Exam 1 Endocrine Flashcards

Question

What are the 4 categories and examples of insulin?

Answer 1

rapid acting: lispro, aspart, gluisine short acting: regular intermediate acting: NPH long acting: no peak glargine, detemir

Answer 2

local allergic reaction systemic allergic reaction insulin lipodystrophy resistance to exogenous insulin morning hyperglycemia

Answer 3

hypoglycemia

Answer 4

Metformin liver: hepatic glucose output and muscle: peripheral glucose uptake pancreas: glucagon and insulin secretion GI: glucose absorption

Answer 5

GI upset, nausea, diarrhea lactic acidosis does not cause hypoglycemia hold 24-48hrs prior to IV contrast

Answer 6

Stimulates insulin secretion by pancreas. Often used with metformin to control serum glucose Risk of significant hypoglycemia Sulfa antibiotics have similar structure, so can cause hypoglycemia together Avoid in client allergic to sulfa Avoid prolonged sunlight since sulfa groups cause photosensitivity

Answer 7

Prevent the reuptake of glucose in the kidney, lowering serum glucose sodium-glucose co-transporter inhibitors The glucose in urine increases risk of UTIs

Answer 8

Reduces insulin resistance on cells thiazodinedones Side-effects are mainly metabolic: weight gain, hyperlipidemia, edema, and liver dysfunction Monitor LFTs, weight, lipids

Answer 9

acitvate the sympathetic nervous system (fight or flight) below 70 mg/dL Too much insulin or oral hypoglycemic agents Excessive physical activity Not enough food Sweating Tremors Tachycardia Palpitations Nervousness Hunger

Answer 10

the brain needs glucose to work so hypoglycemia causes significant CNS interruption Inability to concentrate Headache Confusion Memory lapses Slurred speech Drowsiness Disorientation Seizures Loss of consciousness Death

Answer 11

Give 15 to 20 g of fast-acting, concentrated carbohydrate if alert/awake Three or four glucose tablets 4 to 6 ounces of juice or regular soda (not diet soda) 6 to 10 hard candies 1 tbsp honey Subcutaneous or intramuscular glucagon (1 mg) 25 to 50 mL of 50% dextrose solution IV

Answer 12

Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat Mainly a complication of type 1 diabetes, rarely type 2 Hyperglycemia Dehydration Acidosis

Answer 13

blood glucose of 300-800 ketone bodies in the urine from fat breakdown elevated K, Hg, BUN and Cr low Na lower pH, low bi-card when PCO2 lowers it is d/t respiratory compensation (Kussmaul respirations)

Answer 14

rehydration with NS initially, at glucose of 250 add dextrose * bolus of regular insulin then continuous IV * reverse acidosis w/ insulin and bi-carb * treat hyperkalemia with insulin, bi-carb and albuterol rehydration increased volume which decreases serum potassium ratio. Insulin enhances the movement of potassium into the cell because it rides along with the insulin blood glucose renal functions and urinary output ECG electrolytes VA lung assessments for Kussmaul and fluid overload

Answer 15

Notify healthcare provider if ill Monitor BS every 2-4 hrs. Continue taking insulin/oral meds during illness Consume liquids every hour to prevent dehydration Meet carbohydrate needs through soft food 6-8 times per day Test urine for ketones every 3-4 hrs of if BS is >240 mg/dL Call the provider for: Moderate to large ketones in urine BS >250 mg/dL that does not respond to treatment Fever greater than 101.5°F, does not respond to acetaminophen, or lasts >24 hrs. Feeling disoriented/confused Experience rapid breathing Persistent N/V or diarrhea Inability to tolerate liquids Illness lasts longer than 2 days

Answer 16

hyperglycemic hyperosmolar syndrome lack of sufficient insulin Ketosis/acidosis is minimal or absent since insulin is still present but not enough Severe hyperglycemia (greater than 600 mg/dL) causes an osmotic diuresis, loss of water and electrolytes, hypernatremia, and increased serum osmolality * HHS causes profound dehydration, often up to 10-12 liters of fluid loss Typically, no hyperkalemia, no acidosis, but increased BUN and creatinine from dehydration Manifestations include hypotension, profound dehydration, tachycardia, and variable neurologic signs caused by cerebral dehydration High mortality rate, more than DKA since it occurs more gradually over days, so clients stay home longer

