common endocrine disorders
DESCRIPTION
Common Endocrine DisordersTRANSCRIPT
Common Endocrine Disorders
Sherry L. Knowles, RN, CCRN, CRNI
Orlando Regional Medical Center 2008
Common Endocrine Disorders
SIADH DI
DKA HHNK
Acute Hypoglycemia
Thyroid Storm
Myxedema Adrenal Insufficiency
The Endocrine System
The endocrine system is a network of glands and hormones that regulate and control both long and short term biological functions.
Pineal, Hypothalamus, Pituitary, Thyroid, Pineal, Hypothalamus, Pituitary, Thyroid, Parathyroid, Thymus, Adrenal, Pancreas, Gonads Parathyroid, Thymus, Adrenal, Pancreas, Gonads
The PITUITARY is known as the “master gland" due to its role in controlling and regulating the other glands of the body.
The Endocrine System
Maintains Homeostasis
Controls Metabolism
Regulates Fluid Balance
Controls Growth
Controls Reproduction
Mobilizes Stress Response
Acute Hypoglycemia
What is Acute Hypoglycemia? An Acute Drop In Blood Sugar Serum Glucose < 50
What causes Acute Hypoglycemia?
Causes of Acute Hypoglycemia
Insufficient Nutritional Intake
Excessive Insulin Dosing
Inadequate Production Of Glucose
Renal or Hepatic Insufficiency
Medications
Cardiovascular SignsCardiovascular SignsPalpitations
Tachycardia
Anxiety
Irritability
Diaphoresis
Pale, cool skin
Tachypnea
Signs & Symptoms of Acute Hypoglycemia
Neurological SignsNeurological SignsAgitation
Confusion
Slurred Speech
Staggering Gait
Paraplegia
Seizures
Coma
Treatment of Acute Hypoglycemia
Give Glucose Watch Glucose Levels Carefully
Diabetes Insipitus
What is Diabetes Insipitus? A Condition Resulting From Too Little ADH
Why is it called Diabetes Insipitus? The Term Diabetes Refers To Polyuria
What causes Diabetes Insipitus?
Causes of Diabetes Insipitus
Decreased ADH
Neurological Surgery
Head Trauma
Signs & Symptoms of Diabetes Insipitus
Polyuria
Hypovolemia
Dehydration
Shock
Polyuria
Severe Hypovolemia
Severe Dehydration
Elevated Serum Osmolality
Elevated Serum Sodium
Shock
Treatment of Diabetes Insipitus
Fluid Resuscitation
ADH Replacement (Vasopressin, Pitressin, DDAVP)
Treat The Cause
SIADH
What is SIADH? Syndrome of Inappropriate ADH Too Much ADH Secretion
What causes too much ADH?
Causes of SIADH
Head Trauma
Oat Cell Carcinoma
Other Cancers
Viral Pneumonia
Medications
Stress
Mechanical Ventilation
ADH
ADH Means Water Retention
Water is retained when ADH is secreted
Increased Plasma Concentration stimulates ADH Secretion
Excessive ADH levels may cause water intoxication and cerebral edema
Signs & Symptoms of SIADH
Hyponatremia
Low Serum Sodium Serum NA < 135
Low Serum Osmolality
High Urine Osmolality
Elevated Specific Gravity Urine specific gravity > 1.030
Elevated Urine Osmolality
Elevated ADH Level
Weight Gain Without Edema
Elevated CVP, PAP, PAWP
Hypertension
Concentrated And UOP
Headache
Altered LOC
Seizures
Treatment of SIADH
Monitor Fluid Balance, Monitor I & O
Restrict Fluids
Replace Na+ loss when necessary
May Give 3% (Hypertonic) Saline
May Give Dilantin or Lithium
May require Swan Ganz For Monitoring
May Give Diuretics
SIADH vs Diabetes Insipitus
SIADH Too Much ADH
Water Intoxication
Low Serum Sodium
Low Serum Osmolality
High Urine Osmolality
Diabetes Insipitus Too Little ADH
Dehydration
High Serum Sodium
High Serum Osmolality
Low Urine Osmolality
Treatment of SIADH vs Diabetes Insipitus
SIADH
Fluid Restriction
May Give Dilantin
May Give Lithium
3% Saline
Diabetes Insipitus Fluid Infusions
Hold Dilantin
Hold Lithium
Diabetic Ketoacidosis
What is DKA? Diabetic Ketoacidosis A Life-Threatening Complication Seen With Diabetes Mellitus Type 1
What causes Diabetic Ketoacidosis?
Causes of Diabetic Ketoacidosis?
