endocrine and metabolic emergencies n.
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  2. EndocrineObjectives Upon completion the student will be able to: • Define the term hormone • Discuss the location and function of the following endocrine glands: • Pituitary • Thyroid • Parathyroid • Pancreas • Adrenal • Gonads

  3. EndocrineObjectives • List two functions of the islets of Langerhans • Discuss the function of glucagon • Define diabetes mellitus • Discuss the function of insulin and its relation to glucose metabolism • Compare and contrast Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus • Discuss the osmotic diuresis occurring in diabetes

  4. EndocrineObjectives • Discuss the presentation, assessment, and management of diabetic ketoacidosis • Discuss the presentation, assessment, and management of hypoglycemia

  5. Introduction • Closely tied to the nervous system, it controls many body functions. • Exerts control by secreting hormones • Hormones are chemicals that, when secreted by endocrine glands into the blood stream, affect other endocrine glands or body systems

  6. Introduction • Derives its name from the fact that the various glands release hormones directly into the blood, which in turn transports the hormones to their target tissue • Exocrine glands, transport their hormones to target tissues via ducts

  7. Anatomy and Physiology • Several glands located in various parts of the body.

  8. Pituitary Gland • Small gland located on a stalk hanging from the base of the brain. Referred to as the “master gland” • Primary function to control the other endocrine glands • It also produces many hormones and their secretion is controlled by the hypothalamus

  9. Pituitary Gland • Divided into two areas, differing in structure and function. • Posterior Pituitary • Anterior Pituitary

  10. Posterior Pituitary • Produces oxytocin and antidiuretic hormone (ADH) • Oxytocin is the natural form of Pitocin and is responsible for uterine contraction and milk from the breast. • ADH, (AKA as vasopressin), causes the kidney to retain water.

  11. Anterior Pituitary • Produces: Thyroid-stimulating hormone (TSH) Growth hormone (GH) Adrenocorticotropin (ACTH) Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Prolactin

  12. Anterior Pituitary • These hormones regulate other endocrine glands. • For example: TSH stimulates the thyroid gland to release its hormones, thus increasing metabolic rate.

  13. Thyroid Gland • Lies in the anterior part of the neck just below the larynx. • Has two lobes, located on either side of the trachea • Sacs inside the gland contain a thick material called colloid Within the colloid are the thyroid hormones thyroxine and triiodothyronine, which increase metabolic rates

  14. Thyroid Gland • Also contains specialized cells called “C-cells” that produce calcitonin. Decreases blood calcium levels. • Inadequate levels of thyroid hormones produces hypothyroidism. Symptoms include: facial bloating, weakness, cold intolerance, lethargy and altered mental status. Skin and hair are quite oily.

  15. Thyroid Gland • Increased thyroid hormone release causes hyperthyroidism, commonly called “Graves Disease”. • Signs and symptoms include: insomnia, fatigue, tachycardia, hypertension, heat intolerance, and weight loss.

  16. Parathyroid Glands • Small, pea-shaped glands, located in the neck near the thyroid. • Usually four of them, and they produce the parathyroid hormone which is responsible for increasing blood calcium levels. • If injured or removed they can lead to hypocalcemia occurrences.

  17. Pancreas • Located in the folds of the duodenum within the abdominal cavity. It has both exocrine and endocrine functions. • Exocrine functions involve digestive enzymes • Endocrine structures are referred to as the islets of Langerhans.

  18. Pancreas • Islets are made up of three types of cells: 1. Alpha Cells: secrete glucagon. Glucagon converts stored glycogen back to the form of glucose. Process known as glycogenolysis. It also stimulates production of glucose from other substances: gluconeogenesis.

  19. Pancreas 2. Beta Cells: secrete insulin. Responsible for diffusion of glucose into the cells. Also, convert glucose into glycogen stores in the liver. 3. Delta Cells: secrete somatostatin. Inhibits the release of both glucagon and insulin.

  20. Adrenal Glands • Two small glands that sit atop the kidneys. Two divisions: 1. Adrenal Medulla: secrete the catecholamines, (epinephrine and norepinephrine) 2. Adrenal Cortex: secretes three classes of hormones, all of them are steroid hormones.

  21. Adrenal Glands A. Glucocorticoids B. Mineralocorticoids C. Adrogenic hormones • Also play a role in increasing blood glucose levels as well as an anti-inflammatory actions, and immune suppression in response to stress, trauma or serious infection.

