Over the counter and prescribed drugs taken Assess pts understanding of illness and adherence with treatment o Signs and symptoms to report to health care provider o Drug plan (correct timing and dose) Critical Rescue Ensure that no pt suspected of having DI is deprived of fluids for more than 4 hours, because they cannot reduce urine output and severe dehydration can result Diabetes Insipidus Manifestations CV o Hypotension o Decreased pulse pressure o Tachycardia
o Peripheral pulses weak, easily blocked o Hemoconcentration Increased hemoglobin Increased hematocrit Increased BUN Kidney/Urinary o Increased UO Dilute, low specific gravity Hypo-osmolar Skin o Poor turgor o Dry mucous membranes Neurologic o Increased sensation or thirst o Irritability o Decreased cognition o Hyperthermia o Lethargy to coma o Ataxia Drug Alert Diabinese and Diamox are sound-alike, look-alike drugs Do not confuse them Diamox is a type of diuretic, which could increase urine output and the risk for dehydration Drug Alert The parenteral form of desmopressin is 10 times stronger than the oral form, and the dosage must be reduced Conditions Causing SIADH Malignancies o Small cell lung cancer o Pancreatic, duodenal and GU carcinomas o Thymoma o Hodgkins lymphoma o Non hodgkins lymphoma Pulmonary Disorders o Viral and bacterial pneumonia o Lung abscesses
o Active tuberculosis o Pneumothorax o Chronic lund diseases o Mycoses o Positive-pressure ventilation CNS Disorders o Trauma o Infection o Tumors (primary or metastatic) o Strokes o Porphyria o Systemic lupus erythematosus Drugs o Exogenous ADH o Chlorpropamide o Vincristine o Cyclophosphamide o Carbamazepine o Opioids o Tricylclic antidepressants o General anesthetics Drug Alert Administer tolvaptan or conivaptan in the hospital setting so that serum sodium levels can be monitored closely for the development of hypernatremia Emergency Care of the Pt with Acute Adrenal Insufficiency Hormone Replacement o Start rapid infusion of normal saline or dextrose 5% in normal saline o Initial dose of hydrocortisone succinate (Solu-Cortef) is 100-300mg or dexamethasone 4-12mg as an IV bolus o Infuse additional 100mg of hydrocortisone sodium succinate by continuous IV drop over the next 8 hours o Give hydrocortisone 50mg IM concomitantly every 12 hours o Initiate an H2 histamine blocker (Rantidine) IV for ulcer prevention Hyperkalemia Management o Administer insulin (20-50 units) with dextrose (20-50mg) in normal saline to shift potassium into cells
o Administer potassium binding and excreting resin (Kayexelate) o Give loop or thiazide diuretics o Avoid potassium-sparing diuretics, as prescribed o Initiate potassium restriction o Monitor I&O o Monitor HR , rhythm, and ECG for manifestations of hyperkalemia (slow HR, heart block, tall, peaked T waves, fibrillation, systole) Hypoglycemia Management o Administer IV glucose as prescribed o Administer glucagon, as needed and prescribed o
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- Fall '14
- Endocrine System, thyroid gland, thyroid hormones