Endocrine Disorders – DKA, HHS, SIADH, DI & Nutrition

Vocabulary flashcards covering nutrition recommendations, DKA, HHS, SIADH, and DI—including causes, pathophysiology, clinical findings, lab patterns, treatments, and key nursing considerations.

Carbohydrate-containing foods

Grains, fruits, dairy, legumes, sweets, sugary drinks, and starchy vegetables such as potatoes, corn, peas.

Starchy vegetables

Vegetables higher in starch (potatoes, corn, peas) that provide more carbohydrates per serving than non-starchy varieties.

Low- to no-carb foods

Meat, fish, poultry, most cheeses, nuts, oils, and other fats.

Daily fiber goal for people with diabetes

Approximately 25–30 g of fiber per day.

Fiber benefit in diabetes

Increases satiety, lowers A1C, and reduces cholesterol levels.

Common fiber supplements

Psyllium and β-glucan.

Consensus dietary advice for diabetes

Emphasize non-starchy vegetables, minimize added sugars/refined grains, choose whole foods, reduce total carbohydrate intake.

Diabetic ketoacidosis (DKA)

Acute complication (usually type 1 diabetes) characterized by insulin deficiency, hyperglycemia, ketosis, and metabolic acidosis.

Typical DKA triggers

Infection, illness, stress, inadequate or missed insulin, poor diabetes management.

Key DKA pathophysiology

Absolute insulin deficiency → ↑ lipolysis & proteolysis → ketone production → metabolic acidosis and osmotic diuresis.

Classic DKA triad

Hyperglycemia, ketosis, metabolic acidosis.

DKA clinical dehydration signs

Polyuria, polydipsia, poor skin turgor, tachycardia, hypotension.

DKA respiratory sign

Kussmaul respirations with fruity (acetone) breath.

Typical DKA blood glucose level

250 mg/dL (13.9 mmol/L).

DKA anion gap feature

Elevated anion gap metabolic acidosis (pH < 7.30, HCO₃⁻ < 18 mEq/L).

Electrolyte pattern in untreated DKA

Total body potassium depleted, but serum K⁺ may be normal or elevated until insulin given.

First treatment step in DKA

Initiate isotonic IV fluids (0.9 % NaCl) before insulin.

Insulin infusion rate for DKA

Regular insulin 0.1 U/kg IV bolus then 0.1 U/kg/h continuous infusion.

Potassium rule before insulin in DKA

Serum K⁺ must be > 3.3 mEq/L; replace K⁺ if lower.

DKA glucose threshold for adding dextrose

Add D5 + 0.45 % NaCl when serum glucose reaches 200 mg/dL to prevent hypoglycemia.

Bicarbonate use in DKA

Consider only if arterial pH < 6.9.

Resolution criteria for DKA

Blood glucose < 200 mg/dL plus pH > 7.3, HCO₃⁻ ≥ 18 mEq/L, and closed anion gap.

Hyperosmolar hyperglycemic syndrome (HHS)

Severe hyperglycemia with hyperosmolarity and dehydration, minimal or no ketosis, usually in type 2 diabetes.

Common HHS precipitants

Infection (pneumonia, sepsis), acute illness, undiagnosed type 2 diabetes.

Typical serum glucose in HHS

600 mg/dL (33.3 mmol/L).

Serum osmolality level in HHS

320 mOsm/kg.

Acid–base status in HHS

No significant acidosis; pH usually > 7.30.

Key HHS symptoms

Profound dehydration, hypotension, tachycardia, altered mental status, seizures or coma.

Primary fluid choice in HHS resuscitation

Isotonic saline (0.9 % NaCl) 1 L/h initially.

Insulin protocol for HHS

Regular insulin 0.1 U/kg IV bolus then 0.1 U/kg/h; begin only after fluids and if K⁺ > 3.3 mEq/L.

Target glucose reduction rate in HHS

Decrease by 50–70 mg/dL per hour; adjust insulin if not achieved.

Glucose threshold to add dextrose in HHS

Add D5 with 0.45 % NaCl when glucose reaches 250–300 mg/dL.

Syndrome of inappropriate antidiuretic hormone (SIADH)

Excess ADH release leading to water retention, dilutional hyponatremia, and low serum osmolality.

Most common cause of SIADH

Malignancy, especially small-cell lung cancer.

Diagnostic triad for SIADH

Serum Na⁺ < 135 mEq/L, serum osmolality < 280 mOsm/kg, urine specific gravity > 1.030 (uOsm > sOsm).

Key SIADH symptoms

Low urine output, fluid retention, thirst, dyspnea, muscle cramps, headache, seizures, possible coma.