Answer 17

lack of acidosis in HHS Hyperkalemia is uncommon in HHS Serum glucose is higher in HHS Serum osmolality is higher in HHS

Answer 18

infections, heart attack, stress, sepsis in type 2 diabetics rehydrate with NS (loads of fluids) IV regular insulin to pull glucose into cells monitor fluid volume and electrolytes assess self-care managment

Answer 19

Macrovascular damage: Accelerated atherosclerotic changes in large arterial vessels Coronary artery disease (MIs) Cerebrovascular disease (strokes) Peripheral vascular disease (loss of toes/limbs) Accelerated atherosclerotic changes in small arterial vessels sexual dysfunction Diabetic retinopathy: leading to vision loss Nephropathy: leading to reduced renal function and chronic renal failure Peripheral neuropathy: leading to loss of skin sensation, skin ulcers, and cellulitis

Answer 20

inspect daily do not soak, pat dry do not self-treat corn/calluses consult podiatrist closed-toe, comfortable shoes try on new shoes at end of the day to prevent purchasing shoes that are too tight clean cotton socks no heating pads or hot water bottles treat cuts promptly and well

Answer 21

negative feedback loop to maintain homeostasis oxytocin, positive feedback

Answer 22

orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions hypothalmus pineal pituitary thyroid parathyroid thymus adrenals islets of langerhans in the pancreas

Answer 23

Mainly controlled by the hypothalamus Anterior pituitary has a blood vessel communication with hypothalamus Posterior pituitary has a nerve communication with hypothalamus Notice the optic chiasm is next to pituitary gland Pituitary gland is accessible through the nose for tumor removal Known as the “Master Gland” for its role in producing multiple essential hormones Anterior pituitary produces and secretes hormones Posterior pituitary stores and secretes hormones

Answer 24

Adrenocorticotropic hormone (ACTH): stimulate adrenal cortex Growth hormone: stimulate growth of tissue and bones Thyroid stimulating hormone (TSH): stimulate the thyroid gland/T4 secretion FSH/LH: regulation of menstrual cycles/ovulation, testicular development/testosterone production Prolactin: breast milk production

Answer 25

Antidiuretic hormone (ADH) Oxytocin: Contraction of uterus post-partum, milk ejection/let-down in breasts

Answer 26

Mostly benign and slow growing tumors Functional Secrete pituitary hormones of the affected cells Prolactinoma is the most common pituitary adenoma Effects of tumors are from the secreting hormone and the local compression effects of optic chiasm (visual fields) Non-functional Do not secrete pituitary hormones Clinical manifestations based upon endocrine dysfunction and/or dysfunctional effects on target organs

Answer 27

Surgical removal of pituitary gland tumors Treatment of choice for Cushing syndrome (excess ACTH production) caused by pituitary tumor Transsphenoidal surgery post-op nursing care and client education Monitor for temporary diabetes insipidus Notify provider of clear watery drainage (possible CSF leak) Maintain client in semi- to high-Fowler Assess for meningitis manifestations Headache and nasal congestion for ≈ 1-2 weeks No tooth brushing No blowing nose No forceful coughing Avoid straining or bending at waist

Answer 28

The thyroid gland is like the factory/controls energy level of bodily functions regulates carb, lipid and protein metabolism CNS activity and brain development cardiovascular stimulation bone and tissue growth GI regulation sexual maturation

Answer 29

TSH from the anterior pituitary controls the release of thyroid hormone nd their functions? Iodine is contained in thyroid hormone, and needed in diet for production Triiodothyronine (T3): Controls cellular metabolic activity More potent and rapid-acting than T4 Thyroxine (T4): Controls cellular metabolic activity Calcitonin: Secreted in response to high plasma calcium level and increases calcium deposit in bone/reduces bone breakdown

Answer 30

Majority of thyroid diseases are from disease of thyroid gland, not the pituitary gland

Answer 31

Primary loss of thyroid function is the most common mechanism (autoimmune Hashimoto thyroiditis) Females between 30-60 years old are the majority of clients Metabolism is reduced with reduced levels of T3 and T4 Medications like lithium, amiodarone can directly reduce thyroid function A disease with a spectrum of severity from mild symptoms to myxedema coma

Answer 32

Suboptimal levels of thyroid hormone production Primary: Loss of thyroid hormone production Secondary: Pituitary disease resulting in lack of TSH production Hashimoto disease (primary hypothyroidism) Autoimmune thyroiditis Results in low levels of T3/T4 and elevated TSH levels

