Session 5: Endocrine

Session 5: Endocrine

 

Diabetic Ketoacidosis

  • More common in DM1 but possible in DM2
  • s/s dry mucous membranes, tachycardia, hypotension, Kussmaul respirations, glucose over 250, dehydrated Altered LOC.
  • HypoKAlemia, HypoNatremia,
  • The cells cannot take in glucose so they must metabolize fats, which causes a waste product of Ketone acid.
  • Give Insulin and monitor electrolytes and replace any that are out of normal, Give bicarb

 

HHNS – Hyperosmolar Hyperglycemic nonketotic Syndrome

    • Common in DM2
    • s/s: NO ketones production, GLU > 600,

 

  • FIRST THING TO GIVE: FLUIDS!!!!!, then insulin

 

  • Not giving BiCarb

 

SIADH – Retaining water, not urinating

  • Too much ADH
  • Low electrolytes
  • Do not replace Na too quick due to cerebral swelling.
  • 8-12 MeQ per day Na replacement.
  • These people may need to be on a fluid restriction, with no free water.
  • Demeclocycline – reduces the action of ADH

DI – always urinating

  • Not enough ADH
  • Dehydration
  • Tachycardia, hypotension, thirsty, dehydration…
  • DDAVP – reduces the urine output
    • This will not work with nephrogenic DI because the issue is with the nephron not ADH.

 

Cushing’s disease

  • Increased production of the “stress” hormone ACTH from the pituitary tumor
    • This is usually caused by a pituitary tumor
  • At risk for everything associated with glucocorticoids
  • Buffalo hump, mustache, hair loss, thin arms, large abdomen, Moon face, weight gain, insomnia, thin skin.
  • Alternate s/s: depression, changes in appetite, Fatigue, decreased concentration and libido.
  • These people will need to be on exogenous corticosteroids to counteract the glucocorticoid ACTH
    • Do not abruptly stop the medication.
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