What are the characteristics of Type 1 Diabetes?
-Destruction of pancreatic beta cells, -previously known as Insulin
Dependent DM
(IDDM),
-usually Ketosis Prone
What are the characteristics of Type 2 Diabetes?
-Insulin Resistance/Low Insulin secretion,
-previously known as
Non-Insulin
Dependent DM (NIDDM),
-usually Ketosis Resistant
What is Gestational Diabetes?
Glucose Intolerance (onset pregnancy), DM associated with other conditions.
What are the diagnostic findings for DM (abnormally high blood
glucose
levels)?
- Random: = or>200 mg/dl
-Fasting: = or >126 mg/dl
- Postload Glucose: = or >200 mg/dl - Hypoglycemia: <60
mg/dl (blood glucose)
What are the causes of Hypoglycemia?
-Too much insulin,
-too much hypoglycemic agents,
-too
little food,
-excessive
physical activity
What are the clinical manifestations of Hypoglycemia?
Impaired CNS function
How can Hypoglycemia be prevented?
-Avoid delays in meal timing,
-meal or snacks every 4-5 hours (awake),
-don't skip
meals,
-check blood glucose regularly,
-carry a form of fast-acting sugar at all times, medical ID.
How is Hypoglycemia managed?
-Glucose tablets
-Fruit Juice/Soda,
-Hard Candy,
-Sugar or Honey,
-Glucagon SQ/IM for unconscious.
What is Diabetic Ketoacidosis?
Ketones are byproducts of Fat Breakdown. If not treated can cause altered level of consciousness coma death.
How is Diabetic Ketoacidosis treated?
Insulin,
Fluid and electrolyte replacement.
What is Hyperosmolar Hyperglycemic Non-Ketotic Syndrome (HHNS)?
Osmotic diuresis causes dehydration and altered mental status. No fat breakdown since pancreas is still producing insulin.
How is Hyperosmolar Hyperglycemic Non-Ketotic Syndrome (HHNS) treated?
Insulin,
Fluid and electrolyte replacement.
What are the long-term complications of Diabetes?
Coronary Artery Disease, Cerebrovascular Disease,
Peripheral
Vascular Disease,
Diabetic Retinopathy,
Nephropathy,
Diabetic Neuropathies,
Foot and leg problems.
What is Diabetes Insipidus?
-↓ADH,
-Polydipsia,
-Polyuria (diluted urine),
-Replace ADH with Desmopressin
(synthetic ADH).
What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
-↑ADH,
-Can't excrete a dilute urine,
-Retain fluids,
-Dilutional hyponatremia
How is Syndrome of Inappropriate Antidiuretic Hormone (SIADH) managed?
Fluid restriction,
Diuretics (Furosemide)
What is Hypothyroidism?
-↓ Thyroid hormone,
-Myxedema (advanced form of
hypothyroidism),
- Heat intolerance.
What is Thyroid Storm (Thyrotoxicosis Crisis)?
-High Fever (above 38.5),
-Extreme tachycardia,
-Exaggerated signs of hyperthyroidism.
How is Thyroid Storm (Thyrotoxicosis Crisis) managed?
-Hypothermia blankets,
-Icepacks,
-Avoid Acetaminophen and Aspirin,
-Worsens hypermetabolism by displacing bound thyroid hormones,
-Propylthiouracil and Methimazole
impede formation of
thyroid hormones,
-Iodine decreases output of T4 from the thyroid gland.
What is Thyroiditis?
Inflammation of the thyroid,
May cause thyrotoxicosis and
hypothyroidism or
both
What is Acute Thyroiditis and how is it managed?
-Caused by infection.
-Managed with Antimicrobial agents,
-Fluid replacement,
-Surgical incision and drainage if abscess is present.
What is Subacute Thyroiditis and how is it managed?
-Managed with NSAIDS to control inflammation,
-Avoid Aspirin.
What is Chronic Thyroiditis (Hashimoto's disease) and how is it managed?
-Autoimmune,
-Usually painless, slow and progressive.
-Managed with Thyroid
hormone therapy to reduce thyroid activity.
What is Hyperparathyroidism?
-↑PTH,
-Characterized by bone decalcification and development of renal calculi containing calcium.
What are the clinical manifestations of Hyperparathyroidism?
