FEN/Endocrine Flashcards
Sodium restriction, fluid restriction, monitoring of eyes and nose, administration of diuretics are all management of what endocrine disorder?
S i a d h
What are complications medically of anorexia and bulimia?
Cardiac arrhythmias, severe hypophosphatemia, acid-base disturbances
What causes an adrenal crisis?
Chronic adrenal insufficiency, acute damage, abrupt withdrawal of steroids
A c t h deficiency and a destroyed or inactive adrenal gland are all what types of adrenal insufficiency?
Secondary
How do you calculate an anion gap?
Na - (Cl + HCO3)
What happens to a patient’s bicarb levels during DKA?
Decreases typically less than 15
Surgical removal, addison disease, CAH are all what types of adrenals insufficiency?
Primary
What rate should you correct the sodium of hyponatremia and hypernatremia?
0.5 MEQ’s per liter per hour
What physical findings are seen with hyperthyroidism?
Goiter, except Thelma’s, Cartier, widened pulse pressure
Suppression from steroids for a rapid steroid taper is what kind of adrenal insufficiency?
Tertiary insufficiency
How does DKA present?
Abdominal pain, vomiting, polyuria, hyperglycemia, ketoneuria, lethargy
What is the definition of failure to thrive?
Less than 5% on standard growth chart or when a child’s weight for age crosses more than two major centile lines
Serum sodium of greater than 150 is seen in diabetes insipidus, SIDH, or cerebral salt wasting?
Diabetes insipidus
What is the most severe complication of hyponatremia?
Seizures
What is the clinical presentation of DKA cerebral edema?
Onset of headache, altered mental status, hypoxia, Cushing’s triad
What electrolyte abnormality are you concerned for in a patient with anxiety?
Hypophosphatemia
What EKG changes are seen with hyperkalemia?
Peaked t-waves, depressed ST, wide QRS, absent P wave
Hyperparathyroidism, vitamin d deficiency, renal insufficiency, transfusions, rhabdomyolysis, tumor lysis, ethylene glycol ingestion are all causes of what electrolyte abnormality?
Hypocalcemia
What electrolytes should be checked on a child with nuanced seizures?
Glucose, sodium, calcium
What are causes of high anion gap metabolic acidosis?
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
What electrolytes need to be replaced during DKA?
Potassium in phosphorus
What happens to a patient’s urine pH during DKA?
More acidic typically less than 7.3
What is the risk of correcting sodium to rapidly?
Central pontine demyelination of white matter, seizures
Over what period of time should fluid losses be corrected?
Over 24 to 48 hours
What your an output is normally seen in CSW?
Two to three ml per kg per hour
What is the normal range for an anion gap?
10 to 14
In hyperkalemia what is used to stabilize the myocardium?
Calcium chloride 10% at 20 mg per kilogram
What lab findings are associated with hypothyroidism?
Low free t4 and t3, elevated TSH
A low serum sodium is seen in DI, SIDH, or CSW?
S i a d h and CSW
What is the presentation of type 1 diabetes mellitus?
Polyuria, polydipsia,, polyphagia
List of three levels of hydration and some characteristics
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
Food loss, dehydration, excess sodium intake, DI are all common causes of what electrolyte abnormality?
Hypernatremia
C a h, tumor lysis or rhabdomyolysis, RTA are all common causes of what electrolyte abnormality?
Hyperkalemia
What are some causes of diabetes insipidus?
CNS injury, disorders the hypothalamus, secondary and primary renal defects, tumor resection
If uncorrected what is the final effect of hyperkalemia on an EKG?
Ventricular fibrillation
What is the clinical presentation of hyperthyroidism
Nervousness, irritability, tremor, excessive appetite, weight loss, smooth moist skin, increased perspiration, heat intolerance
What is the most common form of congenital adrenal hyperplasia?
21 hydroxylase deficiency
Slow sodium replacement, normal food intake are part of the management of what endocrine disorder?
