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Endocrine System

Endocrine System. I’m hot, I’m cold, I’m fast, I’m slow. EMT-Paramedic Program. The System Itself. The other regulating system of the body Closely linked to nervous system Uses glands and tissues Via hormones, the system regulates: growth the use of foods for energy

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Endocrine System

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  1. Endocrine System I’m hot, I’m cold, I’m fast, I’m slow. EMT-Paramedic Program

  2. The System Itself • The other regulating system of the body • Closely linked to nervous system • Uses glands and tissues • Via hormones, the system regulates: • growth • the use of foods for energy • pH of body fluids • fluid balance • reproduction • provides resistance to stress

  3. Chemical messengers to either: Body organs Tissues Or Both Binding depends on: Quantity Quality of receptor sites They may be divided into three groups: Amines Tyrosine, epi, norepi Proteins amino acids; insulin, GH, calcitonin, ADH, oxytocin Steroids cholesterol; cortisol, aldosterone, estrogen, progesterone, and testosterone Hormones

  4. Hormone Secretion • Negative feedback mechanism • Endocrine glands respond to blood level changes or other hormones present • Secretion of hormone until stimulus is negated or changed

  5. Pituitary “Master Gland” • Posterior holds hypothalamus hormones ADH and oxytocin • Anterior produces GH, TSH, ACTH, prolactin, FSH, LH

  6. Specific Hormones • ADH • maintains BP by reabsorption of water by kidney tubules and vasoconstriction • Oxytocin • stimulates contraction of uterus and release of milk

  7. Specific Hormones Thyroid Stimulating Hormone Growth Hormone Anterior Pituitary Adrenocorticotropic Hormone

  8. Thyroid Gland • Produces: • T4 - Thyroxine • T3 – Triiodothyronine • Contain Iodine • Regulate energy production & growth • Calcitonin – • Regulates calcium • Maintains strong bones… • Also feeds back through pituitary

  9. Parathyroid Glands • “Pair-a-thyroids?”  • Produces parathyroid hormone • Also involved in calcium & blood phosphate levels

  10. Disorders Associated with Thyroid Gland • Issues directly associated with gland • Tumor • Pituitary malfunction indirectly affecting • Hypothyroidism (Myxedema) • Hyperthyroidism (Grave’s Disease) • Thyrotoxicosis • Thyrotoxic Crisis (Thyroid Storm)

  11. Disorders of the Thyroid Gland • Thyroid Storm • Severe Tachycardia, Dysrhythmias • Heart Failure • Shock • Hyperthermia • Restlessness, Agitation & Paranoia • Abdominal pain • Delirium, Coma • What else does this look like? • What could help you distinguish? • Danger in becoming a cynic?

  12. Adrenal Glands Each adrenal has: • Medulla • -Epinephrine • -Norepinephrine • Cortex • -Aldosterone • -Cortisol

  13. Trouble Associated with Adrenal Gland Cushing’s Syndrome • ACTH Levels too high • Enlarges adrenal gland • May be associated with pituitary tumor

  14. Addison’s Disease Deficiency of cortisol & aldosterone Slow, gradual onset Progressive Fluid volume deficit Hyperpigmentation (bronze) Disorders Associated with Adrenal Glands

  15. Adrenal Gland Disorders Addisonian Crisis • Acute episode preceded by: • Physical or emotional stress • Surgery • Alcohol intoxication • Trauma • Infection • Hypoglycemia • Adrenal cortex cannot comply with body’s increased demand

  16. Ovaries Secrete • Estrogen • Progesterone progesterone

  17. Testes Secrete • Testosterone • Inhibin

  18. Pancreas • U R&L Q • Islets of Langerhans • Produce Glucagon & Insulin

  19. Pancreatic Hormones • Glucagon – Alpha Cells • stimulates liver to change glycogen to glucose • raises blood glucose levels • Insulin – Beta Cells • lowers blood glucose levels by increasing transport of glucose into the cells

  20. Glucose/Dextrose (D-glucose) • An intermediate in metabolism of carbohydrates • The most important carbohydrate, and is formed during digestion; absorbed from intestines into blood of portal vein; in passage through liver, is converted into glycogen

  21. Glucose • May be: • Used immediately • Stored in muscles • Stored in fat • Brain cannot store it’s food • Requires continuous circulating volume • Reason neuro s/s develop quickly

  22. Disorders Associated with Pancreatic Dysfunction Diabetes Mellitus • Hyperglycemia • Hypoglycemia • DKA • HHNK

  23. Diabetes Mellitus • 16 million in North America. & rising • 3 diagnostic types: • IDDM Type I • NIDDM Type II • Other (Secondary) DM

  24. Diabetes Mellitus • IDDM type 1 • Most commonly occurs in children and young adults • Genetic predisposition; Immune mediated destruction of insulin-producing cells

  25. Diabetes Mellitus • NIDDM type II • Usually occurs after age 30. • A strong genetic predisposition is evident but pathogenesis is different. • Most individuals obese • Resistance to insulin action is present. • Exogenous insulin not required.

  26. Promotion of Hyperglycemia • Increased dietary intake (esp. carbohydrates) • Limitation of physical activity • Reduction of hypoglycemic therapy • Limitation of endogenous insulin production • Pancreatic diseases • Drug treatment • Electrolyte disorders

  27. Diabetes Mellitus • Other (secondary) DM • Associates hyperglycemia to another cause including: • Pancreatic disease/Pancreatectomy • Drugs or chemical agents • Others too • Gestational diabetes • Develops during pregnancy and resolves with birth but increased risk of DM later.

  28. Development of Insulin Resistance • Infection • Inflammation • Myocardial ischemia or infarction • Trauma • Surgery • Emotional stress • Pregnancy • Drug treatment

  29. S/S of Hyperglycemia/Insulin Insufficiency or Resistance • Polyuria • Polydipsia • Nocturia • Weight Loss • Fatigue • Blurred vision

  30. Control • Oral • Transplant • Islet cells • Pancreas

  31. Oral Hypoglycemic Drugs Metformin 500-1000 mg PO tid Avandia 4 mg PO qd

  32. Insulin

  33. Diabetic Ketoacidosis • A result of severe insulin insufficiency and an excess of glucagon. Type I • Common causes: • Interruption of insulin therapy • Stress, infection • Non-compliance frequently a factor • Onset slow, from 12-24 hours.

  34. Diabetic Ketoacidosis • Transition from glucose to lipid metabolism • Forms ketones & increase to toxic levels (diuresed) • Metabolic Acidosis • Symptoms • Causes severe osmotic diuresis and severe dehydration • Tx: Requires close monitoring • Draw red-top • Give IV fluids (Typically 3-5 L Low) • Consider thiamine • All vitamins & Electrolytes grossly deranged

  35. Non-Ketotic Hyperglycemic Hyperosmolar Coma (HHNK) • Complication of Type II • Typically preceded by infection &/or diuretics • Hyperglycemic state causes hyperosmolar diuresis • Pronounced volume loss (Towards 10L) • CBG (PG) levels 1000 & higher • Only mild metabolic acidosis • Non-Ketotic • Many electrolytes within normal levels

  36. Hypoglycemia • Common causes • Excessive insulin • Stress • Overexertion • Infection • Under eating • Symptoms • Treatment • O2, IV, CBG (Red Top), 50% dextrose IV

  37. Endocrine Summary • A VERY complicated system • A specialty of it’s own • Much of EMS treatment is symptom oriented • Much of care is cause oriented • Important distinction

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