First-line treatment for SIADH

Treat underlying cause and institute fluid restriction (800–1000 mL/day if Na⁺ > 125 mEq/L).

Safe sodium correction rate in SIADH

Increase serum Na⁺ by no more than 8–12 mEq/L in the first 24 h.

Pharmacologic options for SIADH

Hypertonic saline, salt tablets, loop diuretics (if Na⁺ > 125), demeclocycline, vasopressin receptor antagonists (vaptans).

Key nursing interventions in SIADH

Seizure precautions, strict I&O, monitor serum/urine Na⁺ and osmolality, provide ice chips or sugarless gum for thirst.

"No free water" order meaning

Patient may not receive plain water; all fluids must contain solute to avoid worsening hyponatremia.

Diabetes insipidus (DI)

Deficiency of ADH (central) or renal resistance to ADH (nephrogenic) leading to excessive dilute urine and hypernatremia.

Central vs. nephrogenic DI

Central: inadequate ADH secretion. Nephrogenic: kidneys unresponsive to ADH.

Core DI manifestations

Polyuria (2–20 L/day), polydipsia, low urine specific gravity < 1.005, high serum osmolality, hypernatremia.

Desmopressin (DDAVP)

Synthetic ADH analog used to treat central DI; given intranasally, orally, sublingually, or SQ/IV.

Monitoring effectiveness of DDAVP

Reduced urine output, increased urine specific gravity/osmolality, stabilized serum Na⁺ and osmolality.

Fluid management in DI

Encourage oral intake to thirst; provide hypotonic IV fluids (D5W) cautiously to avoid rapid sodium drop.

Key labs: SIADH vs. DI – serum sodium

SIADH ↓ Na⁺; DI ↑ Na⁺.

Key labs: SIADH vs. DI – urine specific gravity

SIADH ↑ specific gravity (> 1.030); DI ↓ specific gravity (< 1.005).

Key labs: SIADH vs. DI – serum osmolality

SIADH ↓ serum osmolality; DI ↑ serum osmolality.

Electrolyte caution with loop diuretics in SIADH

Give furosemide only if serum Na⁺ > 125 mEq/L to avoid worsening hyponatremia.

Vaptans mechanism

Vasopressin receptor antagonists that promote water diuresis without major sodium or potassium loss.

Polyphagia meaning in DKA

Excessive hunger caused by cellular glucose starvation despite hyperglycemia.

Osmotic diuresis definition

Increased urine output due to osmotic pull of excess glucose/ketones in renal tubules, leading to water and electrolyte loss.

Anion gap significance in DKA

Represents unmeasured anions (ketones); elevated gap indicates metabolic acidosis.

Kussmaul respirations

Deep, rapid breathing pattern that blows off CO₂ to compensate for metabolic acidosis.

Hyperviscosity complication in HHS

Increased blood thickness can cause thrombosis, seizures, and decreased tissue perfusion.

Priming insulin bolus in DKA

Initial 0.1 U/kg IV bolus to fill insulin receptors before continuous infusion.

Criteria to hold insulin in DKA/HHS

Serum potassium < 3.3 mEq/L—replace K⁺ first.

Reason ketosis rare in type 2 diabetes

Even small residual insulin secretion suppresses lipolysis and ketogenesis.

Thirst center location

Hypothalamus; activated by high serum osmolality (e.g., in DI).

Urine osmolality pattern in SIADH

Inappropriately high (> 100 mOsm/kg) despite low serum osmolality.

Urine osmolality pattern in DI

Low (< 100 mOsm/kg) due to inability to concentrate urine.

Fluid restriction goal in SIADH

Create negative water balance to raise serum sodium slowly.

Hemodynamic monitoring indication

Severe hypovolemia or cardiogenic shock in DKA/HHS management.

Magnesium trend in DKA/HHS

Serum Mg²⁺ often low due to osmotic diuresis; may require replacement.

Hypertonic saline concentration

3 % NaCl; used cautiously to treat severe symptomatic hyponatremia in SIADH.

Demeclocycline role in SIADH

Tetracycline derivative inducing nephrogenic DI to counteract water retention.

Central pontine myelinolysis risk

Neurologic damage from overly rapid correction of chronic hyponatremia.

Key nursing assessment in DI

Monitor I&O, daily weight, neurological status, serum/urine electrolytes.

Treatment end-point in HHS

Plasma osmolality ≤ 315 mOsm/kg and patient mentally alert with stable vitals.

Abrupt insulin cessation danger after IV infusion

Can lead to rebound hyperglycemia; overlap IV insulin with first subcutaneous dose for 1–2 h.

“No jokes about sodium?” answer

NA (the chemical symbol for sodium).