Answer 33

Fatigue and lethargy Weight gain w/o increased caloric intake Cold intolerance, subnormal body temperature Dry skin and dry, brittle hair Cardiovascular-related Bradycardia Cardiomegaly Elevated serum cholesterol Atherosclerosis and CAD Menorrhagia Constipation Depression Goiter from TSH stimulation

Answer 34

Dose started low and slowly titrated until desired levels of serum TSH and free T4 concentration are achieved Take in the morning on an empty stomach Treatment is lifelong since thyroid gland rarely recovers function in Hashimoto thyroiditis Non-adherence to levothyroxine will cause hypothyroidism symptoms, low T4 and elevated TSH levels

Answer 35

Monitor for CV changes Low BP, bradycardia, dysrhythmias Monitor weight Low-calorie, high-bulk diet Encourage activity Monitor respiratory status and encourage coughing/deep breathing Administer stool softeners as needed Avoid fiber laxatives which interfere with absorption of levothyroxine Keep the client warm if they have decreased cold tolerance No heating devices which can cause unrecognized burns Monitor mental status and concerns regarding body image Educate client to report chest pain/discomfort immediately Educate client to adhere to medication regimen (time/dose/brand)

Answer 36

Rare, life-threatening, severe form of hypothyroidism 40% mortality rate Causes Undiagnosed hypothyroidism Medication noncompliance (levothyroxine) Stressor (acute illness, surgery, chemotherapy, use of sedatives/opioids) Occurs most often in older women during the winter months

Answer 37

Initial symptoms Depression, diminished cognitive status, lethargy Lethargy may progress to stupor, reduced level of consciousness, coma Hypoventilation progressing to respiratory failure Hyponatremia Hypoglycemia Hypothermia Bradycardia & hypotension – may progress to CV collapse

Answer 38

Goals: restoration of normal metabolic state and prevention of complications Early recognition and aggressive intervention Check for possible sources of infection (blood, sputum, urine) ICU setting ABG analysis and ventilatory support Continuous VS and ECG monitoring Cautious administration of replacement thyroid hormones (IV initially) Passive rewarming Monitor I&O and daily weights Treat hypoglycemia with glucose Administer corticosteroids Initiate aspiration precautions Avoid sedatives and opioids Turn and reposition Q2H

Answer 39

Excessive synthesis and secretion of thyroid hormone (all systems are stimulated!) Symptoms range from mild to life-threatening Causes Graves disease Autoimmune thyroiditis Most common cause of hyperthyroidism Affects women 8x more than men Age of onset normally 20s – 40s Toxic multinodular goiter of thyroid gland Toxic adenoma in thyroid gland Excessive ingestion of thyroid hormone (levothyroxine) Secondary hyperthyroidism from pituitary adenoma (excessive TSH)

Answer 40

Related to the increase in metabolic rate and increased oxygen consumption CNS effects Anxiety, restlessness, irritability Emotional instability Fine hand tremors Cardiovascular effects Tachycardia and palpitations Arrhythmias Elevated SBP GI effects Diarrhea Increased appetite Weight loss Other manifestations Heat intolerance with increased perspiration Exophthalmos (bulging eyes) Muscle wasting and weakness Thin skin Oligomenorrhea Osteoporosis Goiter from overstimulation (autoantibodies) Heart failure from chronic stimulation

Answer 41

bulging of eyes caused by excessive tissue growth behind the eyes

Answer 42

Enlarged thyroid gland (goiter) Bruit over thyroid arteries - sign of increased blood flow to the thyroid is possible Decreased serum TSH Increased serum free T4 Increased radioactive iodine uptake

Answer 43

Medications: Oral propylthiouracil (PTU) or methimazole Radioactive Iodine therapy (destroys partially or fully the thyroid function) Thyroidectomy (removal of thyroid gland) B-blockers (treats the symptoms only, doesn't affect thyroid function)

Answer 44

Methimazole Propylthiouracil (PTU) Block the utilization of iodine, thus inhibiting one or more stages in thyroid hormone synthesis and release Medications are used until client is euthyroid May take several weeks until symptoms relief occurs Gradually taper off dose once euthyroid state is achieved Take with meals in divided doses at regular intervals- do not stop abruptly PTU is preferred in a pregnant woman, less toxicity Monitor CBC and LFTs prior to administration, most concerning adverse effect is bone marrow suppression (monitor for fevers, signs of infection, bruising from thrombocytopenia)

