1Panhypopituitarism is complete loss of.....
- Tropic hormone production
2ADH confirmed indirectly by _________. This is when...
Water Deprivation Testing
3GH Physiologic dosing= ______ & is divided into ___ or ____ doses per week
- 0.3mg/kg/wk
- 6 or 7
4Hydrocortisone for ACTH replacement: __ to __ times/day until ____. Typical dose is _____ mg/m2/day. Stress dosing: ____ ; IM solucortef for emergencies
- 3-4
- until growth completed
- 8-12
- 2-3x
5Fludrocortisone for ACTH treatment/dosing= ______
Typical dose is 0.1mg PO daily
6Levothyroxine for TSH replacement: Typically ~ _______. Titrated based on _____
- 1-2 mcg/kg/day
- labwork
7Type 1 Diabetes is an ______ process of _______ destruction located in the _______, leading to the loss of ______ production
- autoimmune
- pancreatic islet cell (beta cell)
- islets of Langerhans
- endogenous insulin
8Insulin total daily dose calculation....
0.7 x weight in kg (0.5-1.2 units/kg/day)
9Insulin Basal rate dosing calculation....
0.5 x weight in kg (or 1/2 of TDD) divided by 24
10Insulin Bolus dose calculation....
Insulin to carbohydrate ratios: 500/TDD
11 Insulin sensitivity factor calculation....
Current BG - Tatrget BG / ISF 1800/TDD
12Long Acting Insulin action times:
- Detemir: ____ hour action time (Levemir)
- Glargine: _____ hour action time (Lantus, Basaglar, Semglee, Rezvoglar)
- 12-24
- 18-24
13Ultra Long Acting insulin actions times:
- Toujeo (Glargine): _____ hour action
- Tresiba (Degludec): U100 & U200: ____ hour action
- 24-36
- 30-42
14Rapid or “short” acting insulins include _____, _____, & _____
Novolog (Aspart), Humalog (Lispro), Apidra (Glulisine)
15Ultra Rapid Acting Insulins include ______ & ______
Fiasp (Insulin Aspart), Lyumjev (Insulin Lispro-aabc)
16Hypoglycemia= BG < ____. s/s include.....
impaired vision, anxious, irritable, weakness, dizziness, shaking, hunger, rapid heart beat, sweating
17Hypoglycemia treatment: _____ of carbohydrate, IV dextrose- _____ of D5, _____ of D25, _____ of D50, _____, & _____
- 15 g
- 10 cc/kg
- 2cc/kg
- 1 cc/kg
- Baqsimi (Intranasal), Gvoke (subQ)
18Glucagon stimulates glucose release from ______, aka _______. Dosing= _____
- Liver
- glycogenolysis
- IM 0.03 mg/kg, max 1 mg
19Aldosterone (mineralocorticoid) Function= ___ reabsorption and ____ excretion; so when insufficient--> kidney loses _____ and holds on to __
- NA reabsorption and K excretion
- excessive water/na
- K
20Congenital Adrenal Hyperplasia (CAH) is a _______ that occurs at ______ or _____
- Primary AI
- birth or 1-4wks of life
21Congenital Adrenal Hyperplasia (CAH) presentation....
Ambiguous genitalia in females, lethargy, vomiting, diarrhea, FTT, dehydration, hyponatremia and hyperkalemia.
22Congenital Adrenal Hyperplasia (CAH) diagnostics...
- ACTH Stimulation Testing
23ACTH Stimulation Testing is done if cortisol level < ____. the process includes....
- 15
- Baseline cortisol level between 4-8AM
- Cortisol < 3 = adrenal insufficiency- Give injection
- Repeat labs in 30 min.
-If ACTH is high Primary AI
- if low then secondary/tertiary AI
24Adequate Adrenal Function= Cortisol level > _____. Insufficiency = cortisol level < ____
- 15
- 3
25Addison Disease diagnostics....
- ACTH Stimulation Testing
- often requires CT of adrenal glands
26Congenital Adrenal Hyperplasia (CAH) treatment...
If not making aldosterone: replacement of salt and fludrocortisone 0.1-0.2 mg and hydrocortisone as needed.
27Salt-wasting Congenital Adrenal Hyperplasia (CAH) occurs mostly in ____ and is ____
- Males
- most severe
28Salt-wasting Congenital Adrenal Hyperplasia (CAH) treatment
fludro, NaCl supp during infancy, cortisol replacement w/ hydrocort.
