Endocrine Concepts for CCRN Review

Sep 26, 2024

Endocrine Concepts and CCRN Exam Review

Instructor: Nurse Jenny from Nurse Life Academy

Key Topics Covered:

  1. Hypoglycemia and Beta Blockers
  2. Serum Osmolality and Urine Specific Gravity
  3. Antidiuretic Hormone (ADH) and SIADH
  4. Hyperthyroidism and Hypothyroidism
  5. Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS)
  6. Addisonian Crisis and Adrenal Insufficiency
  7. Diabetes Insipidus (DI)

1. Hypoglycemia and Beta Blockers

  • Question: Which medication masks initial signs of hypoglycemia?
    • Answer: Metoprolol (beta blocker).
  • Key Points:
    • Hypoglycemia symptoms: shakiness, increased heart rate, irritability.
    • Beta blockers mask these symptoms leading to severe symptoms like lethargy or coma.
    • Causes of hypoglycemia: excessive insulin, physical activity, stress, interrupted nutrition.
    • Treatment: glucose gel/juice for conscious patients, IV dextrose for unconscious, glucagon IM if no IV access.

2. Serum Osmolality and Urine Specific Gravity

  • Question: Normal values for serum osmolality and urine-specific gravity?
    • Answer: Serum osmolality: 275 to 295 mOsm/kg; Urine-specific gravity: 1.010.
  • Key Points:
    • Serum osmolality: measures solutes in blood, normal range (275-295 mOsm/kg).
    • Urine specific gravity: concentration of solutes in urine, normal 1.010.

3. Antidiuretic Hormone (ADH) and SIADH

  • ADH Function: Maintains fluid balance, part of RAS pathway.
  • SIADH: Excess ADH leads to water retention, low serum osmolality, hyponatremia.
    • Causes: Oat cell carcinoma, viral pneumonia, head trauma.
    • Complications: Risk of seizures due to hyponatremia.
    • Treatment: Free water restriction, correct sodium carefully.

4. Hyperthyroidism and Hypothyroidism

  • Hyperthyroidism
    • Symptoms: Fast metabolism, tachycardia, weight loss, heat intolerance.
    • Labs: Increased T3, T4, decreased TSH.
    • Treatment: Medications to decrease T3 and T4, possible thyroidectomy.
  • Hypothyroidism
    • Symptoms: Slow metabolism, weight gain, fatigue, bradycardia.
    • Labs: Decreased T3, T4, increased TSH.
    • Treatment: Levothyroxine (synthetic T4).

5. Diabetic Ketoacidosis (DKA)

  • Presentation: Type 1 diabetes, hyperglycemia (>250 mg/dL), metabolic acidosis, ketone production.
  • Symptoms: Polyuria, polydipsia, Kussmaul breathing, fruity breath.
  • Treatment: Insulin infusion (drives potassium into cells), fluids to correct hypovolemia, monitor glucose.

6. Hyperglycemic Hyperosmolar State (HHS)

  • Common in: Type 2 diabetes.
  • Key Features: Severe hyperglycemia, profound dehydration, no ketosis.
  • Treatment: Fluid resuscitation first, then insulin.

7. Addisonian Crisis

  • Presentation: Adrenal insufficiency, low cortisol, low aldosterone.
  • Symptoms: Severe hypotension, weakness, hypoglycemia.
  • Treatment: Hydrocortisone IV, fluids.

8. Diabetes Insipidus (DI)

  • Key Features: Lack of ADH, excessive urination, dehydration.
  • Treatment: Desmopressin (synthetic ADH), fluid replacement.

9. Comparison of SIADH and DI

  • SIADH: Increased ADH, water retention, hyponatremia, high urine specific gravity.
  • DI: Decreased ADH, water loss, hypernatremia, low urine specific gravity.

Additional Questions and Discussions

  • Discussed laboratory values to differentiate between DKA and HHS.
  • Emphasized importance of fluid management in hyperglycemic emergencies.

Conclusion

  • Encouragement to like and subscribe for more educational content.
  • Best wishes for those taking the CCRN exam.