DKA
What is the number one cause of DKA?
Infection (sepsis, flu, stomach virus)
What is the main difference between DKA and HHS?
The BG level. DKA is 250 to 500 and HHS is 600+.
What condition occurs as a result of hyperthyroidism?
Thyroid Storm
What are causes of hypothyroidism?
Low iodine, hashimoto's, pituitary tumor, thyroidectomy
What are the symptoms of DI?
Decreased BP, dry skin, diluted urine, thirst, dehydrated, high urine output, high urine output
What is the first line of treatment for DKA?
Fluids, rehydration (NS)
What are the treatments for HHS in degree of importance?
Hydration
Stabilizing BG
Slow correction of BG so we do not cause hypoglycemia.
(no K replacement w/ this)
What are the causes of hyperthyroidism?
Increased T3 and T4, graves disease, iodine excess, levothyroxine excess
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing?
Thyroid storm, Myxedema coma, Iodism, or Toxic Nodular Goiter
b. Myxedema coma
What are then main labs to focus on for this?
Sodium, Serum osmolality, specific urine gravity
What are the three P's of DKA?
Polydipsia, polyphasia, polyuria
Interventions for pt with HHS
Hourly BG checks, stable BP, rehydration, making sure they have an output of 30mL/hr.
What are the symptoms of hyperthyroidism?
Agitation and confusion early sign, weight loss, goiter, exopthalumus (grape eyes), high BP, high HR, heart palpations (Afib), sweatiness, high temp, heat intolerance, diarrhea
What are the symptoms of myxedema coma?
Bradycardia, edema, cognitive changes, low T3 and T4, low RR, hypotension, cold intolerance, low temp, weight gain
These patients will have what lab values?
When do you switch from IV insulin to SQ insulin in DKA patients?
When they are stable and their BG is lower than 200 or they no longer have ketones in their urine.
What are the treatments for HHS?
Fluid first (if Na is elevated or normal, IV fluid changed to hypotonic solution), insulin (regular), manage electrolytes (replace K must be >3.3)
What type of diet do these patients need?
High calorie, high protein, high carb, frequent snacks and meals
NO FIBER, NO Caffeine, NO Spicy foods
What are risk factors and things to avoid with this condition?
Abrupt stop of levothyroxine, thyroidectomy, avoid giving narcotics, avoid giving sedatives
What are the treatments?
Give fluids, desmopressin, thiazide diuretics
You must always add _______ when you give insulin.
Potassium replacement along with the insulin to prevent an MI.
When do you switch from an insulin drip to subcu insulin?
Blood glucose 200 mg/dL or less and at least 2 of the following criteria:
1) venous pH >7.30
2) Sodium bicarb >15 mEq/L
3) Anion gap is a 12 mEq/L or less
monitor glucose at least q6-8 hours
What do you do to treat this?
Methimazole, PTU, SSKI (K iodide), beta blockers, radioactive iodine uptake
What are the treatments?
Levothyroxine (long term will be on this forever)
What is the cause of DI?
damage to brain, brain tumors, trauma, surgery