Answer 45

Irradiation by administration of radioisotope ᶦᶟᶦI (radioactive iodine) Thyroid cells exposed to the radioactive iodine are destroyed One dose may be sufficient; 2nd or 3rd dose may be needed Degree of thyroid destruction varies and may require lifelong thyroid hormone replacement Contraindicated in pregnancy Effects of therapy take 6 to 8 weeks

Answer 46

Prevent radiation exposure to others Do not share toilet for 2 weeks Flush the toilet 2 – 3 times Wash clothing separate from others Run washing machine for a full cycle after washing contaminated clothes Do not share a toothbrush Used disposable plates and utensils

Answer 47

Medication therapy failure or intolerance Radiation therapy is contraindicated Large goiter Thyroid cancer

Answer 48

Airway compromise from hemorrhage and edema can compress the trachea and usually occurs within the first 24 hours Have tracheostomy and suction supplies available Semi-Fowler position Support the head and neck to avoid neck extension Assess the dressing and the back of the neck for excessive bleeding Check for laryngeal nerve damage by asking the client to speak as soon as awake and every 2 hours after Assess for symptoms of hypocalcemia (loss of parathyroids) Ensure calcium gluconate or calcium chloride is immediately available

Answer 49

voice changes

Answer 50

Severe, usually abrupt form of hyperthyroidism from a surge in thyroid hormones uncontrolled Graves disease plus an additional stress to body Usually precipitated by a stressful event: Injury or infection DKA Pregnancy Abrupt withdrawal of antithyroid medications Extreme emotional stress Thyroid surgery, releasing thyroid hormones

Answer 51

Hyperpyrexia (temperature > 38.5⁰ C/101.3⁰ F) CV effects Tachycardia > 130 bpm Hypertension Chest pain Palpitations Dyspnea CNS effects Acute agitation Delirium Psychosis Coma

Answer 52

ICU setting Provide as calm and quiet an environment as possible Continuous VS and ECG monitoring (atrial fibrillation is very common) Temperature reduction Cooling blanket, cooling sponge baths Acetaminophen salicylates (aspirin) are contraindicated- increase free thyroxine levels Heart rate reduction: Beta adrenergic blockers, Digoxin Humidified oxygen Dextrose-containing IV fluids Administration of methimazole or PTU to reduce T4/T3 levels IV fluids to maintain hydration from excessive sweating, monitor input/output Provide supplemental oxygen due to increased oxygen demands

Answer 53

Adrenal cortex is stimulated by adrenocorticotropic hormone (ACTH) Releases cortisol, aldosterone, and androgens Adrenal medulla is stimulated by sympathetic nervous system Functions as part of the autonomic nervous system (sympathetic system) Releases catecholamines Epinephrine Norepinephrine Dopamine

Answer 54

Hormones secreted enable the body to adapt to stress (cortisol) and fluid balance (aldosterone) Glucocorticoids Cortisol Affects cellular metabolism, maintains blood pressure, maintains serum glucose levels Mineralocorticoids Aldosterone Maintains electrolyte balance and fluid balance by reabsorbing Na and secreting potassium in the kidney Part of the RAAS Androgens Little effect when secreted in normal amounts Excess secretion causes masculinization of women such as facial hair and acne

Answer 55

exogenous cause of increased cortisol Most common cause is the use of corticosteroid medications to treat other illnesses such as asthma, allergies, autoimmune disease endogenous cause of increased cortisol Can also occur from excessive glucocorticoid production secondary to adrenal cortex hyperplasia or adenoma (less common) Lastly, can occur from ACTH secreting pituitary adenoma (least common) Diagnostics Serum cortisol are elevated 24-hour urinary cortisol are elevated Low dose dexamethasone suppression test Reduced serum potassium, increased serum sodium and glucose CT scans of brain and abdomen if adrenal hyperplasia or pituitary tumor is felt to be cause

