ENDO/ABD- IM ROSH
hyperglycemic hyperosmolar state (HHS) - ANS--dehydration, hyperglycemia,
hyperosmolarity, and altered mental status
-Decreased insulin (or insulin action) leads to gluconeogenesis and increased
circulating glucose levels.
-->This draws fluid from the intracellular space into the intravascular space.
--->The resultant osmotic diuresis leads to profound intravascular dehydration,
electrolyte abnormalities, and hyperosmolarity.
-Typically, patients will have a blood glucose > 600 mg/dL and an osmolarity > 350
mOsm/L. Blood urea nitrogen and creatinine are usually elevated
-may present with confusion, lethargy, seizures, focal neurologic deficits, or frank coma.
-Significantly higher mortality than DKA
TX: Management includes IV fluids, may also need insulin/electrolyte replacement
Pituitary apoplexy COME BACK - ANS-The patient has pituitary apoplexy from a
pituitary tumor. The initial symptoms of pituitary apoplexy are related to the increased
pressure in and around the pituitary gland. The most common symptom, in more than
95% of cases, is a sudden-onset headache located behind the eyes or around the
temples. It is often associated with nausea and vomiting. The patient's clinical
presentation is also consistent with acute (secondary) adrenal insufficiency due to
inadequate ACTH production from the pituitary gland. Adrenal insufficiency manifests in
this patient as hypotension, fatigue, abdominal pain, and hyponatremia. It is also
associated with hyperkalemia and hypoglycemia. Hydrocortisone is the preferred steroid
to administer because it provides both glucocorticoid and mineralocorticoid effects.
Clinical improvement is usually seen within a few hours of steroid administration.
pituitary tumor - ANS-
Corticoadrenal Insufficiency - ANS-Corticoadrenal Insufficiency
1°: Addison disease
Weakness, fatigue, anorexia, weight loss
Hyperpigmentation (1° disease)
Hyponatremia and hyperkalemia (1° disease)
↑ ACTH = 1° disease
↓ ACTH = 2° disease
Hydrocortisone
Fludrocortisone (1° disease
,Insulin degludec: onset, peak effect, duration of action - ANS-onset: 2 hr
peak: no peak
duration 24 -42 hours.
NPH insulin onset, peak effect, duration of action - ANS-onset: 2hr
peak effect: 4-12hr
duration of action : 8-18hr
NPL insulin onset, peak effect, duration of action - ANS-onset: 2hr
peak effect: 6hr
duration of action: 15hrs
(Novolin N, Humulin N)
This product is a combination of two man-made insulins: intermediate-acting insulin
lispro protamine and rapid-acting insulin lispro. This combination starts working faster
and lasts for a longer time than regular insulin.
Rapid acting insulin: onset, peak effect, duration of action - ANS-Onset: 3-15min
Peak: 45-75min
Duration: 2-4hrs
given at time of meal
Lispro (humalog), Aspart (Novolog) , gulisine
Regular insulin onset, peak effect, duration of action
COME BACK YOU DIDN"T FINISH ALL THE INSULINS THESE NEED TO BE EDITED
- ANS-"short acting"
Onset: 30min
Peak: 2-4hr
Duration: 4-8hr
given prior to meal
(Humulin-R)
Low TSH, High T4, High T3 - ANS-Hyperthyroidism
Low TSH, Normal T4, Normal T3 - ANS-subclinical hyperthyroidism
Low TSH, Normal T4, High T3 - ANS-T3 toxicosis
, Low TSH, High T4, Normal T3 - ANS--Thyroiditis
-T4 Ingestion
-Hyperthyroidism in elderly/comorbid illness
Low TSH, Low T4, Low T3 - ANS--Euthyroid sick syndrome
-Central Hypothyroidism
High TSH, Normal T4, Normal T3 - ANS--subclinical hypothyroidism
-recovery from euthyroid sick syndrome
High TSH, Low T4, Low T3 - ANS-Primary hypothyroidism
High TSH, High T4, High T3 - ANS-TSH producing pituitary adenoma
Hypothyroidism - ANS--generalized weakness, fatigue, facial swelling, constipation, cold
intolerance, and weight gain
-PE: periorbital edema, dry skin and coarse brittle hair
-Labs: high TSH and low free T4, antithyroid peroxidase and antithyroglobulin
autoantibodies
-MC cause Hashimoto's thyroiditis
-TX: levothyroxine
-Takes about 6 weeks to see treatment effects. Monitor TSH
-Hashimoto's: RF for non-Hodgkin lymphoma
Thyroid Storm - ANS--Patient with a history of thyrotoxicosis
- tachycardia, hyperpyrexia, agitation, anxiety
-PE: goiter, lid lag, hand tremor, and warm, moist skin
-Labs: low TSH and high free T4 or T3
-MC cause acute event (infection, trauma)
TX:
1) beta blocker (propranolol)
2) thionamide (propylthiouracil or methimazole)
3) iodine solution
4) glucocorticoids
5) empiric antibiotics if infection is suspected
American Association Of Diabetes Diagnostic Criteria - ANS-- Symptoms of diabetes +
random BG >200mg/dl
-Fasting BG >126mg/dl on two separate occasions
-BG>200mg/dl two hours after 75 glucose load during an oral glucose tolerance test**
