Endocrine Emergency I Flashcards
Not enough ADH in the blood to keep fluid on board, causing polyuria, polydipsia, and if fluid restricted, dehydration and hypernatremia
diabetes insipidus
Too much ADH causing the blood to become dilute from all the extra free water; therefore they are relatively hyponatremic, but not because they are low on salt, rather because there is a cork in the normal synphon
SIADH
presentation and treatment of hyperglycemia?
Presentation
- isolated high blood sugar- usually present asymptomatic.
- may have a bit of nausea and a headache
Treaetment
- BG > 250 with no other symptoms or lab findings to support DKA or HHS => give fluids and their daily sliding dose of insulin
- reapeat BG in an hour
presentation and treatment of hypoglycemia
presentation
- diaphoretic, nauseated, tremulous and can have altered mental status from subtle confusion to focal neuro deficits to a seizure to a full coma
Treatment
- Tolerating PO: juice, glucose tabs, sandwich if they can tolerate. Recheck BG in 15
Not tolerating PO
- IV Amp of D50 (25 grams of glucose in prefilled syringe) then start bolus with D5N5
- No IV: 1mg IM injection of glucagon, roll on side to prevent aspiration
ALL altered patients get blood sugar at the door
Pathogenesis of DKA?
- insulin deficiency
- increased stress hormones
- osmotic diuresis
management of DKA?
- IV started, blood drawn for labs
fix K BEFORE you give insulin (they are total body depleted- they may show up a normal or even high K)
- K >5.3 just watch this with repeat BMP every 1-2 hours as the insulin goes in
- K > 3.3 but < 5.5 add 20 mEq to their NS bolus
- K < 3.3, NO insulin fix their K first, why? prolonged Qtc and torsades
Insulin
- once BG is < 250, you can switch to including dextrose in fluids
Find a cause
- lack of insulin
- infection
- MI
- CVA
- surgery
- ETOH
- similar to hyperglycemia but the key in their diagnosis is that they are ALTERED mentally, and they do NOT have a metabolic acidosis from their hyperglycemia
- these patients are badly dehydrated (often 8-12 liters at arrival)
- no ketones in their urine, bicarb/pH is close to normal
- often older patients
- longer prodrome usually
- frequently have multiple other medical co-morbidities
Hyperglycemic hyperosmolar syndrome
management of HHS
IV Fluids
- give normal saline unless hypernatremic then give 0.45 NaCl
Fix K Before you give insulin
- potassium replaced same as DKA
Insulin
- stop at 250mg/dL switch to sub q
- Na < 120 puts them at risk for cerebral edema, seizures, respiratory arrest
- go slow with fluids, too much given rapidly can cause central pontine myelolinolysis
SIADH
- they pee a lot
- neurologic causes: the pituitary isn’t making enough ADH. tumor, trauma, surgery, etc.
- Nephrogenic causes: the kidneys aren’t sensing the ADH that the the brain is making. Drugs, genetics, etc
DI
decreased serum Na
Increased urine
overloaded fluid status
SIADH
Increased serum Na
decreased urine osm
Dry fluid status
DI
increased serum Na
Increased Urine
Dry fluid status
Dehydration
