Patho-Pharm: DKA & Thyroid Quiz SG

physiological changes that occur w/ DKA

- hyperglycemia due to increased glucose production & decreased utilization

- osmotic diuresis & dehydration

- hyperlipidemia due to increased lipolysis

- metabolic acidosis/ketosis

- altered potassium balance

- excess acids result in increased anion gap

- altered consciousness related to acidosis & dehydration

what causes high levels of ketones in DKA

- DKA develops when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy

- instead, your liver breaks down fat for fuel, a process that produces acids called ketones

electrolyte imbalances seen in DKA

- abnormal K+, phosphorus, calcium, & magnesium

- decreased Na+

- decreased bicarb/HCO3 & pH

differences between DKA & HHS

HHS:

- blood sugar is greater than DKA; average is >100mg/dL

- more "normal" ABGs

- more electrolyte imbalances & renal dysf.

- higher serum osmolarity than DKA

- ketosis absent or mild

DKA vs HHS

- DKA is associated with hyperglycemia & ketoacidosis (high serum & urine concentrations of ketone bodies causing acid build-up in the blood )

- HHS mainly has severe hyperglycemia & hyperosmolarity (blood has a high concentration of sodium, glucose, etc... drawing water out of organs)

metabolic acidosis

- pH: decreased (less than 7.35)

- PaCO2: normal (35-45)

- HCO3: decreased (less than 22)

- PaO2: normal (72-104)

type of insulin used for insulin drips

regular/short-acting

s/s of hyperglycemia

- elevated fasting blood glucose (higher than 126mg/dL) or a hemoglobin A1C (HbA1C) level greater than or equal to 6.5%

- polyuria (frequent urination)

- polydipsia (thirst)

- polyphagia (hunger)

- glycosuria (glucose in urine)

- unexplained weight loss

- fatigue

- blurred vision

s/s of hypoglycemia

early:

- confusion

- irritability

- tremor

- sweating

late:

- hypothermia

- seizures, coma, & death will occur if not treated

what hormones does the thyroid gland secrete

3 hormones essential for proper regulation of metabolism

- triiodothyronine (T3)

- thyroxine (T4)

- calcitonin

functions of thyroid gland

- regulates BMR

- regulates lipid & carb metabolism

- responsible for normal growth & development

- controls heat regulation system

- various effects on cardiovascular, endocrine & neuromuscular systems

role of pituitary gland in thyroid hormone levels

release thyroid-stimulating hormone (TSH), which stimulates your thyroid to release T3 & T4

hypothyroidism s/s

- dry hair/hair loss

- goiter

- lethargy

- bradycardia

- weight gain

- constipation

- cold intolerance

- possible infertility, increased risk of miscarriage, & irregular periods

hyperthyroidism s/s

- hair loss

- exophthalmos (bulged eyes)

- goiter

- tachycardia

- weight loss

- diarrhea

- heat intolerance

- periods may occur less often or w/ longer cycles

goiter

enlargement of the thyroid gland

relationship between iodine & production of thyroid hormones

you must have enough iodine in your diet to produce thyroid hormones

what do you monitor in DKA (labs)

- ABG

- blood glucose

- electrolytes

- ketones

what do you monitor for pts receiving thyroid replacement (labs)

- TSH

- T3 & T4

- thyroid AB

what glucose level is considered to be hypoglycemic

glucose lower than 70 mg/dL

radioactive iodine precautions

- pregnancy

- childbearing age & during lactation

- young children

- maintain 6 ft distance from others

- limit contact with others to 30 mins a day per person

what drugs can increase glucose levels

- beta blockers

- corticosteroids

- calcium channel blockers

levothyrozine class

thyroid hormone

levothyrozine MOC

- synthetic form of thyroxine (T4)

- will increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume & growth processes

- dosed in mcg

levothyrozine use

- hypothyroidism

- maintenance of thyroid hormone levels after surgery or radiation of the thyroid

- used for emergency tx of myxedema coma

levothyrozine complications

- overmedication

- chronic over treatment

levothyrozine interactions

- increase requirement for insulin & digoxin

- interacts w/ many anticonvulsants

levothyrozine daily dose

- best in morning on empty stomach

- morning dosing avoids potential sleep disturbances

methimazole class

thioamide

methimazole MOC

blocks the synthesis of thyroid hormones & prevents oxidation of iodine

methimazole use

- treatment for graves disease

- produces a euthyroid state prior to thyroid removal surgery

- as an adjunct to irradiation of thyroid gland

- emergency tx of thyrotoxicosis

methimazole complications

- hypothyroidism

- agranulocytosis (fever, sore throat)

methimazole interactions

anticoagulants, digoxin

rapid-acting insulin onset (lispro)

15-30 min

regular/short-acting insulin onset (Humulin R)

30-60 min

intermediate-acting insulin onset (NPH)

1-2 hr

long-acting insulin onset (glargine)

1-2 hr

cause of HHS vs DKA

- HHS: when your blood glucose (sugar) levels are too high for a long period

- DKA: when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy; liver breaks down fat for fuel & produces too many ketones