Key Takeaways
- DKA: fruity breath, Kussmaul respirations, hyperglycemia, ketones (Type 1)
- Hypoglycemia: treat with 15 g fast-acting carbs, recheck in 15 minutes
- Hyperthyroidism: heat intolerance, weight loss, tachycardia
- Hypothyroidism: cold intolerance, weight gain, bradycardia
- SIADH causes hyponatremia; DI causes hypernatremia
Endocrine and Metabolic Alterations
Endocrine disorders affect hormone production and metabolism, impacting virtually every body system. LPN/VNs must recognize signs and symptoms and understand management of common endocrine conditions.
Diabetes Mellitus
Types of Diabetes:
| Feature | Type 1 | Type 2 |
|---|---|---|
| Onset | Usually childhood/young adult | Usually adult onset |
| Cause | Autoimmune destruction of beta cells | Insulin resistance, decreased production |
| Body Type | Usually thin | Often overweight |
| Insulin | Absolute requirement | May or may not require |
| Ketosis | Prone to DKA | Rarely develops ketosis |
Diabetes Complications:
| Complication | Manifestations |
|---|---|
| Retinopathy | Vision changes, blindness |
| Nephropathy | Proteinuria, renal failure |
| Neuropathy | Numbness, tingling, foot ulcers |
| Cardiovascular | MI, stroke, peripheral vascular disease |
| Infections | Poor wound healing, UTIs |
Diabetic Emergencies
| Feature | Hypoglycemia | DKA (Type 1) | HHS (Type 2) |
|---|---|---|---|
| Onset | Rapid (minutes) | Gradual (hours-days) | Gradual (days-weeks) |
| Blood Glucose | < 70 mg/dL | > 250 mg/dL | > 600 mg/dL |
| Ketones | Absent | Present | Absent or minimal |
| pH | Normal | < 7.30 (acidosis) | Normal or slightly low |
| Symptoms | Shakiness, sweating, confusion, tachycardia | Kussmaul breathing, fruity breath, N/V, abdominal pain | Severe dehydration, confusion, seizures |
| Treatment | Fast-acting glucose, glucagon | IV fluids, insulin, electrolytes | IV fluids, insulin, electrolytes |
Hypoglycemia Treatment (Rule of 15):
- Give 15 g fast-acting carbohydrate (4 oz juice, glucose tabs)
- Wait 15 minutes
- Recheck blood glucose
- Repeat if still < 70 mg/dL
- Follow with complex carbohydrate/protein snack
Thyroid Disorders
Hypothyroidism vs. Hyperthyroidism:
| Feature | Hypothyroidism | Hyperthyroidism |
|---|---|---|
| Metabolism | Decreased | Increased |
| Weight | Weight gain | Weight loss |
| Temperature | Cold intolerance | Heat intolerance |
| Heart Rate | Bradycardia | Tachycardia, palpitations |
| Energy | Fatigue, lethargy | Restlessness, insomnia |
| Skin | Dry, coarse, cool | Warm, moist, diaphoretic |
| Bowel | Constipation | Diarrhea |
| Mental Status | Slow thinking, depression | Anxiety, irritability |
| Appearance | Puffy face, periorbital edema | Exophthalmos (Graves') |
Thyroid Storm (Thyrotoxic Crisis): Medical emergency in uncontrolled hyperthyroidism
- High fever (> 104°F)
- Extreme tachycardia
- Hypertension
- Altered mental status
- Treatment: Beta blockers, antithyroid drugs, cooling measures
Myxedema Coma: Medical emergency in severe hypothyroidism
- Hypothermia
- Bradycardia
- Hypotension
- Decreased LOC → coma
- Treatment: IV thyroid hormone, supportive care, slow rewarming
Adrenal Disorders
Addison's Disease (Adrenal Insufficiency): Decreased cortisol and aldosterone production
| Signs/Symptoms | Cause |
|---|---|
| Hypotension | Aldosterone deficiency → sodium/water loss |
| Hyperpigmentation | Increased ACTH |
| Weakness, fatigue | Cortisol deficiency |
| Weight loss | Decreased metabolism |
| Hyperkalemia | Aldosterone deficiency |
| Hypoglycemia | Cortisol deficiency |
Addisonian Crisis:
- Triggered by stress in someone with Addison's
- Severe hypotension, shock
- Treatment: IV hydrocortisone, fluids, vasopressors
Cushing's Syndrome (Cortisol Excess):
| Signs/Symptoms | Cause |
|---|---|
| Moon face, buffalo hump | Fat redistribution |
| Truncal obesity | Fat redistribution |
| Hypertension | Mineralocorticoid effect |
| Hyperglycemia | Glucocorticoid effect |
| Thin skin, easy bruising | Protein catabolism |
| Muscle weakness | Protein catabolism |
| Osteoporosis | Calcium loss |
| Immunosuppression | Glucocorticoid effect |
Diabetes Insipidus (DI) vs. SIADH
| Feature | Diabetes Insipidus | SIADH |
|---|---|---|
| Problem | Insufficient ADH or kidney unresponsive | Excess ADH |
| Urine Output | Excessive (polyuria) | Decreased (oliguria) |
| Urine Specific Gravity | Low (< 1.005), dilute | High (> 1.030), concentrated |
| Serum Sodium | High (hypernatremia) | Low (hyponatremia) |
| Fluid Status | Dehydration | Fluid overload |
| Thirst | Extreme | Decreased |
| Treatment | Desmopressin (DDAVP), fluid replacement | Fluid restriction, diuretics |
Memory Aid:
- DI = "Diabetes Insipidus = Dilute, Insatiable thirst"
- SIADH = "Sodium Is Always Dropping Here"
Parathyroid Disorders
Hyperparathyroidism (↑ PTH → ↑ Calcium):
- "Bones, stones, moans, and groans"
- Bone pain, fractures
- Kidney stones
- Abdominal pain, constipation
- Muscle weakness, fatigue
Hypoparathyroidism (↓ PTH → ↓ Calcium):
- Tetany, muscle spasms
- Positive Chvostek's and Trousseau's signs
- Seizures
- Cardiac arrhythmias
- Paresthesias
A patient with type 1 diabetes presents with fruity breath, deep rapid respirations, and blood glucose of 450 mg/dL. Which condition should the LPN/VN suspect?
Which signs would the LPN/VN expect in a patient with hyperthyroidism?
A patient is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What laboratory finding would the LPN/VN expect?