Endocrine assessment and dx

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Author:
hrisney
ID:
245314
Filename:
Endocrine assessment and dx
Updated:
2013-11-06 20:08:12
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Critical Care Test
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Endocrine system
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  1. S&S of hyperglycemia
    • blurred vision
    • HA
    • weakness
    • fatigue
    • drowsiness
    • anorexia
    • flushed skin
    • polyuria
    • polydipsia
    • vomiting
    • dehydration
    • change in loc

    • kussmaul respirations
    • nausea
    • abd pain
    • hypoactive bowel sounds
  2. s&s hypoglycemia
    • shaky
    • dizzy
    • sweaty
    • tiredness
    • extreme hunger
    • HA
    • dizziness
    • blurred vision
    • diaphoretic
    • change in loc
  3. hypoglycemia glucose level
    severe-
    • glucose less than 70
    • less than 40
  4. normal fasting plasma glucose
    70-110 mg/dl
  5. HgbA1c
    normal
    dx of DM
    goal for diabetic
    • 4-6 %
    • 6.5
    • 7
  6. Ketones-
    why are ketones seen
    • -by product of fat metabolism
    • -in hyperglycemic pts sugar can't get into cells so body burns fat and produces ketones
  7. urine ketones
    • normally not present- seen when body metabolizing fat for energy
    • -not specific
  8. fx of ADH
    controls fluid in body
  9. where is ADH formed?
    hypothalamus, released from posterior pituitary
  10. normal urine osmolality
    50-1400 mOsm/kg H2O
  11. normal serum osmolality
    275-295 mOsm
  12. most accurate measure of fluid balance
    serum and urine osmolality
  13. target glucose level for critically ill pt
    140-180
  14. DKA- different than HHS in that
    • -associated w/ type 1 DM
    • -associated with illness and usually develops rapidly
    • -one of most commonly seen
  15. dx criteria for DKA:
    glucose-
    pH-
    bicarb-
    other-
    • greater than 250 mg/dl
    • arterial pH 7.3
    • serum bicarb less than 15 meq/L
    • moderate ketonemia or ketouria
  16. DKA dx by
    serum ketones, BMP, and ABG
  17. blood glucose levels in DKA can be
    300-800 mg/dl
  18. s&s DKA
    • malaise/extreme fatigue
    • HA
    • polyuria
    • polydipsia
    • N/V
    • CNS depression and decreased LOC, stupor
    • coma
    • dehydration
    • flushed dry skin
    • tachycardia and hypotension-due to dehydration
    • kussmaul respirations
    • fruity odor of acetone
  19. treatment DKA
    • follow protocol
    • replace insulin
    • reverse ketoacidosis
    • replenish fluids and electrolytes
    • -give NS
  20. HHS different than DKA in that
    • rarely seen
    • slow onset
    • type 2 DM complication
    • usually effects elderly
    • higher glucose levels than DKA
  21. dx criteria HHS:
    blood glucose-
    arterial pH
    serum bicarb
    serum osmolality
    ketones-
    • greater than 600 mg/dl
    • greater than 7.3
    • greater than 15 meq/l
    • greater than 320
    • minimal or no ketonemia or ketouria because type 2's have some insulin
  22. treatment of HHS
    • rapid rehydration with NS- need more fluid than DKA
    • -replace insulin
    • -correct electrolytes - K and phosphorus
    • -treat underlying stimulus for HHS
  23. DI
    • -result of not enough ADH
    • -characterized by large amount of dilute urine production/ greater than 300 ml/hr
  24. cause of DI
    most common cause in CC-
    • hyothalamus producing insufficient ADH
    • posterior pituitary failing to release ADH
    • kidney nephron resistance to ADH

    head trauma or pituitary surgery
  25. treatment of DI
    • ADH replacement
    • fluid replacement
    • meds- vasopressin (pitressin) and DDAVP (desmopressin)
    • treat cause
  26. SIADH
    • holding on to fluid because of too much ADH
    • kidneys hold on to too much water
    • dilutional hyponatremia
  27. causes of SIADH
    • head/ cns injury
    • malignant small cell carcinoma and other cancer
    • meds- thiazide diuretics and SSRI
    • PEEP with mechanical ventilation
  28. SIADH results in
    • overhydration
    • low sodium (dilutional)
    • concentrated urine
  29. treatment of SIADH
    • restrict fluids
    • Na replacement - concentrated saline 3%
    • stop meds that cause SIADH
    • diuretics- Lasix

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