urine volume normalizes

- decrease in UOP, but still high

Question 16

third phase of diabetes insipidus

Answer 16

• central DI is permanent in 10-14 days
• DI from head trauma usually improves with tx
• DI following surgery is more likely to become permanent

Question 17

s/s of diabetes insipidus

Answer 17

• polydipsia
• polyuria 5-20L/day
• low SG 295 mOsm/kg
• hypernatremia
• hypovolemia, hypotension, tachycardia, shock
• weight loss, poor skin turgor
• CNS manifestations
• constipation

Question 18

tx of nephrogenic diabetes insipidus

Answer 18

• low Na diet: 3g/day
• diuretics: thiazide
• prostaglandin inhibitors: indomethacin

Question 19

tx of central diabetes insipidus

Answer 19

• hormone replacement
• D5W or 0.45NS
• titrate to replace UOP

Question 20

hyperparathyroidism

Answer 20

• increased secretion of parathyroid hormone PTH

- oversecretion of PTH = increased Ca levels

Question 21

primary hyperparathyroidism

Answer 21

-usually there is a tumor

Question 22

secondary hyperparathyroidism

Answer 22

• cause is outside the parathyroid gland
• decreased vit D
• chronic renal failure
• increased phosphatemia
• malabsorption of Ca in gut

Question 23

tertiary hyperparathyroidism

Answer 23

hyperplasia of parathyroid gland

Question 24

s/s of hyperparathyroidism

Answer 24

• decreased bone density
• hypercalciuria
• osteoporosis
• fx
• cyst formation
• general weakness
• calculi formation

Question 25

diagnostic studies hyperparathyroidism

Answer 25

-PTH -Ca -phos -electrolytes -bone density measurements X-rays, UTZ, MRI

Question 26

surgical tx for hyperparathyroidism

Answer 26

- parathyroidectomy | - autotransplantation

Question 27

nonsurgical tx for hyperparathyroidism

Answer 27

- monitor electrolytes - low Ca diet - phosphorus supplements - drugs - ambulation: put weight on bone, gain weight

Question 28

candidates for hyperparathyroidism surgery

Answer 28

- Ca: 12+ - urine Ca: 400+ - decreased bone density - hx of renal calculi

Question 29

complications of hyperparathyroidism surgery

Answer 29

- tetany in neck, swelling - hemorrhage - larnygospasms * trach tray should be bedside

Question 30

hypercalcemic crisis

Answer 30

- Ca 15+ | - results in neuro, CV, and renal s/s

Question 31

interventions for hypercalcemic crisis

Answer 31

- tx involves rehydration with large volumes - diuretics to promote renal excretion of Ca - dialysis - I/O - IV calcium gluconate: for dysrhythmias - frequent monitoring for Chvostek's and Trousseau's signs - mobility to promote bone calcification - rebreather mask/paper bag

Question 32

hypoparathyroidism

Answer 32

- inadequate circulating PTH - hypocalcemia - most common cause is iatrogenic

Question 33

s/s of hypoparathyroidism

Answer 33

- numbness and tingling - tonic spasms - dysphagia - laryngospasm - decreased Ca and PTH - increased phos

Question 34

tx of hypoparathyroidism

Answer 34

- IV ca chloride, gluconate, or gluceptate - ECG monitoring - rebreathing, lower pH - oral Ca, vit D - high Ca diet