Endocrine Em

Front 1

ENDOCRINE EM

Back 1

ENDOCRINE EM

Front 2

Define neuroglyopenic

Back 2

an autonomic catagory of hypoglycemia. Shortage of glucose in nerve cells of the brain.

Front 3

Define hyperepinephrinemic

Back 3

A sympathomimetic catagory of hypglycemia.

Front 4

Define hypoglycemia

Back 4

an abnormally low concentratrion of glucose in the circulating blood

Front 5

Define diabetic ketoacidosis

Back 5

DKA: buildup of ketones in blood due to breakdown of stored fats for energy: untreated can lead to death

Front 6

Define hyperosmolar hyperglycemic nonketotic

Back 6

complication seen in DM. marked hyperglycemia occurs causing osmotic shifts in water in brain cells and resulting in coma. Can be fatal or lead to permanent neurologic damage

Front 7

Define alcoholic ketoacidosis

Back 7

an accumulation of ketones in the blood, caused by excessive alcohol consumption

Front 8

When serum glucose levels are <50mg/dl what is it called

Back 8

hypoglycemia

Front 9

What clinical situations may be associated with hypoglycemia

Back 9

DM, sepsis, liver disease, alcohol intoxication, starvation and certain toxic ingestions.

Front 10

What are the 2 main catagories of hypoglycemia

Back 10

neuroglycopenic (autonomic) and hyperepinephrinemic (sympathomimetic)

Front 11

Describe signs and symptoms of hypoglycemia

Back 11

potential cause of altered mentation, can mimic sxs of stroke, TIA, seizures, narcolepsy, MS, psychosis, drug OD, hysteria just to name a few

Front 12

Explain the primary metabolic derangement and precipitating factors in DKA

Back 12

lack of insulin & exces counterregulatory hormones result in hyperglycemia (due to excess production and underutilization of glucose), osmotic diuresis, pre-renal azotemia, ketone formation, & wide-anion gap metabolic acidosis

Front 13

Discuss clinical features of DKA

Back 13

Abnormal vitals may be only PE finding. Tachycardia, orthorstasis or hyptension. Poor skin turgor, acidemia, Kussmaul resp, fruity odor, hypothermia, abd px

Front 14

Discuss typical changes in chem panel and CBC for DKA

Back 14

↑anion gap, acidosis, glycosuria, hyperglycemia, ↓pH,(↑amylase but↑lipase more specific to pancreatitis & used to differentiate)

Front 15

What ECG changes might you see with DKA

Back 15

May be transient due to rapidly changing metabolic status. Underlying rhythm is sinus tachycardia then progresses: Tall peaked T, short QT interval → prolonged PR → wide WRS flat P → V-fib, complete heart block & asystole

Front 16

What diagnostic tests help in evaluating and managing DKA

Back 16

glucose test strip, urine dip, ECG, blood gas, serum electrolytes evaluating for wide anion gap and metabolic acidosis

Front 17

Identify the treatment goals for DKA

Back 17

volume repletion, reversal of metabolic consequences of insulin insufficiency, correction of electrolyte & acid base imbalances, recognition & tx of causes and avoid complications

Front 18

Discuss the treatment of DKA with respect to fluid administration

Back 18

Rapid fluid administration single most important initial step. helps restore volume & normal tonicity, perfuse organs, improve GFR & ↓ serum glucose & ketones

Front 19

Discuss the treatment of DKA with respect to insulin

Back 19

Avoid IM/subQ insulin. Absorption erratic when volume depleted delaying adequate insulin level. Delayed absorption can cause later hypoglycemia

Front 20

Discuss the treatment of DKA with respect to Potassium

Back 20

Large amounts of K+ necessary 1st 24-36h. Goal is to maintain normal extracellular K+ during acute phase and replace intracellular deficit over days

Front 21

Describe signs nad symptoms of alcoholic ketacidosis AKA-AKA and precipitating factors

Back 21

No specific PE soley w/AKA. Most common: tachycardia, tachypnea, mild-moderate abd tenderness. Volume depletion from anorexia, diaphoresis, NV.