-↑Calcium in blood,
-Renal Calculi, also known as kidney stones
-Skeletal pain,
-Pathologic fractures.
How is Hyperparathyroidism diagnosed?
-Elevation of serum calcium levels, --Elevated concentration of
parathormone,
-X-ray bone changes
How is Hyperparathyroidism managed?
-Parathyroidectomy,
-Hydration therapy
-(2000ml or more
to prevent calculus formation,
-Cranberry extracts lower urine pH).
What is Hypoparathyroidism and its causes?
-↓PTH,
-Causes
-inadequate secretion of parathormone,
-removal of parathyroid gland.
What are the clinical manifestations of Hypoparathyroidism?
Hypocalcemia→ Tetany
How is Hypoparathyroidism diagnosed?
-Positive Trousseau's sign
-(Carpopedal spasm is induced by
occluding blood flow
for 3mins),
-Positive Chvosteks's
sign
-(Sharp tapping over facial nerve causes spasm or
twitching).
What is the medical management for Hypoparathyroidism?
-IV Calcium gluconate (at bedside),
-Parenteral Parathormone,
-Quiet and dark environment for tetany.
What is Pheochromocytoma?
Tumor in adrenal medulla (Epi and Norepi)
What are the clinical manifestations of Pheochromocytoma?
FIVE H's
-Hypertension,
-Headache,
-Hyperhidrosis
(Diaphoresis),
-Hypermetabolism,
-Hyperglycemia.
How is Pheochromocytoma diagnosed?
-Urine and Plasma measurement of catecholamines (epi and
norepi),
-Urine and
Plasma measurement of Metanephrine
(catecholamine metabolite),
-Vanillylmandelic
acid.
-Avoid Vanilla, Coffee, Tea, Chocolate, Banana, Aspirin as they may
alter test
results.
-Imaging; CT, MRI, UTZ.
How is Pheochromocytoma managed?
-Hypertension or anxiety attack,
-Bed rest with head of the
bed elevated,
-Adrenelectomy.
What is Addison’s Disease (adrenocortical insufficiency)?
-Cortical hormones (steroids)
-Glucocorticoids
(hydrocortisone),
-Mineralocorticoids (aldosterone),
-Sex hormones (androgen). Causes
-Autoimmune,
-Idiopathic
atrophy of the adrenal glands,
-Tuberculosis infections destroy
adrenal glands,
-Therapeutic use of corticosteroids.
What are the clinical manifestations of Addison’s Disease
(adrenocortical
insufficiency)?
-Muscle weakness,
-Anorexia,
-Fatigue,
-Hypotension,
-Low blood glucose,
-Low serum sodium,
-High serum potassium,
-Altered mental status,
-Addisonian’s Crisis
(hypotensive crisis) (cyanosis,
circulatory shock, pallor)
How is Addison’s Disease (adrenocortical insufficiency) diagnosed?
Serum cortisol and ACTH.
How is Addison’s Disease (adrenocortical insufficiency) managed?
-Monitor glucose and K levels,
-Administer meds to replace low
levels of cortisol
and aldosterone - Prednisone and
hydrocortisone, Fludrocortisone.
-Diet Increased CHON
&
CHO,
-avoid stress.
What is Cushing’s Syndrome?
-Increased cortical hormones (steroids).
-Causes
-Steroid tx,
-Pituitary tumor,
-Adrenal hyperplasia.
What are the clinical manifestations of Cushing’s Syndrome?
-Central obesity,
-Buffalo hump,
-Thin extremities,
-Sleep disturbance,
-Glucose intolerance,
-Na &
H2o retention,
-Moon Face,
-Virilization (masculine features).
How is Cushing’s Syndrome diagnosed?
Dexamethasone suppression test.
How is Cushing’s Syndrome managed?
Tumor excision, Radiation, Adrenalectomy
Dopamine antagonist (Hyperparathyroidism)
Bromocriptine cabergaline
Somatostatin (Hyperparathyroidism)
Ocreotide
Corticosteroids for Hypopituitarism
Levothyroxine
Central DI
Desmopressin
Vasopressin
Nephrogenic DI
Hydrochlorothiazide
DOC for calcium supplementation in post total thyroidectomy
Calcium gluconate
DOC for pregnant women with hyperthyroidism
Propylthiouracil
Antihypertensive DOC for clients with pheochromocytoma
Nitroprusside