endocrine emergency Flashcards
What do endocrine glands do?
secrete chemical substances call hormones directly in the blood, they are ductless. These chemical have specific effects on specified organs/tissues.
what are the hormones of the pancreas (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*
what are normal bgl?
4-6mmol/l (adults)
3-6mmol/L )<2yrs
1.5-3mmol/L newborn (1st 2hrs of life)
some functions of insulin?
help to absorb fatty acids, converts excess glucose innto glycogen in the liver
Diabetes?
insufficient production/cell resistance to insulin or both.
onset of type 1?
early onset commone age 4-7 & 10-14, 1/1000 children develop it by age 20
what causes type 1?
can be heriditry or caused by a stress on the bodies immune system such as a viral infection.
s/s of typ 1 diabetes…
polyuria, polydipsia, polyphagia, weakness, weiht loss, DKA
type 2 diabetes
- 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)
complications of typ2?
retiopathym cataracts, HTN, progressive renal failure, coronary artery disease, neuropathy, peripheral vascular disease, ++RISK OF INFECTION
how is diabetes determined?
fasting bgl of 7mmol/L or higher, or blood test w +levels of A1C
why is the brain affected by bgl?
because it doesn’t need insulin to use glucose.
causes for hypoglycemia?
too much meds taken, not enough food eaten wit meds, +exercise, alcohol, hormonal changes, cancer
presentation of hypoglycemia
alt loa, weakness (unilateral), seizures, diaphoresis, BGL of <4mmol/L(adults)/<3mmol/L for ages <2yrs, PCD
Tx for hypoglycemia?
1) food/drink if tolerated
2) glucagon paste ( if mild presentation)
3) glucagon or dextrose
glucagon indications and conditions….
indications: suspected hypoglycemia
Conditions:
age:n/a (>4 yrs for IN powder)
LOA: alt
other: hypoglycemic
contraindications for glucagon?
allergy or sensitivity/ phenochromocytoma
glucagon Tx for pt who weighs less than 25kg?
weight=<25kg
route: im
dose: 0.5 mg
max singl dose: 0.5 mg
dose int: 20 mins
max # doses: 2
Glucagon TX for a pt who weighs more than 25 kg?
weigh:>25kg
route: IM
dose: 1mg
max sing dose:1mg
Dose int:20mins
Max #:2
if the pt responds to the glucagon what els can we do for them?
- give them glucagon paste/food/juice
if the pt wants to refuse transport we must…
get a final set of vitals including BGL and get pt to sign a refusal , and document everything!
how old dose the patient have to be for IN powder glucagon?
older or equal to age 4
what are some considerations for treat and discharge?
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
what must aso be met inoder to discharge a pt?
- 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
treatment for IN powder glucagon…
age >4
route IN
dose=3mg, max=3mg
dose int:20 mins
max #=2
what is insulinoma?
-rare neurodendocrine turmor that affects the pancreatic islets too ake excess insulin.
-90% benign,
s/: episodic hypoglycemia, CNS dysfunciton
tx: surgically remove
Hyperglycemia issues can be caused by…
chronic cell resistance to insulin–>HHNS(typ2)
or pt is not taking meds
what is the presentation of DKA?
CBG of 33mmol/l+, polyuria/dipsipa/phagia, dehydration, general weakness, lethargy, alt loa, n/v/, pain , nocturia, fruity breath, kussmals resp
how to manage hyperglycemia?
- IV established give fluid to replace water and electrolytes, bolus very slowly to prevent hydrocephalus
what are some common insulins?
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)
how does metformin work?
acts on cells making them less sensitive to glucose. if hypoglycemia caused by metformin=transport!
diabetes inspipidus:
ADH insufficency/kidney resistance to adh causing dehydration and lots of diluted pee.
s/s and managementof insipidius…
severe dehydration, hypernatremia, fever, CV collapse, death
management: look for dehydration/hypotension & treat w NaCl prn
common diseased of the adrenals…
addisons: insufficent adh +cortisol
cushings: too much cortisol and adh
