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CCRN Study Deck > Endocrine System 4% > Flashcards

Endocrine System 4% Flashcards

1
Q

Hypoglycemic Event

A
  • Critically low serum glucose
  • Can lead to seizures
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2
Q

Hypoglycemia Treatment

A
  • Mild hypoglycemia is 10 to 15g of either PO or IV
  • Complex carbohydrates by mouth
  • PO: 4oz of orange juice (unless patient has renal failure with lower potassium, lower water options are better).
  • IV glucose: 12.5g - 25g (amp)
    • D5W has 5g of dextrose per 100ml (20 calories)
    • D50W has 50g of dextrose per 100ml (12.5g of carbohydrate and 50 calories)
  • Glucagon: given only if IV glucose is not possible
    • ↓ GI motility, monitor for nausea/vomiting
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3
Q

SIADH Clinical Indications

A
  • Lethargy
  • Headache
  • Nausea/Vomiting
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4
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A
  • Increase in antidiuretic hormone (ADH) and water intoxication.
  • Causes the retention of water, dilution of sodium, and serum hypo-osmolality.
  • Hyponatremia
    • Watch for cerebral edema and seizures
  • Frequently occurs in oat cell carcinoma of the lung and other malignancies
  • Too much ADH > Water retention > ↓ serum Na, ↓ urine output, ↓ osmolality
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5
Q

Hypoglycemia Early Signs

A
  • Early signs mediated by the sympathetic nervous system which acts to mobilize glucose stores.
    • Tachycardia
    • Tachypnea
    • Diaphoresis
    • Palpitations
    • Irritability
    • Restlessness
  • Late signs related to low glucose levels in the brain (neuroglycopenia)
    • Confusion
    • Lethargy
    • Slurred speech
    • Seizure
    • Coma
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6
Q

Diabetic Ketoacidosis (DKA)

A
  • Absolute insulin deficiency
  • glycogenolysis
  • gluconeogenesis
    • Causes the incomplete breakdown of free fatty acids
    • Results in ketones in the blood and urine
  • **Positive ketones
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7
Q

Hyperosmolar Hyperglycemic State (HHS)

A
  • Relative insulin deficiency
  • glycogenolysis
  • **Negative ketones
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8
Q

DKA vs. HHS

A

DKA

  • Lower serum glucose
  • Higher insulin
  • Absolute insulin deficit
  • Lower fluid deficit
  • Lower potassium deficit

HHS

  • Higher serum glucose (more osmotic diuresis)
  • Greater potassium deficit
  • Less insulin
  • Relative insulin deficit
  • Higher fluid deficit
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9
Q

Hyperglycemia

A
  • Caused by insulin deficiency and therefore the inability of insulin to move into the cell
  • Leads to:
    • Hypertonic diuresis
    • Dehydration
    • Elevated serum osmolality
  • Glyconeogenesis -> acidosis, hyperkalemia
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10
Q

Glyconeogenesis

A
  • Causes the breakdown of fats and proteins for energy
  • Results in an increase in ketone bodies and acidosis
  • Causes potassium to move out of the cell and into the serum (hyperkalemia)
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11
Q

Diabetes Insipidus

A
  • Decreased amount or effect of antidiuretic hormone
  • Massive diuresis / Polyuria
  • Urine is low in sodium and specific gravity
  • Sodium concentrates in the blood,
    • –>Hypernatremia
    • –>Hyperosmolality
  • Dilute urine (specific gravity 1.001 - 1.005)
  • Not enough ADH > water loss > ↑serum Na, urine output low urine S.G., ↑ serum osmolality
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12
Q

Antidiuretic Hormone

A

Causes the retention of water, not the retention of sodium

Does not affect serum glucose levels

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13
Q

Patients with low calcium or magnesium levels should be monitored for what?

A

Tetany

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14
Q

Somogyi Phenomenon

A

Due to the release of counterregulatory hormones (epinephrine, glucagon, glucocorticoids, and growth hormone). after hypoglycemia.

Suspected when the morning serum glucose is unexpectedly elevated.

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15
Q

Counterregulatory Hormones

A
  • Epinephrine
  • Glucagon
  • Glucocorticoids
  • Growth Hormone
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16
Q

Why monitor serum glucose in patient receiving enteral feedings?

A

High-glucose enteral feedings increase risk of developing glucose intolerance and hyperglycemic hyperosmolar state (HHS)

-Requires monitoring of serum glucose and sliding scale insulin to prevent development of HHS and life-threatening dehydration.