29Addison disease treatment
- Mineralocorticoids: fludrocort
-Glucocorticoid: hydrocort q6
30Primary adrenal insufficiency patients will need SDS if .... Dosing=
sick, febrile >101, mild to mod trauma, seizure, injured, and pre-op.
-Stress Dose: 25-50mg/m2/day
31Central DI= _______ and is caused by....
-Insufficient production or failure of pituitary
gland to secrete ADH
- Genetic (Wolfram Syndrome), Congenital (midline defects), Acquired (tumor, trauma, surgery, infection)
32Nephrogenic DI= _______ and is caused by....
- Resistance of renal collecting ducts to ADH
- Renal disease, Metabolic disturbances, Medications (AmphoB, Lithium)
33Differentiation of central vs. nephrogenic= Water deprivation test (nephron), Vasopressin (central)
....
34Diabetes insipidus is excretion of ____ d/t ADH deficiency
large volumes of dilute urine
35Syndrome of Inappropriate ADH is _____ secretion despite _____ & _____. Excessive H20 absorption in renal tubules→ ________ and _______ without ______
- excessive ADH
- normal osmolarity and euvolemia
- dilutional hyponatremia and weight gain without s/s edema
36Cerebral salt wasting is...
Renal loss of sodium leading to hyponatremia and volume depletion
37Three main hormones of the adrenal cortex are _______, _____, & _____
- Mineralocorticoids = Aldosterone
- Glucocorticoids = Cortisol
- Adrenal Androgen = Dehydroepiandrosterone
(DHEA)
38Signs and Symptoms of Mineralocorticoid (aldosterone) Deficiency
Weight Loss
Fatigue
Nausea, Vomiting, Anorexia
Salt-Craving
Hypotension
Hyperkalemia, Hyponatremia
Metabolic Acidosis with Normal Anion Gap
39Signs and Symptoms of Mineralocorticoid (Aldosterone) Excess
Hypertension
Elevated Sodium
Low Potassium
High Calcium
Fatigue
Headache
Muscle Weakness
40Cortisol release is controlled by the secretion of _____ by the _____ gland, which is controlled by _______ hormone secreted by the ______
- ACTH
- anterior pituitary
- corticotropin-releasing hormone (CRH)
- hypothalamus
41Cortisol fxn: Stimulates the liver to ________
& tells the body to ______. Inhibits _____ & stimulates catabolism of _____; has _____ effects; and decreases _____ & _____
- make glucose (gluconeogenesis)
- hold onto glucose
- muscle protein
- Anti-inflammatory
- eosinophils and lymphocytes
42Signs and Symptoms of Glucocorticoid (Cortisol) Deficiency
Hypoglycemia
Nausea, Vomiting
Fatigue
Muscle Weakness
43DI diagnostics
- inc. Serum NA+ (> 150)
- serum osmolality > 295
- low urine na: < 30
- Urine osmolality < 200
- urine SG < 1.005
- Inc. UOP
- Dehydrated
44DI management: calc free water deficit, Decrease Na+ levels by ___ to ___ mEq/L every ___ to ___ hours with a max of ___ to ____ mEq/L/24h
- 1-2
- 2-4
- 10-12
45DI vasopressin dosing
Start @ 0.5 mu/kg/h and increase by 0.5 mu/kg/h until UOP <2 mL/kg/h
46SIADH diagnostics
- dec Serum NA+ (< 135)
- serum osmolality < 280
- High urine na: > 30
- Urine osmolality > 200
- urine SG >1.020
- low UOP < 0.5 ml/kg/hr
- Hydration: normal or mild edema
47Cerebral Salt Wasting presentation
HA, NV, dehydration, hypotension, Depressed mental state, agitation, lethargy, seizures, coma
48Cerebral Salt Wasting diagnostics
- dec Serum NA+ (< 135)
- serum osmolality < 280
- High urine na: > 80
- Urine osmolality > 200
- urine SG >1.010
- High UOP > 2-3 ml/kg/hr
- Dehydration
49Cerebral salt wasting management: Correct Na+ slowly to prevent _______. Increase Na+ levels by _____ mEq/h and no greater than ____ mEq/L/24h
- central pontine demyelination
- 0.5-1
- 10-12
50Hyperglycemic Hyperosmolar State (HHS) complication of diabetes, usually type ____ due
to an ______ and an increase in ________
- 2
- insulin deficiency
- counter regulatory hormones