Answer 56

osteoporosis

Answer 57

Rapid testing The dose is given before sleeping Blood sample is taken after waking and before getting out of bed Stay overnight Usually, the PO dose is given at 11 pm and the blood cortisol level is taken at 8 am If there is no decrease in blood cortisol level, the test is repeated with a higher dose Prolonged testing Baseline 24-hr urine cortisol and blood cortisol 2 continuous days of urine collection while dexamethasone is administered every 6 hours Monitor the client’s blood glucose and potassium levels for adverse effects Expected finding is suppression of cortisol Nonsuppression indicates Cushing disease

Answer 58

Moon face from fat redistribution to the face and central body with smaller limbs from muscle wasting Striae from thinning of skin and exposure of deeper tissue/blood vessels Buffalo hump also from fat redistribution

Answer 59

Treatment depends upon the cause (exogenous or endogenous cause): Hypophysectomy if syndrome is caused by an ACTH pituitary tumor Adrenalectomy for unilateral primary adrenal hyperplasia Adrenal enzyme inhibitors Ketoconazole.....also an antifungal medication, not a cure, but a treatment Mitotane....destroys adrenal cells, used for adrenal cancers, less for adrenal hyperplasia Attempt to reduce or taper dose of corticosteroids to the minimum dosage needed to treat the underlying disease process (asthma, colitis......etc.) Monitor blood glucose and monitor blood pressure Prevention of peptic ulcer disease with H-2 blockers or a PPI Calcium and vitamin D to protect bones and prevent osteoporosis

Answer 60

Monitor I&O and daily weight Assess for signs of hypervolemia Maintain safe environment to decrease risk of fractures/skin trauma Encourage activity within reason for the client Prevent infection Use surgical asepsis with dressing changes/invasive procedures Monitor WBC count daily Monitor skin integrity Turn client every 2 hrs. Meticulous skin care

Answer 61

Addison's disease Primary adrenal insufficiency/Addison disease: resulting in reduced serum cortisol and aldosterone levels Secondary adrenal insufficiency: sudden cessation of exogenous corticosteroid therapy causes a rapid drop in serum cortisol levels; adrenal gland don't have time to compensate by secreting cortisol (most common cause of adrenal insufficiency)

Answer 62

Weakness and fatigue Salt cravings Abdominal pain N/V/D Anorexia Unintentional weight loss Hypotension Dark/bronze skin discoloration Hypoglycemia Hyponatremia Hyperkalemia Hypercalcemia Increased WBC Fluid volume deficit Increased BUN and creatinine Glucose within expected range or decreased

Answer 63

Cortisol is needed for maintaining blood pressure, blood sugar, and proper GI functioning ** Aldosterone is needed for reabsorbing NA and secreting K in the kidneys, plus maintaining fluid balance

Answer 64

autoimmune adrenal destruction Lifelong therapy will be needed with a cortisol (hydrocortisone) and a mineralocorticoid (fludrocortisone)

Answer 65

Primary goal is to prevent circulatory shock Monitor F&E status Measure orthostatic BP Obtain daily weights IV N/S fluid boluses for BP Observe for dehydration IV hydrocortisone infusion Replace mineralocorticoid (fludrocortisone) Monitor and treat hyperkalemia with sodium polystyrene, insulin/glucose, bicarbonate, calcium gluconate, and albuterol

Answer 66

Administer hydrocortisone Increase dose during periods of stress such as an illness Administer with food to avoid gastric irritation Taper dose to avoid acute adrenal insufficiency if discontinuing Monitor for hypoglycemia Administer glucagon as needed with reduced LOC Administer oral glucose if awake Monitor for signs of infection with cortisol causing immunosuppression

Answer 67

Life-threatening complication of adrenal failure/insufficiency May lead to circulatory collapse and shock Triggering factors Most common cause is abrupt withdrawal of glucocorticoid therapy Or a client with known Addison disease, but needing more cortisol due to the following stressors: Sepsis/ infection Trauma Stress MI, surgery, anesthesia, hypothermia, volume loss, hypoglycemia

Answer 68

Severe hypotension Dehydration Hyponatremia Hyperkalemia Increased BUN and creatinine Profound fatigue Confusion and restlessness Place client in recumbent position with legs elevated Administer IV fluids Administer IV hydrocortisone Administer vasopressors as needed to increase BP Treat electrolyte imbalances (hyponatremia and hyperkalemia) Administer insulin and dextrose to move K+ into cells Administer Ca+ to counteract hyperkalemia and protect the heart Treat underlying cause of the Addisonian crisis

