FEN/Endocrine Flashcards

1
Q

Sodium restriction, fluid restriction, monitoring of eyes and nose, administration of diuretics are all management of what endocrine disorder?

A

S i a d h

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2
Q

What are complications medically of anorexia and bulimia?

A

Cardiac arrhythmias, severe hypophosphatemia, acid-base disturbances

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3
Q

What causes an adrenal crisis?

A

Chronic adrenal insufficiency, acute damage, abrupt withdrawal of steroids

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4
Q

A c t h deficiency and a destroyed or inactive adrenal gland are all what types of adrenal insufficiency?

A

Secondary

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5
Q

How do you calculate an anion gap?

A

Na - (Cl + HCO3)

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6
Q

What happens to a patient’s bicarb levels during DKA?

A

Decreases typically less than 15

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7
Q

Surgical removal, addison disease, CAH are all what types of adrenals insufficiency?

A

Primary

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8
Q

What rate should you correct the sodium of hyponatremia and hypernatremia?

A

0.5 MEQ’s per liter per hour

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9
Q

What physical findings are seen with hyperthyroidism?

A

Goiter, except Thelma’s, Cartier, widened pulse pressure

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10
Q

Suppression from steroids for a rapid steroid taper is what kind of adrenal insufficiency?

A

Tertiary insufficiency

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11
Q

How does DKA present?

A

Abdominal pain, vomiting, polyuria, hyperglycemia, ketoneuria, lethargy

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12
Q

What is the definition of failure to thrive?

A

Less than 5% on standard growth chart or when a child’s weight for age crosses more than two major centile lines

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13
Q

Serum sodium of greater than 150 is seen in diabetes insipidus, SIDH, or cerebral salt wasting?

A

Diabetes insipidus

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14
Q

What is the most severe complication of hyponatremia?

A

Seizures

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15
Q

What is the clinical presentation of DKA cerebral edema?

A

Onset of headache, altered mental status, hypoxia, Cushing’s triad

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16
Q

What electrolyte abnormality are you concerned for in a patient with anxiety?

A

Hypophosphatemia

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17
Q

What EKG changes are seen with hyperkalemia?

A

Peaked t-waves, depressed ST, wide QRS, absent P wave

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18
Q

Hyperparathyroidism, vitamin d deficiency, renal insufficiency, transfusions, rhabdomyolysis, tumor lysis, ethylene glycol ingestion are all causes of what electrolyte abnormality?

A

Hypocalcemia

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19
Q

What electrolytes should be checked on a child with nuanced seizures?

A

Glucose, sodium, calcium

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20
Q

What are causes of high anion gap metabolic acidosis?

A

The acronym CAT MUDPILES

Carbon monoxide, Cyanide, Congenital
heart failure

Aminoglycosides
Teophylline, Toluene (Glue-sniffing)
Methanol
Uremia
Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation ketoacidosis
Paracetamol/Acetaminophen, Phenformin, Paraldehyde
Iron, Isoniazid, Inborn errors of metabolism
Lactic acidosis
Ethanol (due to lactic acidosis), Ethylene glycol
Salicylates/ASA/Aspirin

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21
Q

What electrolytes need to be replaced during DKA?

A

Potassium in phosphorus

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22
Q

What happens to a patient’s urine pH during DKA?

A

More acidic typically less than 7.3

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23
Q

What is the risk of correcting sodium to rapidly?

A

Central pontine demyelination of white matter, seizures

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24
Q

Over what period of time should fluid losses be corrected?

A

Over 24 to 48 hours

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25
Q

What your an output is normally seen in CSW?

A

Two to three ml per kg per hour

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26
Q

What is the normal range for an anion gap?

A

10 to 14

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27
Q

In hyperkalemia what is used to stabilize the myocardium?

A

Calcium chloride 10% at 20 mg per kilogram

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28
Q

What lab findings are associated with hypothyroidism?

A

Low free t4 and t3, elevated TSH

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29
Q

A low serum sodium is seen in DI, SIDH, or CSW?

A

S i a d h and CSW

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30
Q

What is the presentation of type 1 diabetes mellitus?

A

Polyuria, polydipsia,, polyphagia

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31
Q

List of three levels of hydration and some characteristics

A

Mild is 5% fatigue, normal vitals, refusing PO

Moderate is 10% thirsty, irritable, mild change in vitals like tachycardia, decreased tears, dry oral mucosa

Severe is 15% lethargy, alteration in all vitals, cool, modeled, minimal output, deep breathing

32
Q

Food loss, dehydration, excess sodium intake, DI are all common causes of what electrolyte abnormality?

A

Hypernatremia

33
Q

C a h, tumor lysis or rhabdomyolysis, RTA are all common causes of what electrolyte abnormality?

A

Hyperkalemia

34
Q

What are some causes of diabetes insipidus?

A

CNS injury, disorders the hypothalamus, secondary and primary renal defects, tumor resection

35
Q

If uncorrected what is the final effect of hyperkalemia on an EKG?

