diabetes > DKA, HHS, DI, SIADH

DKA is more common in what kind of diabetics

type 1

HHS is more common in what kind of diabetics

type 2

name the term: complication of diabetes when BG is extremely high for too long, and leads to severe dehydration without any significant acidosis

HHS

glucagon promotes what

breakdown of glycogen in the liver

thick blood causes what

cellular dehydration

what does urea do to WBCs

impairs their ability to function

in HHS what are two common compensatory mechanisms

glucosuria and polyuria

what respiratory sign will you NEVER see with HHS

Kussmaul’s respirations

HHS has a greater mortality in patients when they are >___

60

with HHS as long as the patient can _____ they are okay to deal with it at home

drink

• AMS

• EXTREME dehydration

• polyuria

these are all clincal S/S of what

HHS

what are three common causes of HHS

UTI, pneumonia, sepsis

HHS affects what population

older

HHS can sometimes mimic the S/S of a

stroke

with HHS the BG will be > _____

600

with HHS the osmolality will be >_____

320

with treatment of HHS what kind of fluids will we start with

istonic/NS

besides IVF what else will be in the treatment plan for a patient with HHS

electrolyte replacement and possible insulin

if HHS progresses the mental status can progress to what two things

stupor or coma

what two things should the nurse educate on before discharging a patient who had HHS

hydration, very easy to get HHS again

what food do we want to instruct the patients to decrease if they can after having HHS

red meat

when do we switch from NS to dextrose while rehydrating someone for HHS

BG 250

when the patient has DKA or HHS what 5 things should the nurse be checking regularly (besides BG)

BP, cap refill, skin color + temp, urine output

what is the leading cause of adult blindness, ESRD, not trauma lower limb amputations,

diabetes

DM increases the risk of what two things

heart disease and stroke

what three things does your posterior pituitary gland secrete

vasopressin/ADH, oxytocin

ADH is secreted when there is an increase in

osmolality of blood (blood concentration)

ADH is secreted when there is a decrease in

blood pressure

what does ADH do

keep you from peeing

• dehydration

• increased serum osmolarity

• low BP

• trauma

• pain

• anxiety

these are all causes of what

release of ADH

what does increased serum osmolarity mean

increased blood concentration

• overhydration

• decreased osmolarity

• high blood volume

these are all indications that ADH will be

inhibited

what are three effects of the release of ADH

less urine, hypertonic urine, body water retention

what are three effects of the inhibition of ADH

more urine, hypotnoic urine, body water loss

• glucocorticosteroids

• lithium

• morphine antagonists

• norepinephrine

• amphotericin B

these are all medications that affect ADH by _________ the level/action

decreasing

• acetaminophen

• morphine

• merperidine

• most anesthetics

• cancer drugs

• tricyclic antidepressants

these are all medications that affect ADH by _______ the level/action

increasing

what is the problem in diabetes insipidus

the body is not holding onto water

what is central diabetes insipidus

failure of the posterior lobe to secrete ADH

what is nephrogenic diabetes insipidus

nephrons cannot respond to ADH

what is primary diabetes insipidus

excessive water intake

with primary diabetes insipidus what is unusual

they are not dehydrated

what are three common causes of central diabetes insipidus

tumor, post head injury, infection

the onset of central diabetes insipidus can be what

slow or sudden

every single ICU patient is at risk of what

central diabetes insipidus

what is usually the cause of nephrogenic diabetes insipidus

damage to the nephrons

what are three drugs that can cause nephron damage leading to nephrogenic diabetes insipidus

lithium, amphotericin B, steroids

what two disease processes can cause obstructive uropathy

sickle cell anemia, tubular necrosis

with nephrogenic DI what would the nurse instruct the patient to do when going home

daily weights, f/u with HCP

what is considered polyuria for a patient with DI

2-20 L per day

with polydispia what can we give the patient

ice chips

• polyuria

• polydipsia

• anorexia

• weight loss

• weakness/fatigue, confusion, possible seizures

• tachycardia

• hypotention

• dry skin and poor turgor

these are all things the nurse would find during her assessment of a patient who has what

DI

with DI the patient’s sodium levels are likely to be what

>145

decreased specific gravity means what

more diluted/less concentrated

increased specific gravity means what

less diluted/more concentrated

when a patient has DI what kind of diet should they be on

low sodium

for DI the patient may receive what medication to help with BP

vasopressin

with DI the patients who have primary or central DI will receive what two things

hormone replacement and vasopressin

what three kinds of fluids would be given to a patient with DI

D5W, 0.45% NaCl, 0.25% NaCl

only in nephrogenic DI will the patient receive what meds

thiazide diuretics

name the term: abnormally high production of ADH unrelated to plasma osmolarity

SIADH

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• cancers: lung, brain, leukemia

• CNS disorders: head injury, stroke, infection (meningitis)

• meds: opioids, thiazide diuretics, SSRIs, tricyclics, chemo

these are all possible causes of what

SIADH

increased levels if ADH lead to increased

water reabsorption

what is the biggest S/S of SIADH

AMS/confusion

• confusion, HA, agitation, seizures possible

• weakness, muscle cramps, twitching > hypo reflexes

• weight gain without edema

• HTN

• oliguria

• vomiting

• polydipsia

these are all S/S of what

SIADH

what surgical procedure puts someone at risk of SIADH

craniotomy

what three labs decrease when someone has SIADH due to dilution

BUN, Cr, Hct

when someone has SIADH they will also have what electrolyte imbalance

hyponatremia

what are three signs of hyponatremia

diarrhea, diminshed reflexes, confusion

what is the treatment plan for SIADH

fluid restrictions, replacement NaCl, diuretics

what meds may be given for someone in SIADH

tolvaptan or conivaptan

what can the nurse do to help combat polydipsia

ice chips/hard candy

if giving diuretics what electrolytes should the nurse monitor

K+

if sodium falls below _____ then it is a medical emergency

125

what kind of IVF would be given (if necessary) for a patient with SIADH

hypertonic