  22. Adrenal Glands • A prolonged increase in adrenal cortex hormone secretion results in Cushing’s disease. • Patients exhibit increased blood sugar, unusual body fat distribution, and rapid mood swings. • High levels of sodium are present resulting in dysrhythmias, coma or death. Tumor is responsible and must be removed.

  23. Gonads • Involved with reproduction. • Female: ovaries produce eggs • Male: testes produce sperm • Both have endocrine functions.

  24. Ovaries • Located in the abdominal cavity adjacent to the uterus. • Also manufacture estrogen and progesterone. • Functions of these hormones include: sexual development and preparation of the uterus for implantation of the egg.

  25. Testes • Located in the scrotum. • Also manufacture testosterone which promotes male growth and masculinization.

  26. Endocrine Emergencies • Most common endocrine emergencies involve the disease known as diabetes mellitus. • Frequent complications include diabetic ketoacidosis and hypoglycemia

  27. Diabetes Mellitus • One of the most common disease in North America. • Characterized by decreased insulin secretion by the beta cells. • Complications of this disease are numerous and include: heart disease, stroke, kidney disease, and blindness.

  28. Glucose Metabolism • Glucose is required by the cells to produce energy. • Sugars, also called carbohydrates, are one of the three major food sources used by the body. • Other two are proteins and fats. • Most sugars in the human diet are classified as complex and must be broken into simple, before they can be used by the body.

  29. Glucose Metabolism • For the body to convert glucose to energy it must first be transported through the cell membrane. • Because of its size it cannot readily diffuse and must bind with insulin (facilitated diffusion) to cross the cell membrane.

  30. Glucose Metabolism • Diabetes mellitus results from inadequate amounts of circulating insulin. • Disease divided into two categories: 1. Type I 2. Type II

  31. Type I Diabetes Mellitus • Insulin dependent. Characterized by inadequate production of insulin. • Cause is not well understood. • Heredity appears to be a factor in increasing a person’s chance in contracting the disease. • Patient must take daily doses of insulin.

  32. Type I Diabetes Mellitus • When patients cannot move glucose into the cell they become hyperglycemic. This results in decreased utilization of other compounds, such as ketones. • As utilization of ketones decreases they start to accumulate resulting in a state known as ketosis. Which will result in ketoacidosis.

  33. Type I Diabetes Mellitus • Also, as the concentration of glucose increases in the blood stream the kidneys will start to excrete large amounts of glucose, this will also result in large amounts of water being eliminated resulting ins an osmotic diuresis, which causes dehydration in this group of patients.

  34. Type II Diabetes Mellitus • Non-insulin dependent • Occurs more commonly than Type I • Also characterized by decreased insulin levels. • Usually is adult onset and is due to a sluggish pancreas. • Often associated with obesity.

  35. Type II Diabetes Mellitus • This group is usually controlled by diet, such as low carbohydrate diets. • Also oral medications can be utilized. Causing a stimulation to produce more insulin. • Type II diabetes does not usually result in DKA, but can develop into nonketotic hyperosmolar coma.

  36. Diabetic Ketoacidosis • Also known as Diabetic Coma • Serious complication of diabetes mellitus. • This occurs once an individual has developed hyperglycemia and ketoacidosis.

  37. Clinical Presentation • Onset is slow, (12-24 hours). • Early signs and symptoms: increased thirst, excessive hunger, urination, and malaise. • Characterized by nausea, vomiting, marked dehydration, tachycardia, and weakness. • Skin is warm and dry. Breath may have a sweet or acetone-like character due to attempting to blow of the ketones in the blood

  38. Clinical Presentation • Present with a deep, rapid respiration called Kussmaul’s respirations. • This is a compensatory mechanism attempting to blow off the metabolic acidosis. • Occurs in patients who fail to take their insulin or who take an inadequate amount.

  39. Assessment • Same as with all patients. • Pay attention for medic alert tags • Intervention: Oxygen IV Transport

  40. Hypoglycemia • AKA Insulin Shock • Occurs when insulin levels are excessive. • This is a true medical emergency because the whole presentation involves the central nervous system and could result in serious brain injury.

  41. Pathophysiology • Can occur if a patient accidentally or intentionally takes too much insulin or eats an inadequate amount of food after taking insulin.

  42. Clinical Presentation • Presentation is typically CNS involved: Abnormal mental status Inappropriate anger Seizure Coma • Physical signs include: diaphoresis and tachycardia. • Occurs quickly in contrast to DKA

  43. Assessment • Perform normal assessment, look for medic alert tags • Determine blood glucose levels (glucometer)

  44. Intervention • IV • D50 if glucose levels are low • IF alcoholism is suspected Thiamine before D50. • Oxygen • Transport