Answer 69

Consider it part of the sympathetic nervous system Secretes mainly epinephrine and norepinephrine from sympathetic stimulation Excessive secretion of epinephrine/norepinephrine can occur from an adrenal tumor called a pheochromocytoma With a pheochromocytoma, massive amounts of epinephrine/norepinephrine are sporadically secreted, resulting in a set of symptoms/signs

Answer 70

Rare, usually benign tumor of the adrenal medulla Cause of HTN in 0.1% of clients diagnosed with HTN Fatal if undetected or untreated from strokes and heart attacks Peak incidence between ages 40 –50 Males and females affected equally Familial link Definitive treatment is surgical removal of tumor (adrenalectomy)

Answer 71

Classic triad Episodic headache Sweating Tachycardia “Five Hs” HTN Headache Hyperhidrosis (excessive sweating) Hypermetabolism Hyperglycemia

Answer 72

testing urine for epinephrine metabolites called metanephrines also clonidine suppression test avoid caffeine or alcohol prior to test since these affect results Surgical treatment: Preoperatively Bedrest with HOB elevated during a hypertensive crisis episode Alpha blockers Beta adrenergic blockers Calcium channel blockers Intraoperatively Surgical manipulation of tumor may cause hypertensive crisis Postoperatively Corticosteroid therapy if bilateral adrenalectomy performed IV immediately post-op PO after recovering from acute stress of surgery

Answer 73

reabsorbs fluid in the kidneys to maintain normal fluid levels, electrolyte levels, and urine concentration diabetes insipidus. Results in massive loss of fluids in the urine, dehydration, dilute urine, and concentrated serum NA levels (hypernatremia) syndrome of inappropriate ADH secretion. Results in excessive intravascular fluid volume, dilute serum, concentrated urine, and low serum NA levels (hyponatremia)

Answer 74

hypothalamic or pituitary injury from trauma, meningitis, surgery Results in a lack of ADH secretion kidney injury not responding to ADH Most common cause is lithium use which can cause damage to nephrons Causes a deficiency of antidiuretic hormone (ADH) ADH is also known as vasopressin

Answer 75

Serum Think CONCENTRATED Increase in Serum osmolarity Serum sodium Serum potassium Urine Think DILUTE Decrease in Urine specific gravity 1.001 – 1.005 Urine osmolarity Urine sodium Urine potassium

Answer 76

Urine output > 250 mL/hr Very dilute urine (<1.005) Polydipsia Polyuria Thirsty Hypotension Tachycardia Dehydration Weight loss

Answer 77

Identify and treat underlying cause Adequate fluid replacement in acute phase Strict I & O monitoring, weigh daily Frequent VS Monitor for signs and symptoms of hyponatremia during treatment (desmopressin) Desmopressin/DDAVP (synthetic vasopressin) Drug of choice for central DI, life-long therapy Given orally or intranasally Use cautiously in clients with CAD (can cause vasoconstriction) or HF (fluid overload) Dose is adjusted based on urine output and fluid balance in body Monitor for headaches or confusion due to development of hyponatremia from ADH

Answer 78

treating underlying cause and restricting fluids Restrict oral fluid intake < 1000 mL/day (avoids further hemodilution) Strict I & O, daily weights Frequent VS Frequent monitoring of neurological status (hyponatremia) headaches, confusion, seizures, and coma Monitor for manifestations of hypervolemia shortness of breath/lung crackles, hypertension Administration of loop diuretics if fluid overload/heart failure Administration of hypertonic saline (3%) if severely hyponatremic

Answer 79

Tetracycline derivatives (demeclocycline) Blocks effect of ADH in the kidneys Like tetracycline, avoid dairy products, antacids, and iron during ingestion Can cause photosensitivity rash and oral thrush ADH (vasopressin) antagonists Tolvaptan blocks the effect of ADH in the kidneys Furosemide (loop diuretic): to help remove excessive fluid if needed: monitor weight, sodium levels, renal function, and ototoxicity 3% N/S only for severe hyponatremia that may cause seizures

Answer 80

Excessive fluid volume Pulmonary edema/lung crackles, edema, hypertension Report shortness of breath, monitor daily weights, restrict fluid Hyponatremia Monitor for N/V, seizures, confusion, altered level of consciousness, coma Monitor serum electrolytes, especially sodium **Central pontine myelinolysis: a complication of the rapid reversal of hyponatremia : monitor serum sodium and any neurologic deterioration