Session 5: Endocrine
- 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
- 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.
- 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.