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Endocrinology, Neurological, Gastrointestinal Disorders

Terms in this set (165)

H&P of diabetic ketoacidosis
diabetes symptoms and abdominal pain, N/V, dehydration (polydipsia/polyuria), hypotension, tachycardia, tachypnea (kussmaul respirations), fruity breath, altered mental status...check levels of electrolytes/Na/K/glucose/Cl/CO2/anion gap using BMP and do urinalysis and EKG and also check for ketones
ICU admission
Normal saline IV (isotonic fluid)
Insulin IV Bolus then Infusion
Monitor and correct electrolytes (potassium, sodium, magnesium, phosphate)
Treat underlying cause
Consider Sodium bicarbonate...continue monitoring!
treatment for diabetic ketoacidosis
H&p of hypoglycemia
Sweating, blurred vision, dizzy, anxiety, hunger, confusion, irritability, shakiness, fast heartbeat, fatigue
Diaphoresis, tachycardia, agitation, neurologic findings (any ranging from altered mental status or tremor to focal neurologic deficit or seizure...whipple's triad (symptoms, low plasma glucose documented, relief of symptoms when glucose level raised
Outpatient: If no altered mental status - self care, Fast-acting Oral glucose tabs/Food like OJ, Followed by complex CHO; If altered/needs assistance- Glucose paste (tube of frosting or Glucagon IntraNasal /SQ or IM Call 911)...
EMS and Hospital (stepwise): Glucose oral or IV (dextrose in 50% solution), Glucagon IM or SQ, IV infusion 10% dextrose solution may be required, Hypoglycemia refractory to glucose may require hydrocortisone or glucagon, Octreotide used to prevent recurrent sulfonylurea-induced hypo (inhibit secretion of insulin from pancreas)
treatment for hypoglycemia
H&P of hyperthyroidism in general
Nervousness, Anxiety, Hyperactivity, Fatigue, Heat intolerance, Increased perspiration, Palpitations, exertional dyspnea, angina, Increased bowel movements - hyperdefecation, Weight loss or weight gain, Amenorrhea/oligomenorrhea
Warm, moist, smooth skin, Sweating, Fine hair growth, Onycholysis, Fine Hand tremor, Muscle weakness, Hyperreflexia
Thyroid exam: ± Goiter ± Bruit, Cardiopulmonary: Sinus tachycardia, A. Fib, PACs, Systolic hypertension...Eye manifestations: Lid lag with downward gaze, Upper eyelid retraction, Stare...check TSH-low and T4/T3-high antithyroid ab, and radioactive iodine uptake and scan, possible US, CBC, CMP, Lipid panel
Anti-thyroid Medications (Methimazole preferred, Propylthiouracil used in pregnancy, Iodinated contrast agents to block conversion of T4 to T3 (Iopanoic acid or ipodate sodium), Radioactive Iodine with I131 (RAI) to Ablate the thyroid, Propranolol for relief of tachycardia/tremor/diaphoresis/anxiety until hyperthyroidism resolves...consider thyroidectomy
treatment for hyperthyroidism in general
H&P of graves disease
symptoms of hyperthyroidism with diplopia, gritty eyes, diffuse goiter (assymetric, nontender, possible bruit), exopthalamos, thyroid dermopathy (lateral aspects of shins thickened skin), thyroid acropachy (swelling/clubbing of finger toes)...test for TSI (positive) and look at RAI
Methimazole/propylthiouracil, iodinated contrast, RAI (ablation of thyroid, presence of opthalmopathy is contraindication and pregnancy considerations)
Consider: decompressive therapy and orbital radiotherapy and glucocorticoids (to help with inflammation of eyes)
treatment for grave's disease
H&P of thyroid storm
Fever, Palpitations, Vomiting, Diarrhea, Abdominal pain, CNS dysfunction (Marked agitation, Seizures, Delirium, stupor, Coma), anxiety, psychosis, symptoms of hyperthyroidism (tremor, warm moist skin, goiter, opthalmopathy)
Fever (frequently exceeds 40C), cardiac HTN (maybe hypotension in late stages with shock), tachycardia, a-fib, CHF, dehydration, respiratory distress where TSH is decreased and T4/T3 extremely elevated
ICU admission
IV fluids
Aggressive control of hyperthermia (ice/cooling blankets/antipyretics)
Meds: IV propranolol, Propylthiouracil Oral/IV, glucocorticoids, Oral/IV ipodate sodium (start 1 hr after PTU)
Supportive care usually required: Vasopressors, mechanical ventilation, dialysis, venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock
Definitive treatment is RAI (ablation of thyroid) after storm resolves
treatment for thyroid storm
H&P of addison disease
Sx may be acute and gradual (mo-yrs)
Sx due to glucocorticoid deficiency: fatigue, asthenia (reduced stamina), weakness, anorexia, wt loss, myalgia, arthralgia, irritability/anxiety, depression
Symptoms for 1° due to mineralocorticoid deficiency: salt craving, dizzy, abdominal pain, N/V
Androgen deficiency: abnormal menstruation...Hypotension, orthostatic hypotension, hyporeflexia, fever
1° signs: excess ACTH stimulates melanocytes so skin pigment of freckling to bronze appearance
Adrenal androgen deficiency: scant pubic hair and hypogonadism
Corticosteroids (hydrocortisone), Mineralocorticosteroids needed for only primary (fludrocortisone), Consider DHEA
Patient Education: Medical alert bracelet stating use of corticosteroids, Dose escalation schedule (double dose if stress/illness, triple if infection, surgery, trauma) Infections treated immediately
treatment for addisons disease
H&P of addisonian crisis
profound hypotension, acute pain (abdomen, lower back), nauseas, vomiting, diarrhea, dehydration, altered mental status
give 5 S's (salt/sugar/steroids/support/search for cause): IV saline, IV glucose, IV hydrocortisone phosphate, correct electrolytes, treat underlying cause (IV abx if infection)
treatment for addisonian crisis
bell's palsy (CN VII nerve palsy)
Paralysis of facial nerve (CN VII), unknown cause but could be due to herpes or viral as the virus lays dormant in the nerve root...Development of sxs in 24-48 hours, unilateral involvement of the facial nerve, no other neuro deficits (stroke with have paresthesia of limbs/same side all down body), Bell's palsy only involves the face!, +/- post auricular pain
Unilateral face droop with forehead involvement (stroke won't involve forehead), sudden onset, +/- hx of comorbidities
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