Type 1 DM
Insufficient Insulin Dosing
Dilantin
Thiazide/Sulfonamide Diuretics
Signs & Symptoms of DKA
Serum Glucose 300-800
Ketoacidosis Present
Large Serum And Urine Ketones
Fruity Breath
Kussmaul Respirations
Serum pH < 7.3
Treatment of DKA
Reverse Dehydration
NS, then ½ NS
Restore Glucose Levels
D5 ½ NS When Glu 250
Restore Electrolytes
HHNK
What is HHNK? Hyperglycemic Hyperosmolar Nonketonic
Coma
A life threatening complication seen with Diabetes Mellitus Type 2
What causes HHNK?
Signs & Symptoms of HHNK
Serum Glucose 600-2000
Ketoacidosis Not Present
Absent Or Slight Serum And Urine Ketones
Normal Breath
Shallow Respirations
Serum pH Normal
Treatment of HHNK
Reverse Dehydration
NS, then ½ NS
Restore Glucose Levels
D5 ½ NS When Glu 250
Restore Electrolytes
DKA vs HHNK
DKA
Faster Onset
Glucose 300-800
Acidosis
Fruity Breath
Kussmaul Respirations
HHNK
Slower Onset
Glucose 600-2000
No Acidosis
Normal Breath
Shallow Respirations
Treatment of DKA vs HHNK
Reverse Dehydration
NS, then ½ NS
Restore Glucose Levels
D5 ½ NS When Glu 250
Restore Electrolytes
Thyroid Storm
What is Thyroid Storm? Critical Hyperthyroidism
What causes Thyroid Storm? Too Much Thyroid Medication Glandular Dysfunction Thyroid Tumors Medication
Signs & Symptoms of Thyroid Storm
Tachycardia
Palpitations
Murmurs
PAC’s/PVC’s
Hypertension
CHF
Nervousness
Confusion
Psychosis
Convulsions
Weakness
Heat Intolerance
Tremors
Diaphoresis
Nausea
Weight Loss
Pruritus
Alopecia
Treatment of Thyroid Storm
Treat Symptoms Give Medication
PTU (Anti-Thyroid) Glucocorticoids Iodides Calcium Channel Blockers
Myxedema
What is Myxedema? Hypothyroidism
What causes Myxedema?
Causes of Myxedema
Usually Precipitated By An Illness Infection, Trauma, Exposure To Cold Abrupt Withdrawal of Thyroid Hormones
Usually Seen In The Elderly
Has A High Mortality Rate
Signs & Symptoms of Myxedema
Altered mental Status
Defective Thermoregulation
Slowed Body Systems Decreased LOC Decreased respirations Decreased Heart Rate Hypotension Hypothermia
Treatment of Myxedema
Treat The Symptoms Warm Patient Give Fluids As Needed
Give Levothyroxine (Thyroid Supplement)
Adrenal Insufficiency
What is Adrenal Insufficiency? Life-Threatening Steroid Deficiency
What causes Adrenal Insufficiency? Steroid Withdrawal Acute Exacerbation of Chronic Insufficiency
Adrenal Insufficiency
Hypoadrenalism (Addison’s Disease)
hypotension, anorexia, weakness, hyperpyrexia
Hyperadrenalism (Cushing’s Syndrome)
hypertension, round face, hunchback, DM, psychosis
Signs & Symptoms of
Adrenal Insufficiency
Decreased Appetite
Weight Loss
Progressive Fatigue
Weakness
Nausea and Vomiting
Abdominal Pain
Dizziness
Personality Changes
Irritability
Restlessness
Diarrhea or Constipation
Increased Skin Pigmentation
Treatment of
Adrenal Insufficiency
Lifelong hormone replacement
Corticosteroids
Diabetes Mellitus
Type I - IDDM (5% - onset 15 yo) Type II - NIDDM (95% - onset 40+)
• 25-30% will require insulin eventually
Gestational - GDM Other types resulting from:
• pancreatic disease• hormonal disease• drug therapy• obesity (NIDDM)
Signs & Symptoms of Diabetes Mellitus
Primary Presentation polydipsia polyuria polyphagia weight loss loss of strength
Signs & Symptoms of Diabetes Mellitus
Additional Findings altered vision infections irritability drowsiness malaise
nocturia vulvular pruritis paresthesias impotence postural hypotension
Basic Insulin Therapies
Insulin (onset / peak / duration) Short acting
regular, semi-lente (15 min / 4-6 hrs / 6-8 hrs)
Intermediate NPH, lente (3 hrs / 8-12 hrs / 18-24 hrs)
Long acting PZI, ultralente (3-4 hrs / 14-20 hrs / 24-36 hrs)
Newer Insulin Therapies
Humalog / Novolog Rapid onset of action and clearance Allows for better matching to carbohydrate intake May give immediately after meals in small children
Lantus 24 hr basal insulin delivery No “ peak” effect Alternative basal-bolus therapy to the pump
End of Part One!
The Endocrine System