Module 6 Med Surg 2: DKA, HHS, SIADH, DI

SEVERE HYPERGLYCEMIA signs and symptoms “What Fucking Bitch Has Chlamydia Today? Don’t Die Hoe Comon”

weight loss, fatigue, blurred vision, hypotension, cardiac arrhythmias, tachycardia, decreased skin turgor, decreased mental status, hypothermia, coma 

Diabetic ketoacidosis patho 1st process

lack of insulin, ketone production, presence of ketones, anion gap acidosis, potassium shifts

Diabetic ketoacidosis patho 2nd process

lack of insulin, hyperglycemia, dehydration, impaired renal function, potassium shifts

Diabetic Ketoacidosis signs and symptoms “A MAN KKK”

acetone breath, metabolic acidosis, abdominal pain, nausea and vomiting, kussmaul respirations, ketonemia, ketonuria

What labs will increase in DKA?

potassium/sodium, BUN, CRT, osmolarity, hemoglobin, hematocrit, beta hydroxybutyric acid, ketone, glucose

what does an increased osmolarity and specific gravity mean? (DKA)

dehydration

What labs will decrease in DKA?

ph, PaCo2, PaHCO3

DKA Nursing care fluids 

normal saline, sodium bicarbonate, D5 when glucose is greater than 250

DKA Nursing care

insulin infusion, glucose monitoring, electrolyte replacement, nausea/vomiting, pain management, NPO, education

infusion protocol DKA

start fluids and start regular insulin drip to stop diuresis and maintain hemodynamic stability

Hyperosmolar Hyperglycemic State

insulin is present but not utilized efficiently leading to increased glucose production causing extreme hyperglycemia, the body produces just enough insulin to suppress ketosis which means NO acidosis

HHS Hallmark symptoms “Extremely Evil Clown That Secretes Sugar”

extreme hyperglycemia, extreme dehydration, thrombosis risk, seizure risk, serum osmolarity >300mL

What is the diagnostic criteria that makes HHS different from DKA?

HHS does not develop acidosis like DKA because of this HHS has no potassium issues, instead high sodium

HHS Nursing interventions and treatment

volume resuscitation over 36-72 hours, glucose control, neuro checks (cerebral edema from hypernatremia), electrolyte monitoring

when giving an insulin drip when should a dextrose source be added?

if blood glucose drops to 250

In HHS should we volume resuscitate fast or slowly in HHS?

volume resuscitate slower at minimum day and a half to 3 days, to only shift sodium 4 points a day max to prevent irreversible brain damage

syndrome of inappropriate antidiuretic hormone

antidiuretic hormone (vasopressin) is secreted even when serum osmolarity is normal or low (low osmo indicates fluid overload)

signs and symptoms of SIADH “WATER LOSS”

water retention, AMS, Tired/lethargy, Edema, Reduced urine output, Low sodium (hyponatremia), Overhydration/ Headache, Seizures, Sick to stomach (N/V)

SIADH Labs

hyponatremia, decreased serum osmolarity, increased urine osmolality (concentrated urine)

SIADH Nursing Care

manage fluid volume, electrolyte imbalances (check sodium every 2 hrs) , fluid restriction of 1.5 L, strict I/O, daily weights

Medications for Syndrome of Inappropriate ADH

hypertonic saline to increase sodium and help hypotonic state, diuretics, vasopressin receptor antagonists (vaptans) Tolvaptan, Conivaptan

What is the serious black box warning of Tolvaptan?

can shift sodium too quickly which can kill the patient

diabetes insipidus 

constant state of diuresis due to antidiuretic hormone (ADH) deficiency or inability of the kidneys to respond to ADH

neurogenic cause of diabetes insipidus

something in the brain is telling the pituitary gland to not secrete ADH

nephrogenic cause of diabetes insipidus

the kidney has become injured, it no longer cares if there is ADH and doesnt respond

diabetes insipidus signs and symptoms 

excessive urination, excessive thirst, dehydration, hypotension, tachycardia, changes in LOC

diabetes insipidus labs

hypernatremia, increased serum osmolarity, decreased urine osmolality (no solutes)

Diabetes insipidus nursing care

manage hypovolemia, strict I/O, daily weights, timely labs (hypernatremia), medications

meds for diabetes insipidus

isotonic then hypotonic fluids, desmopressin therapy (DDAVP) used for neurogenic cause, HCTZ used for nephrogenic cause