endocrine dx Flashcards
SIADH
- overproduction/oversecretion of ADH
- excess ADH=reabsorption of water into circulation=low Na
causes of SIADH
- drugs
- head trauma
- Ca
- metabolic dz
- CVA
- SLE
- hypothyroidism
- lung infx
s/s of SIADH
- 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
diagnostic studies for SIADH
- urine osmolality
- serum osmolality less than 280
- low Na
- SG greater than 1.005
tx for SIADH if Na > 125 mEq/L
- fluid restriction 800-1000mL/24 hours
- hypertonic saline solution 3-5%
- diuretics
tx for SIADH if Na less than 120
- fluid restriction 500mL/24 hour
- demeclocycline, lithium
- vasopressin
- ICU or monitored bed
positioning for SIADH
- flat
- 10 degree HOB elevation
diet for SIADH
supplement Na, K
diabetes insipidus
- deficiency of production of ADH
- decreased renal response to ADH
central diabetes insipidus
- most common
- neurogenic
- occurs when there is an organic lesion that interferes with ADH synthesis or release
- secondary to intracranial surgery or head trauma
nephrogenic diabetes insipidus
adequate but decreased response to ADH by the kidney
psychogenic diabetes insipidus
- dispogenic
- associated with excessive water intake
causes of diabetes insipidus
- head trauma
- tumors
- surgical ablation or irradiation of pituitary
- infx of CNS
- drugs
acute phase of diabetes insipidus
- abrupt onset of polyuria
- 1-5L/hour
interphase of diabetes insipidus
- urine volume normalizes
- decrease in UOP, but still high
third phase of diabetes insipidus
- 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
s/s of diabetes insipidus
- polydipsia
- polyuria 5-20L/day
- low SG 295 mOsm/kg
- hypernatremia
- hypovolemia, hypotension, tachycardia, shock
- weight loss, poor skin turgor
- CNS manifestations
- constipation
tx of nephrogenic diabetes insipidus
- low Na diet: 3g/day
- diuretics: thiazide
- prostaglandin inhibitors: indomethacin
tx of central diabetes insipidus
- hormone replacement
- D5W or 0.45NS
- titrate to replace UOP
hyperparathyroidism
- increased secretion of parathyroid hormone PTH
- oversecretion of PTH = increased Ca levels
primary hyperparathyroidism
-usually there is a tumor
secondary hyperparathyroidism
- cause is outside the parathyroid gland
- decreased vit D
- chronic renal failure
- increased phosphatemia
- malabsorption of Ca in gut
tertiary hyperparathyroidism
hyperplasia of parathyroid gland
s/s of hyperparathyroidism
- decreased bone density
- hypercalciuria
- osteoporosis
- fx
- cyst formation
- general weakness
- calculi formation
diagnostic studies hyperparathyroidism
-PTH
-Ca
-phos
-electrolytes
-bone density measurements
X-rays, UTZ, MRI
surgical tx for hyperparathyroidism
- parathyroidectomy
- autotransplantation
nonsurgical tx for hyperparathyroidism
- monitor electrolytes
- low Ca diet
- phosphorus supplements
- drugs
- ambulation: put weight on bone, gain weight
candidates for hyperparathyroidism surgery
- Ca: 12+
- urine Ca: 400+
- decreased bone density
- hx of renal calculi
complications of hyperparathyroidism surgery
- tetany in neck, swelling
- hemorrhage
- larnygospasms
- trach tray should be bedside
hypercalcemic crisis
- Ca 15+
- results in neuro, CV, and renal s/s
interventions for hypercalcemic crisis
- 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
hypoparathyroidism
- inadequate circulating PTH
- hypocalcemia
- most common cause is iatrogenic
s/s of hypoparathyroidism
- numbness and tingling
- tonic spasms
- dysphagia
- laryngospasm
- decreased Ca and PTH
- increased phos
tx of hypoparathyroidism
- IV ca chloride, gluconate, or gluceptate
- ECG monitoring
- rebreathing, lower pH
- oral Ca, vit D
- high Ca diet