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17
Q

Glucagon

A

Hormone that causes the body to mobilize glucose

-indirect way to increase the serum glucose and will take longer than giving glucose directly

18
Q

Patient education with the medication acarbose

A

Acarbose is an a-glucosidase inhibitor. -

Delays digestion of ingested carbohydrates

  • Results in smaller rise in serum glucose after meals
  • Simple sugar must be given for hypoglycemia
  • Instruct patients to carry glucose tablets for signs of hypoglycemia
19
Q

Demeclocycline

A

Given for SIADH

  • Blocks the action of ADH or ADH-like substance on the renal tubes
  • Allows diuresis to occur
20
Q

What hormone regulates sodium levels

A

Aldosterone

21
Q

Diabetic Ketoacidosis Treatment

A

Rapid infusion of normal saline

  • Regular insulin intravenous injection followed by infusion
  • Potassium replacement
  • Dextrose should be added to the NS or 1/2 NS (depending on serum osmolality) when the blood glucose decreases to less than 250 mg/dl but only in a concentration of D5W.
22
Q

Metformin side effects

A

Lactic acidoses and Rhabdomyolysis

  • weakness
  • fatigue
  • muscle pain
  • abdominal discomfort
23
Q

Rate for serum glucose reduction

A

50 to 100 mg/dl/hr Rapid reduction in serum glucose reduces the intravascular osmolality so that fluid moves into the more hypertonic brain cells causing cerebral edema

24
Q

Which medication would prevent the early symptoms of hypoglycemia?

A

Sympathetic blocking agents like Metoprolol.

-Early signs of hypoglycemia are mediated by the sympathetic nervous system (tachycardia, nervousness, diaphoresis)

25
Q

SIADH common lab values

A

High urine specific gravity

  • Low serum osmolality
  • Hyponatremia (due to hemodilution)
26
Q

In which type of diabetes do each of the following occur?

diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS)?

A

Type 1 DM = DKA Type 2 DM = HHS

27
Q

What does osmolality show?

A

Osmolality is a reflection of solutes in solution. As urine osmolality decreases, serum osmolality increases.

28
Q

SIADH interventions

A

Seizure precautions

  • Fluid restrictions
  • Diuretics Contraindications:
  • D5W infusion
29
Q

DI common lab values

A

Decreased specific gravity of urine

  • Increased serum osmolality
  • Increased serum sodium
30
Q

Why are patients with HHS at increased risk for thrombosis and pulmonary embolism?

A

Average glucose in HHS is 1100 mg/dl.

  • Causes tremendous osmotic diuresis and dehydration.
  • Dehydration causes hypercoagulability and predisposes the patient to thrombosis and pulmonary embolism.
31
Q

Serium Osmolality

A
  • Endocrine problems often result in abnormalities of serum osmolality (osmo)
  • Osmolality of body fluids: the measure of the umber of particles in a solution
    • expressed as milliosmoles
    • normal osmolality of body fluids is 275-295 mOsm/kg
    • hypo-osmolar < 275
    • hyperosmolar > 295
  • cell membranes are permeable to water, serum osmo will affect intracellular fluid (ICF) osmo
32
Q

Variables Affecting Osmolality

A

Serum Sodium (Na), BUN, Glucose

increase in Na, BUN, and/or glucose will cause an increase in serum osmolality

33
Q

Hypothalamus

A
  • Endocrine “monitoring central”
  • Regulates
    • Temperature
    • Intake drives
    • Autonomic nervous system (sympathetic/parasympathetic)
  • Only pancreas and parathyroid release hormones not controlled by hypotalamus
34
Q

Antidiuretic Hormone (ADH)

A
  • Formed in hypothalamus
  • Stored in posterior pituitary
  • Works on distal convoluted and collecting tubule of kidney to reabsorb water (prevents diuresis)
  • Concentrates urine
    • Normal urine osmolality (1.010 - 1.020)
35
Q

Etiology of SIADH

A
  • Oat Cell carcinoma
  • Viral pneumonia
  • Head problems
  • Increased osmolality, anesthesia, analgesia, stress
  • Thiazide diuretics (especially elderly)
36
Q

Biggest Danger of Hyponatremia

A

Seizures

37
Q

SIADH Treatment

A
  • Address etiology:
    • Oat cell carcinoma
    • viral pneumonia
    • head problems
  • Fluid restriction
  • 3% saline (generally reserved for Na less than 120 mEq/L)
  • Administer phenytoin (Dilantin) > inhibits ADH secretion
  • NO hypotonic solutions or free water
38
Q

DI Etiology

A
  • head problems (surgery, trauma)
  • Phenytoin (Dilantin)
39
Q

DI complication

A

Hypovolemia, hypovolemic shock

40
Q

DI treatment

A
  • Give ADH (pitressin, DDAVP), use cautiously in those with heart disease, may cause coronary artery ischemia
  • Give fluids to replenish intravascular volume
  • Monitor urinary output/specific gravity
41
Q

Arterial pH and K+ Relationship in Acidosis

A

Every 0.1 decrease in pH = 0.6 mEq/L increase in serum K+

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