Endocrine Disorders Dr. Naiema Gaber Critical Care Nursing Endocrine Disorders Dr. Naiema Gaber

I-Diabetic Emergencies Endocrine Disorders I-Diabetic Emergencies

Diabetic Disorders: Learning Outcomes Identify the three main diabetic emergencies (D E) Discuss the principal features of (DE) Explain the management plan of (DE) Develop nursing plans for managing (DE)

Diabetes mellitus (DM) DM Is Hyperglycemia Due To The Decrease , Destruction Or Impaired Effectiveness Of Insulin. Types : 1-type I: DM (IDDM) Its Onset Is In Childhood Or Adolescence II-type 2:dm (NIDDM). Its Onset Is After 40 Years Of Age (Maturity Onset Dm

Types of DM cont. III- Secondary DM (Insulin Resistance Which Is Due TO drug Therapy OR Metabolic Endocrine Diseases And Critical Illness

Diabetes mellitus (DM) Primary D M * drug therapy * endocrine disease *critical illness Secondary DM NIDDM IDDM

The Three Main Diabetic Emergencies 1- Diabetic ketoacidosis (DKA) 2-Hyperosmolar, Hyperglycemic States (HHS) 3-hypoglycemis coma

1- Diabetic ketoacidosis (DKA) It is characterized by hyperglycemia, ketosis, and acidosis, often with coma. It is life threatening condition even if the patient is not comatose. About 1/3 of DKA patients are newly diagnosed diabetics.

1- Diabetic ketoacidosis (DKA) The causes of DKA include , infection, MI, thromboembolic episodes, non compliance with treatment and altered level of consciousness. Coma is not always present

What is pathophysiology of ketoacidosis? The patient can not utilize glucose from food due to insufficient insulin. Energy is provided by fat breakdown (lipolysis) Some of the free fatty acids released by lipolysis are converted into ketones by the liver causing a profound metabolic acidosis. This patient compensates for this acidosis by hyperventilation (Kussmaul respiration)

The Principal Features of DKA Hyperglycemia Dehydration Electrolyte Loss Ketoacidosis

Why DKA patient has dehydration? 1- Increased concentration of glucose in the blood the kidney does not reabsorb the excess glucose which is excreted in urine. increase osmotic diuresis results large volume of water and electrolytes are lost. 2- loss of fluids through hyperventilation, vomiting, sweating, fever and decreased fluid intake due to coma

The Clinical Manifestations of Dehydration are Extreme Thirst Polydeipsic And Later on, Hypovolemic Shock ( Hypotension And Tachycardia).

What is the management of DKA? Every patient will differ in their: * degree of hypovolemia * blood glucose levels * level of consciousness. *underlying condition Resuscitation must be guided Patent airway

What is the management of DKA? Cont. Intravenous fluid replacement Cardiac output monitoring A continuous infusion of insulin Hourly blood glucose measurements ECG monitoring ABG. Monitoring Prevent DVT formation Treat the underlying causes

What is the nursing management of DKA? Nursing diagnosis 1-Inadequate airway protection related to decreased level of consciousness Intervention: Maintain patent and protected airway Mechanical ventilation for deeply comatose Naso-gastric tube to decrease the risk of aspiration Respiratory rate and pattern monitoring Blood gases and oxygen therapy accordingly

What is the nursing diagnosis of DKA? cont Hypovolemia related to dehydration Hyperglycemia Electrolyte depletion related to polyuria Metabolic acidosis related to ketosis Potential deep vein thrombosis

II hyperosmolar hyperglycemic states (HHS) HHS Commonly occurs in undiagnosed patient with NDDM. It is much less common than DKA Factors predisposing to HHS: Elderly, infection, trauma including burn, MI, pancreatitis, hepatitis Renal failure, hypothermia Carbohydrate overload Drugs as phenytoin, thiazides

What is the difference between DKA and HHS? In DKA the level of free fatty acids and counter regularity hormones is lower This is properly due to sufficient insulin still being secreted to prevent lipolysis but not hyperglycemia. Ketosis may thus be absent or mild

What is the management of HHS Level of conscious: active management of coma Fluid replacement as dehydration is often severe Insulin therapy as ordered as patient is having insulin sensitivity and need lower doses. Anticoagulation as prolonged immobility, hypervescosity of circulating blood

III- hypoglycemic coma It result from a low blood glucose level. This may be due to * insulin overdose(diabetic or accedental) *excessive exercise for diabetic patients and inadequate food intake. The onset of coma is usually rapid Most patient are aware of the onset of symptoms and can prevent it occurrence by taking sugar

How can we diagnose and manage a comatose patient Bedside blood glucose analysis. Treatment must be rapid as hypoglycemia can cause irreversible brain damage. 20-50 ml IV of 50% glucose

Deference between hyper and hypoglycemia Hyperglycemia Restlessness Thirst Vomiting Abdominal pain Hot dry flushed skin Drowsiness Tachycardia deep sighing Hypotension coma Hypoglycemia Headache Hunger, faintness Cool moist skin Sweating Slurred speech Tachycardia/ bradycardia Irrational behavior, agitation coma

Review questions 1-The term insulin resistance is applied to which type of diabetes? a- type 1 b-type 2 c- insipetus d-secondary (D)

Review questions 2-Mr Ali admitted to ER in coma. His wife said that he is diabetic. To diagnose the cause of coma, the nurse need to: a- observe the patient’ conditions b- analysis bedside blood glucose levels c-do urine analysis d-do physical examination (b)

Review questions 3-during your training in the critical care unit, you observed that Mr. hammed who is 60 year old with 2o% deep burn in chest, is having Restlessness, Thirst, Vomiting, Abdominal pain and Hot dry flushed skin. This feature is due to a- hypoglycemia b-ketoacidosis c- hyperglycemia d-thyroid crisis ©

Review questions 4-What is the difference between DKA and HHS? In HHS a- Ketosis increased with acidosis b-Ketosis increased without acidosis c –Ketosis increased with free fatty acid d-Ketosis may thus be absent or mild (D)

Review questions 5- The level of free fatty acids and counter regularity hormones is low in a- Diabetic Ketoacidosis b- Hyperosmolar Hyperglycemic States c- Diabetes Mellitus d- Hypoglycemic Coma 6- This is may be due to a- sufficient insulin b- lipolysis c- insufficient insulin d- insufficient fluid intake (b & a)

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