Endocrinology, Electrolytes, and Acid/Base

1. Endocrinology, Electrolytes, and Acid/Base

2. OpeningCase Endocrinology, Electrolytes, and Acid/Base

3. SICK? Sick or Not-yet-sick? Why? or NOT YET SICK?

4. 41 Y/O Erin • You receive a call for an unresponsive woman at the office complex. When you arrive, you find a woman slouched at her desk. Office workers tell you she was acting irrational and confused prior to becoming unconscious.

5. Erin’s Case • A good friend of the patient’s tells you that Erin is not a diabetic. But does take Synthroid. • She has also been talking a new diet pill, Aqua-Ban. Erin has been urinating excessively.

6. What are the possibilities of Erin’s condition? • Hypoglycemia • Hypothyroid • Heat stroke • CVA

7. What are the possibilities of Erin’s condition? • Hypoglycemia • Hypothyroid • Heat Stroke • CVA

8. Applied Anatomy and Physiology

9. The Endocrine Glands

10. Hypothalamus • Located in the lower part of the brain • Helps regulate the body’s metabolism and temperature • Hormones secreted suppress or stimulate the pituitary gland

11. Pituitary Gland • Known as the master gland • It is located behind the hypothalamus, divided into two lobes • Produces hormones that control the functions of most other endocrine glands

12. Posterior pituitary: Responsible for storing several hormones produced by the hypothalamus Anterior pituitary gland produces: Thyroid Stimulating Hormone (TSH) Adrenocorticotropin hormone (ACTH) Antidiuretic hormone (ADH) Oxytocin Pituitary Gland

13. Located in the lower portion of the anterior neck Produces two hormones: Thyroxine (T4) Triiodothyronine (T3) Involved in regulation of metabolism, bone growth, and development of the brain and nervous system Thyroid Gland

14. Located on the thyroid gland, four small, pea-shaped glands Regulate levels of calcium in the blood and bone density Interruption in this process can lead to hypocalcemia Parathyroid Gland Pharynx Posterior View

15. Located on the top of each kidney Composed of two different portions: Adrenal cortex Adrenal medulla Adrenal Glands

16. Located in the middle of the brain Secretes melatonin Regulates the wake/sleep cycle Pineal Gland

17. Located in the posterior portion of the upper abdomen Has both exocrine and endocrine functions Pancreas

18. Pathophysiology

19. Glucose • Absorbed through the intestine into the bloodstream and carried to cells • Cannot enter the cells without insulin, which is used as a transport mechanism

20. Insulin • Produced by the beta cells of the pancreas • Required by almost all of the body’s cells

21. Glucagon • Protein hormone that is produced and secreted by the alpha cells of the pancreas

22. Glucagon • It stimulates two functions: • Glycogenolysis: the breakdown of glycogen by the liver and muscles into glucose • Gluconeogenesis: the formation of glycogen to be stored for later usage

23. Balancing Insulin and Glucagon Levels • The presence of food in the intestine causes the pancreas to release insulin

24. Balancing Insulin and Glucagon Levels • The body’s cells take in the needed glucose and the remainder is absorbed by the liver, fat, and muscle

25. Balancing Insulin and Glucagon Levels • When there is insufficient or absent insulin, no matter what the level of glucose in the blood, it cannot be used by the body’s cells

26. Balancing Insulin and Glucagon Levels • In an attempt to keep the body going, fats are broken down and ketones are formed and excreted from the body • This breakdown can result in a condition of ketoacidosis, a potentially deadly condition

27. Street Secret Diabetics sometimes have a triad of symptoms called the: • Polyuria (increased urine output) • Polydipsia(increased thirst) • Polyphagia(increased appetite) 3 Ps

28. SpecificConditions

29. Diabetes Mellitus • In the United States,more than 10 million people have been diagnosed with diabetes • Morbidity and mortality associated with diabetes is related to short- and long-term complications

30. Diabetes—Type 1 • Known as juvenile onset or insulin-dependent diabetes mellitus • Characterized by the inability of the pancreas to secrete insulin

31. Diabetes—Type 1 • Type 1 diabetics are reliant on an external source of insulin to maintain homeostasis

32. Diabetes—Type 2 • Referred to as adult-onset diabetes (AODM) or non-insulin–dependent diabetes (NIDDM) • In type 2 diabetes, the body can produce insulin; however, it is insufficient to maintain adequate glucose levels

33. Diabetes—Type 2 • Incidence is increasing • Risk factors include • Over the age of 45 • Obesity • Family history • Nationality • History of hypertension

34. Hypoglycemia 40 • Glucose level that is inadequate to effectively fuel the body’s blood cells • Normal range is between 60 to 120 mg/dl

35. Hypoglycemia • May be a condition by itself, or it may be a complication of diabetes or other disorders • Patients can appear as though they are intoxicated

36. Altered Behavior Patients who are altered, aggressive, intoxicated, or simply in police custody should have their blood glucose checked

37. Sweating Tremors Anxiety Hunger Dizziness Headache Impaired vision Confusion or altered mental status Signs and Symptoms of Hypoglycemia

38. Hyperglycemia • The result of the inability of insulin to trigger cells to absorb glucose molecules from the blood • If left unchecked, hyperglycemia can lead to diabetic ketoacidosis

39. Hyperglycemia • Caused by: • Unchecked/undiagnosed diabetes • Infection • Ingestion of certain medications (e.g., diuretics) • Myocardial infarction • Cerebral vascular accident

40. Polyphagia (hunger) Polyuria (urination) Polydipsia (thirst) Fatigue Wounds that do not heal well Dry mouth Dry, itchy skin Visual difficulties Signs and Symptoms of Hyperglycemia Remember the three Ps?

41. Diabetic Ketoacidosis (DKA) • Results from a lack of insulin and involves a change in metabolism • The onset of DKA tends to be gradual and may evolve over 12–24 hours or longer

42. Diabetic Ketoacidosis (DKA) • Signs and symptoms can include • Increased thirst • Excessive hunger • Urination • Malaise

43. Street Secret • Suspect diabetic ketoacidosis when the blood sugar level is over 300 mg/dL

44. Hyperosmolar Hyperglycemic Nonketotic Syndrome • Involves severe hyperglycemia • Blood sugar often exceeds 600 mg/dl and electrolyte imbalances occur 600

45. Hyperosmolar Hyperglycemic Nonketotic Syndrome • Results from hyperglycemia, hypovolemia, the development of ketones, and subsequent acidosis 600

46. Hyperosmolar Hyperglycemic Nonketotic Syndrome • Signs and symptoms include • Poor skin turgor • Dry mucous membranes • Sunken eyeballs • Hypotension

47. Hypothyroidism

48. Hypothyroidism • Resulting from the decreased production of the thyroid hormone • Can be chronic or acute onset • Signs and symptoms of hypothyroidism include • Weakness (99%) • Mononeuropathy • Menstrual irregularity

49. Hyperthyroidism • Occurs from an overactive thyroid gland • Leads to increased in sympathetic nervous system stimulation

50. Hyperthyroidism • Signs and symptoms include • Proptosis (bulging eyes) • Weakness • Weight loss • Heat intolerance • Nervousness • Palpitations