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CPNP- AC > FEN/Endocrine > Flashcards

FEN/Endocrine Flashcards

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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
What your an output is normally seen in CSW?
Two to three ml per kg per hour
26
What is the normal range for an anion gap?
10 to 14
27
In hyperkalemia what is used to stabilize the myocardium?
Calcium chloride 10% at 20 mg per kilogram
28
What lab findings are associated with hypothyroidism?
Low free t4 and t3, elevated TSH
29
A low serum sodium is seen in DI, SIDH, or CSW?
S i a d h and CSW
30
What is the presentation of type 1 diabetes mellitus?
Polyuria, polydipsia,, polyphagia
31
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
32
Food loss, dehydration, excess sodium intake, DI are all common causes of what electrolyte abnormality?
Hypernatremia
33
C a h, tumor lysis or rhabdomyolysis, RTA are all common causes of what electrolyte abnormality?
Hyperkalemia
34
What are some causes of diabetes insipidus?
CNS injury, disorders the hypothalamus, secondary and primary renal defects, tumor resection
35
If uncorrected what is the final effect of hyperkalemia on an EKG?
Ventricular fibrillation
36
What is the clinical presentation of hyperthyroidism
Nervousness, irritability, tremor, excessive appetite, weight loss, smooth moist skin, increased perspiration, heat intolerance
37
What is the most common form of congenital adrenal hyperplasia?
21 hydroxylase deficiency
38
Slow sodium replacement, normal food intake are part of the management of what endocrine disorder?
CSW
39
What are three options to help remove potassium from the patient?
Kayexalate, dialysis if severe, diuretics or albuterol if mild
40
What is a normal urine sodium for SIDH?
Greater than 30
41
What is a normal urine osmolarity for DI?
Less than 200
42
What you're an output is typically seen in DI?
Greater than or equal to 4 ml per kg per hour
43
Vasopressin or DDAVP is used to treat what endocrine disorder?
Di
44
SIDH, adrenal insufficiency, hyperbola bulimia, hypovolemia, excess H2O intake are all causes of what electrolyte abnormality?
Hyponatremia
45
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
46
What is a normal urine sodium for CSW?
Greater than 80
47
What are some common causes of cerebral salt wasting?
Seen us injury or infection, endocrine disturbances, cardiac disease
48
For hypoglycemia what is the dose of glucose replacement?
10 or 25% glucose at 0.5-1 g per kg
49
What are three complications of hypocalcemia?
Seizures, tetany, myocardial irritability, long QT
50
What clinical findings are associated with hypothyroidism?
Growth retardation for muscle tone cold intolerance weight gain, bradycardia constipation
51
Is serum osmolarity less than 280 in DI, SIADH, CSW?
S i a d h and CSW
52
What you're an output is normally seen in SIADH?
Less than or equal to one ml per kilo per hour
53
What can be used to enhance the movement of potassium into the cells?
Sodium bicarbonate 1-2 mEq per kg
54
What sodium level constitutes hyponatremia? Hypernatremia?
Less than 135 severe is less than 125 Greater than 145 severe is greater than 160
55
What is a normal urine osmolarity for SIDH and CSW?
Greater than 200
56
What is the fluid management for DKA?
10 ml per kg bolus with slow fluid replacement over 24 to 48 hours
57
What additional medical complication you concern for in a patient with bulimia?
Dentition problems
58
What is Cushing's triad?
Hypertension, bradycardia, respiratory depression
59
What lab findings are associated with hyperthyroidism or thyroiditis?
Elevated t4 and a decreased TSH
60
What causes SIADH?
Sinus injury, high dose chemotherapy, diseases of hypothalamus or pituitary
61
What is the management for adrenal insufficiency?
Glucocorticoids
62
What key findings point to a metabolic disorder?
Hypoglycemia, hyperammoniemia, metabolic acidosis
63
What is the treatment for cerebral edema in DKA?
Manito 0.5 to 1 g per kg or 3% hypertonic saline.
64
What does the typical insulin drip start at in DKA?
.05 to 1 units per kg per hour
65
Newborn with ambiguous genitalia, salt wasting are signs of what endocrine disorder?
Congenital adrenal hyperplasia
66
What are some causes of metabolic acidosis with a normal anion gap?
Diarrhea, adrenal insufficiency, chronic kidney disease, spironolactone, hypoaldosteronism
67
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
68
What is unique about cerebral salt wasting?
Sodium excretion into the urine and diuresis with resultant type monotremia and euvolemia
69
Is serum osmolarity greater than 295 in DI, SIADH, or CSW?
D i
70
What is a normal urine sodium for DI?
Less than 30
71
What additional lab studies should be drawn in a patient with new onset diabetes
Insulin level, thyroid function tests, c-peptide levels
72
What are risk factors for cerebral edema in DKA?
Young age, new onset, bolus insulin dosing, bicarb administration, rapid fluid administration, kidney injury
73
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
74
A life-threatening condition causing hypertension, fever, tucka cardiac, and sweating is what hyperthyroid condition?
Thyroid storm
75
Is failure to thrive more commonly organic or inorganic?
90% inorganic
76
hypoglycemia, hyponatremia, hyperkalemia are a classic triad for what disorder?
adrenal insufficiency

CPNP- AC (14 decks)

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