Endocrine

Case 1:
DKA
Check SERUM ketones: B-hydroxy butyrone and/or acetic acid
---Ketones in urine can happen after a skipped meal, with low carb diet,
etc -> ketonuria not a concern/non-specific.
B-hydroxybutyrate > 90 indicates DKA
--- 10-15 not a concern
ABG:
pCO2: 7
pO2: 82
PH 6.94
Normal pCO2 is 40.
Acute: For every 10 pCO2 changes, pH changes by 0.08
Chronic: 10mmHg change of pCO2 0.03 change in pH
Ex:
pCO2 40 7 = 33 - pH decreases by 0.24
pH 6.94 + 0.24 - 7.16 therefore something else contributing to
acidosis
DKA management:
Liberal IV fluids (NS)
Insulin drip
--when glucose falls to 200 and gap is closed, switch to SC injx
As academia corrects add 20meq K to IV fluids
Should be managed in ICU, most pts downgraded w/in 12 hours
CASE 2:
79F from nursing home, difficult to arouse
CC: lethargic/stuporous shallow resp
Myxedema coma:
Hallmark sx: decreased mental status and hypothermia
Other Sx: hypoTN, bradycardia, hyponatremia, hypoglycemia,
hypoventilation, nonpitting edema with abnormal deposits of mucin
Can be insidious or acute(longstanding hypothyroidism vs infx, MI, cold
temps, sedatives, opioids_
Possibility for focal or generalized seixures due to hyponatremia. Would
have no-specific EEG

Possibility of relative elevation in diastolic pressure on a relative

systolic hypotension ie 95/80 bc thyroid hormone normally reduces
peripheral vascular resistance
Mortality 30-40%
3 common causes of lethargy, AMS in elderly
-UTI
-Meds, polypharmacy
-pneumonia
BNP is NOT diagnostic for CHF, but if less than 100 it can rule out HF.