disease: d/t ACTH-producing pituitary tumor

syndrome: usually iatrogenic; caused from medications (corticosteroids). syndrome more common than disease.

Name the endocrine disorder:

increase of corticosteroids, which causes

increased aldosterone

and increased glucocorticoids

Name the endocrine disorder:

Name the endocrine disorder:

r/f: FVE

hypernatremia

hypokalemia

metabolic alkalosis

hypocalcemia

Hypercortisolism (Cushings)

FVE: d/t increased aldosterone

hypernatremia: d/t increased aldosterone

hypokalemia: because its excreted in exchange for Na+

metabolic alkalosis: r/t H+ shifting intracellulary in exchange for K+

hypocalcemia: incresed Na+ promotes excretion of Ca+ and because Ca+ acts as a buffer against alkalosis by binding to albumin

Name the endocrine disorder:

hyponatremia

FVE

SIADH

hyponatremia: d/t excess water retention

FVE: r/t excess ADH

Name the endocrine disorder:

FVD

hyponatremia

hyperkalemia

r/f metabolic acidosis

Addison's Disease

FVD: r/t decreased aldosterone

hyponatremia: r/t decreased aldosterone

hyperkalemia: r/t decreased aldosterone

r/f metabolic acidosis: r/t H+ shifting extracellularly in exchange for K+

Name the endocrine disorder:

r/f FVD

r/f hypernatremia

Diabetes Insipidus

r/f FVD: d/t water loss d/t inadequate ADH

r/f hypernatremia: r/t water loss without Na+ loss

diuretics

Na+ restriction

diet: high in potassium, low in carbs

increase calcium and vitamin D in diet

calcium carbonate

FVD and/or hyponatremia: IV NS with hydrocortisone

hyperkalemia: kayexalate with 20-100 ml sorbitol

metabolic acidosis: treat hyperkalemia and administer HCO3 if ph <7.1

FVE: restrict fluid intake to <500-1000ml, hypertonic saline (3-5%), furosemide

hyponatremia: diet high in Na+ and protein, free water restriction, democlocycline and/or lithium

FVD: allow free water, if not taking PO than hypotonic IV (d5w or .45NS), vassopressin, thiazide diuretics

hypernatremia: slow onset (over 2 days) - correc slowly with hypotonic soln (.45NS)

acute (present <12 hrs) - correct more rapidly with 6-8 meq over 3-4hrs then 1meq/L/hr

watch salt intake if taking thiazide diuretic

Sick days and diabetes:

When should they call the doctor?

 BG >300 X2

BG <90

inability to drink adequat fluids

inability to control diarrhea or vomiting

moderate or greater ketones

Diabetes and sick days: 

what to do if BG >300?

drink only carbohydrate-free beverages, at least 4oz/hr

call MD of >300 X2

1. resuscitate with 0.9%NaCl unless corrected Na is high

2. Insulin administration

3. When blood sugar is <250, add D5 to IV soln (usually d5.45NaCl)

4. IV K+ supplementation when K+ <5.2meq/L, use potassium phosphate for 1/3 of replacement

5. No bicarb replacement needed unless pH < or = 6.9

6. monitor bg hourly, BMP (electrolytes) q 2 hrs

7. monitor for hypophosphatemia, replace prn

Principles for ketoacidosis treatment:

Insulin administration

a. hold if K+ is < or = 3.3meq/L (replace K+ first)

b. Give IV regular insulin bolus (0.1 unit/kg)

c. insulin infusion via protocol to lower BG by 50 - 100/hr, continue until ketones clear (usually 24-72 hours)

Sick days and diabetes: 

What to do if unable to eat usual foods?

test bg q4hrs

if BG is under 300, eat sick day foods

hourly (ex. 4oz. 7-up) to prevent

hypoglycemia and dehydration

  If BG > 300, drink only carbohydrate-

      free beverages, at least 4 oz/hr

Protein will increase renal solute load and thus increase urinary output

Why administer Kayexalate with 20-100 ml Sorbitol for treatment of hyperkalemia d/t Addison's Disease?

Kayexelate releases Na+ in exchange for K. Helps K+ be moved to intestines to be excreted.  Sorbitol helps move Kayexlate into the intestines 

Loss of excess K+ will allow H+ to move back into cells, correcting acidosis