CSW
What are three options to help remove potassium from the patient?
Kayexalate, dialysis if severe, diuretics or albuterol if mild
What is a normal urine sodium for SIDH?
Greater than 30
What is a normal urine osmolarity for DI?
Less than 200
What you’re an output is typically seen in DI?
Greater than or equal to 4 ml per kg per hour
Vasopressin or DDAVP is used to treat what endocrine disorder?
Di
SIDH, adrenal insufficiency, hyperbola bulimia, hypovolemia, excess H2O intake are all causes of what electrolyte abnormality?
Hyponatremia
How do you calculate maintenance fluids?
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
What is a normal urine sodium for CSW?
Greater than 80
What are some common causes of cerebral salt wasting?
Seen us injury or infection, endocrine disturbances, cardiac disease
For hypoglycemia what is the dose of glucose replacement?
10 or 25% glucose at 0.5-1 g per kg
What are three complications of hypocalcemia?
Seizures, tetany, myocardial irritability, long QT
What clinical findings are associated with hypothyroidism?
Growth retardation for muscle tone cold intolerance weight gain, bradycardia constipation
Is serum osmolarity less than 280 in DI, SIADH, CSW?
S i a d h and CSW
What you’re an output is normally seen in SIADH?
Less than or equal to one ml per kilo per hour
What can be used to enhance the movement of potassium into the cells?
Sodium bicarbonate 1-2 mEq per kg
What sodium level constitutes hyponatremia? Hypernatremia?
Less than 135 severe is less than 125
Greater than 145 severe is greater than 160
What is a normal urine osmolarity for SIDH and CSW?
Greater than 200
What is the fluid management for DKA?
10 ml per kg bolus with slow fluid replacement over 24 to 48 hours
What additional medical complication you concern for in a patient with bulimia?
Dentition problems
What is Cushing’s triad?
Hypertension, bradycardia, respiratory depression
What lab findings are associated with hyperthyroidism or thyroiditis?
Elevated t4 and a decreased TSH
What causes SIADH?
Sinus injury, high dose chemotherapy, diseases of hypothalamus or pituitary
What is the management for adrenal insufficiency?
Glucocorticoids
What key findings point to a metabolic disorder?
Hypoglycemia, hyperammoniemia, metabolic acidosis
What is the treatment for cerebral edema in DKA?
Manito 0.5 to 1 g per kg or 3% hypertonic saline.
What does the typical insulin drip start at in DKA?
.05 to 1 units per kg per hour
Newborn with ambiguous genitalia, salt wasting are signs of what endocrine disorder?
Congenital adrenal hyperplasia
What are some causes of metabolic acidosis with a normal anion gap?
Diarrhea, adrenal insufficiency, chronic kidney disease, spironolactone, hypoaldosteronism
When should you add glucose into your management of DKA?
When serum glucose is 250 to 300 or glucose levels are dropping faster than 100 per hour
What is unique about cerebral salt wasting?
Sodium excretion into the urine and diuresis with resultant type monotremia and euvolemia
Is serum osmolarity greater than 295 in DI, SIADH, or CSW?
D i
What is a normal urine sodium for DI?
Less than 30
What additional lab studies should be drawn in a patient with new onset diabetes
Insulin level, thyroid function tests, c-peptide levels
What are risk factors for cerebral edema in DKA?
Young age, new onset, bolus insulin dosing, bicarb administration, rapid fluid administration, kidney injury
What are catecholamines means and why do we care about them?
Released in response to stress, surgery, illness and results in free fatty acid depletion, glycogen storage depletion, hyperglycemia, lipid intolerance and protein catabolism
A life-threatening condition causing hypertension, fever, tucka cardiac, and sweating is what hyperthyroid condition?
Thyroid storm
Is failure to thrive more commonly organic or inorganic?
90% inorganic
hypoglycemia, hyponatremia, hyperkalemia are a classic triad for what disorder?
adrenal insufficiency