Front 22

Explain the basis for the diagnosis of AKA and the use of confirmatory laboratory testing

Back 22

electrolytes, BUN, creatinine, hepatic/pancreatic enzymes, WBC, hematocrit, UA, anion gap, serum lactic acid, osmolarity, ABG

Front 23

Describe the general treatment of AKA

Back 23

glucose & volume repletion: D5NS.

Front 24

What do DKA and HHNS (hyperosmolar Hyperglycemic Nonketotic Syndrome) have in common

Back 24

hyperglycemia, hyperosmolality, severe volume depletion, electrolyte disturbances, sometimes acidosis.

Front 25

What do pt's with DKA have that pt's with HHNS don't have

Back 25

higher levels of lipolysis and more profound acidosis.

Front 26

Describe the presentation and PE findings in HHNS

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poor skin turgor, dry membranes, sunken eyes, hypotension, hyperglycemia, hyperosmolality, hypothermia, 15% seizures resistant to anticonvulsants

Front 27

What precipitating causes may be present with the non-diabetic pt with HHNS

Back 27

Acute CVA, burns, MI, infection, pancreatitis or other acute illness.

Front 28

Discuss the treatment of HHNS including the importance of fluid rescuitation

Back 28

tissue perfusion key to effective recovery in HHNS. correct hypovolemia, underlying causes, electrolyte abn, hyperglycemia, osmolarity.

Front 29

Discuss thyroid storm as it relates to precipitating events

Back 29

infection, truama, DM ketoacidosis, MI, CVA, pulmonary thromboembolic disease, general surgery, withdrawal of thyroid rx, iodine, palpation of thyroid gland, ingestion of thyroid hormone, idopathic 20-25%

Front 30

Discuss thyroid storm as it relates to mortality rates

Back 30

mortality rates high even with tx: 10-75%

Front 31

Discuss thyroid storm as it relates to confirmatory lab findings

Back 31

lab analysis not helpful. nonspecific findings might include: leukocytosis, hyperglycemia, increased transaminases and bilirubin. Further tests aimed at underlying causes

Front 32

Describe the treatment of thyroid storm

Back 32

1.ABC 2.↓ de novo synthesis: propylthioracil / methimazole 3.Prevent relase of hormone: iodine, lithium carbonate 4. Prevent peripheral effect: B-blocker, guanethidine, reserpine 5. Other considerations: corticosteroids, antipyretics

Front 33

What consideration must be factored before administering iodine in pt with thyroid storm

Back 33

Do not administer iodine until the synthetic pathway has been blocked. Otherwise may promote further hormone production

Front 34

describe myxedema coma

Back 34

rare clinical state with long standing preexisting hypothyroidism presents with life threatening decompensation. Mostly common in elderly

Front 35

Describe precipitating events for myxedema coma

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infection, cold exposure, rx (sedatives, lithium, amiodarone) trauma, stroke, CHF, inadequate thyroid hormone replacement & undx hypthyroidism

Front 36

Describe clinical features of myxedema coma

Back 36

severe decompensated metabolic state, ↓ mental status, hypothermia, bradycardia, hypoventilation, periorbital edema, nonpitting edema, delayed DTR, hypoglycemia, hyponatremia

Front 37

Describe treatment for myxedema coma

Back 37

Recognition, supportive including vent, thyroid replacement, glucocorticoid, hyothermia, electrolyte correction, hypoglycemia, Tx cause, admit for monitoring

Front 38

Why is glucocorticoids recommended for myxedema coma

Back 38

avoids the portential of precipitating adrenal crisis in pts with unrecognized adrenal insufficiency or hypothyroidism secondary to hypopituitarism. Baseline cortisol level should be obtained

Front 39

Identify the most common cause of tertiary adrenal insufficiency

Back 39

chronic administration of exogenous glucocorticoids, leading to failure of anterior pituitary to secrete ACTH resulting in adrenal atrophy

Front 40

Discuss the cause and presentation of adrenal crisis

Back 40

life-threatening hypotension resistant to catecholamine and IV fluids. If cortisol not replaced - death.

Front 41

Discuss the response to treatment and the main causes of death in adrenal crisis

Back 41

tx w/glucocorticoids, several liters of D5NS to correct hypovolemia/glycemia

Front 42

Suspected what when unexplained hyponatremia & hyperkalemia in setting of hypotension & unresponsive to catecholamine & fluid administration?

Back 42

Adrenal crisis