A

Ventricular fibrillation

36
Q

What is the clinical presentation of hyperthyroidism

A

Nervousness, irritability, tremor, excessive appetite, weight loss, smooth moist skin, increased perspiration, heat intolerance

37
Q

What is the most common form of congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

38
Q

Slow sodium replacement, normal food intake are part of the management of what endocrine disorder?

A

CSW

39
Q

What are three options to help remove potassium from the patient?

A

Kayexalate, dialysis if severe, diuretics or albuterol if mild

40
Q

What is a normal urine sodium for SIDH?

A

Greater than 30

41
Q

What is a normal urine osmolarity for DI?

A

Less than 200

42
Q

What you’re an output is typically seen in DI?

A

Greater than or equal to 4 ml per kg per hour

43
Q

Vasopressin or DDAVP is used to treat what endocrine disorder?

A

Di

44
Q

SIDH, adrenal insufficiency, hyperbola bulimia, hypovolemia, excess H2O intake are all causes of what electrolyte abnormality?

A

Hyponatremia

45
Q

How do you calculate maintenance fluids?

A

421 rule

3 to 10 kg 4 milliliters per kilogram per hour

10 to 20 kg 40 ml per hour+ 2 ml per kg per hour for each additional kilogram

Greater than 21 kg is 60 mph plus 1 ml per kilo per hour for each additional kilogram

46
Q

What is a normal urine sodium for CSW?

A

Greater than 80

47
Q

What are some common causes of cerebral salt wasting?

A

Seen us injury or infection, endocrine disturbances, cardiac disease

48
Q

For hypoglycemia what is the dose of glucose replacement?

A

10 or 25% glucose at 0.5-1 g per kg

49
Q

What are three complications of hypocalcemia?

A

Seizures, tetany, myocardial irritability, long QT

50
Q

What clinical findings are associated with hypothyroidism?

A

Growth retardation for muscle tone cold intolerance weight gain, bradycardia constipation

51
Q

Is serum osmolarity less than 280 in DI, SIADH, CSW?

A

S i a d h and CSW

52
Q

What you’re an output is normally seen in SIADH?

A

Less than or equal to one ml per kilo per hour

53
Q

What can be used to enhance the movement of potassium into the cells?

A

Sodium bicarbonate 1-2 mEq per kg

54
Q

What sodium level constitutes hyponatremia? Hypernatremia?

A

Less than 135 severe is less than 125

Greater than 145 severe is greater than 160

55
Q

What is a normal urine osmolarity for SIDH and CSW?

A

Greater than 200

56
Q

What is the fluid management for DKA?

A

10 ml per kg bolus with slow fluid replacement over 24 to 48 hours

57
Q

What additional medical complication you concern for in a patient with bulimia?

A

Dentition problems

58
Q

What is Cushing’s triad?

A

Hypertension, bradycardia, respiratory depression

59
Q

What lab findings are associated with hyperthyroidism or thyroiditis?

A

Elevated t4 and a decreased TSH

60
Q

What causes SIADH?

A

Sinus injury, high dose chemotherapy, diseases of hypothalamus or pituitary

61
Q

What is the management for adrenal insufficiency?

A

Glucocorticoids

62
Q

What key findings point to a metabolic disorder?

A

Hypoglycemia, hyperammoniemia, metabolic acidosis

63
Q

What is the treatment for cerebral edema in DKA?

A

Manito 0.5 to 1 g per kg or 3% hypertonic saline.

64
Q

What does the typical insulin drip start at in DKA?

A

.05 to 1 units per kg per hour

65
Q

Newborn with ambiguous genitalia, salt wasting are signs of what endocrine disorder?

A

Congenital adrenal hyperplasia

66
Q

What are some causes of metabolic acidosis with a normal anion gap?

A

Diarrhea, adrenal insufficiency, chronic kidney disease, spironolactone, hypoaldosteronism

67
Q

When should you add glucose into your management of DKA?

A

When serum glucose is 250 to 300 or glucose levels are dropping faster than 100 per hour

68
Q

What is unique about cerebral salt wasting?

A

Sodium excretion into the urine and diuresis with resultant type monotremia and euvolemia

69
Q

Is serum osmolarity greater than 295 in DI, SIADH, or CSW?

A

D i

70
Q

What is a normal urine sodium for DI?

A

Less than 30

71
Q

What additional lab studies should be drawn in a patient with new onset diabetes

A

Insulin level, thyroid function tests, c-peptide levels

72
Q

What are risk factors for cerebral edema in DKA?

A

Young age, new onset, bolus insulin dosing, bicarb administration, rapid fluid administration, kidney injury

73
Q

What are catecholamines means and why do we care about them?

A

Released in response to stress, surgery, illness and results in free fatty acid depletion, glycogen storage depletion, hyperglycemia, lipid intolerance and protein catabolism

74
Q

A life-threatening condition causing hypertension, fever, tucka cardiac, and sweating is what hyperthyroid condition?

A

Thyroid storm

75
Q

Is failure to thrive more commonly organic or inorganic?

A

90% inorganic

76
Q

hypoglycemia, hyponatremia, hyperkalemia are a classic triad for what disorder?

A

adrenal insufficiency