endocrine emergency

Question 1

What do endocrine glands do?

Answer 1

secrete chemical substances call hormones directly in the blood, they are ductless. These chemical have specific effects on specified organs/tissues.

Question 2

what are the hormones of the pancreas (2)?

Answer 2

glucagon: made by the alpha cells in the islets of langerhans, increases bgl
insulin: made by beta, lowers BGL
somatostatin: inhibits the secretion of pancreatic hormones/enzymes*

Question 3

what are normal bgl?

Answer 3

4-6mmol/l (adults)
3-6mmol/L )<2yrs
1.5-3mmol/L newborn (1st 2hrs of life)

Question 4

some functions of insulin?

Answer 4

help to absorb fatty acids, converts excess glucose innto glycogen in the liver

Question 5

Diabetes?

Answer 5

insufficient production/cell resistance to insulin or both.

Question 6

onset of type 1?

Answer 6

early onset commone age 4-7 & 10-14, 1/1000 children develop it by age 20

Question 7

what causes type 1?

Answer 7

can be heriditry or caused by a stress on the bodies immune system such as a viral infection.

Question 8

s/s of typ 1 diabetes…

Answer 8

polyuria, polydipsia, polyphagia, weakness, weiht loss, DKA

Question 9

type 2 diabetes

Answer 9

• later onset, caused by partial destruction of the iselt cells–>-response to insulin. there is some genetic predisposition (90% of kidswill develop if their parent shave)

Question 10

complications of typ2?

Answer 10

retiopathym cataracts, HTN, progressive renal failure, coronary artery disease, neuropathy, peripheral vascular disease, ++RISK OF INFECTION

Question 11

how is diabetes determined?

Answer 11

fasting bgl of 7mmol/L or higher, or blood test w +levels of A1C

Question 12

why is the brain affected by bgl?

Answer 12

because it doesn’t need insulin to use glucose.

Question 13

causes for hypoglycemia?

Answer 13

too much meds taken, not enough food eaten wit meds, +exercise, alcohol, hormonal changes, cancer

Question 14

presentation of hypoglycemia

Answer 14

alt loa, weakness (unilateral), seizures, diaphoresis, BGL of <4mmol/L(adults)/<3mmol/L for ages <2yrs, PCD

Question 16

Tx for hypoglycemia?

Answer 16

1) food/drink if tolerated
2) glucagon paste ( if mild presentation)
3) glucagon or dextrose

Question 17

glucagon indications and conditions….

Answer 17

indications: suspected hypoglycemia
Conditions:
age:n/a (>4 yrs for IN powder)
LOA: alt
other: hypoglycemic

Question 18

contraindications for glucagon?

Answer 18

allergy or sensitivity/ phenochromocytoma

Question 19

glucagon Tx for pt who weighs less than 25kg?

Answer 19

weight=<25kg
route: im
dose: 0.5 mg
max singl dose: 0.5 mg
dose int: 20 mins
max # doses: 2

Question 20

Glucagon TX for a pt who weighs more than 25 kg?

Answer 20

weigh:>25kg
route: IM
dose: 1mg
max sing dose:1mg
Dose int:20mins
Max #:2

Question 21

if the pt responds to the glucagon what els can we do for them?

Answer 21

• give them glucagon paste/food/juice

Question 22

if the pt wants to refuse transport we must…

Answer 22

get a final set of vitals including BGL and get pt to sign a refusal , and document everything!

Question 23

how old dose the patient have to be for IN powder glucagon?

Answer 23

older or equal to age 4

Question 24

what are some considerations for treat and discharge?

Answer 24

pt = >18AND <65
pt=diagnosed w diabetes
-hypoglycemia can be explained by insulin admin/oral intake
-pt responded in a single dose ofglucose admin(any form)
- single episode iin 24 hrs
- pt returned to normal loa + asymptomatic
- complete set of vital WNL
- not intentional OD
-hypoglycemia unrelated to alc/drug withdrawl
-no seizure activity
-not an oral hypoglycemic
- pt not ptregnant
-hypoglycemia considered not to be an acute medical illness

Question 25

what must aso be met inoder to discharge a pt?

Answer 25

• pt has acess to adequate food, resonabile adult agress o stay w pt for next 4 hrs, all sdm questions=answered, the pt/sdm has been advised to follow up w their dr
  -instructed to call 911 if they need to
• they have the ability to call 911
  -pt/sdm has consent to discharge

Question 26

treatment for IN powder glucagon…

Answer 26

age >4
route IN
dose=3mg, max=3mg
dose int:20 mins
max #=2

Question 27

what is insulinoma?

Answer 27

-rare neurodendocrine turmor that affects the pancreatic islets too ake excess insulin.
-90% benign,
s/: episodic hypoglycemia, CNS dysfunciton
tx: surgically remove

Question 29

Hyperglycemia issues can be caused by…

Answer 29

chronic cell resistance to insulin–>HHNS(typ2)
or pt is not taking meds

Question 30

what is the presentation of DKA?

Answer 30

CBG of 33mmol/l+, polyuria/dipsipa/phagia, dehydration, general weakness, lethargy, alt loa, n/v/, pain , nocturia, fruity breath, kussmals resp

Question 31

how to manage hyperglycemia?

Answer 31

• IV established give fluid to replace water and electrolytes, bolus very slowly to prevent hydrocephalus

Question 32

what are some common insulins?

Answer 32

lispro/humalog: very fast act (2-3hrs)
regular/fast act:(2-5 hrs)peak (5-8hrs)
intermediate act: extended insulin/zince suspension: peak (4-12hrs)(16-24hrs)
long act: extendedzinc release peak (16-18)(>32hrs)

Question 33

how does metformin work?

Answer 33

acts on cells making them less sensitive to glucose. if hypoglycemia caused by metformin=transport!

Question 34

diabetes inspipidus:

Answer 34

ADH insufficency/kidney resistance to adh causing dehydration and lots of diluted pee.

Question 35

s/s and managementof insipidius…

Answer 35

severe dehydration, hypernatremia, fever, CV collapse, death
management: look for dehydration/hypotension & treat w NaCl prn

Question 36

common diseased of the adrenals…

Answer 36

addisons: insufficent adh +cortisol
cushings: too much cortisol and adh