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Flashcards in HORMONES Deck (32)
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1
Q

Why do we get AM cortisol levels?

A

because peak plasma concentration between 4 am - 8 am

2
Q

What kind of feedback does HPA axis have

A

negative feedback

3
Q

What releases CRH +?

A

Hypothalamus

4
Q

What releases ACTH+?

What releases cortisol?

cortisol is bound to?

A

Pituitary releases ACTH

Adrenal releases cortisol

Cortisol is highly protein bound

5
Q

Why would your HPA axis wont work?

What causes adrenal insufficiency?

A

acute setting: hemodynamic instability

6
Q

What are the clinical manifestations of adrenal insufficiency?

What are the laboratory findings?

A
7
Q

Common clinical manifestations of CIRCI

A

Common clinical manifestations of CIRCI
• Hypotension

  • Unresponsiveness to catecholamine infusion
  • Ventilator dependence
8
Q

How to Diagnose CIRCI using ACTH stim test

A

ACTH stimulation test

  • Dosing of IV ACTH is controversial – 250 mcg vs 1 mcg
  • Adrenal insufficiency if delta ≤9 mcg/dL after 250 mcg dose
9
Q

A steroid that does not impact ACTH results

A

Dexamethasone

10
Q

Managemet of CIRCI

take home points

A
11
Q

What has the highest mineralcorticoid potency is

A

Fludcortisone

12
Q

What should be on your differential for refractory hypotension?

A

Adrenal insufficiency esp. if you gave etomidate

13
Q

Adrenal insufficiency and etomidate

A

Reduction of corticol secretion in etomidate

doesn’t translate to long term outcomes

14
Q

Management of CIRCI w/o septic shock

A

Taper is not needed for steroid duration <7 days

15
Q

If someone is exposed to <5 mg /day

A

—> can be
considered not to have a suppression of HPA axis

16
Q

Management for periopertive steroids in patients receiving chronic prednisone 5 mg daily

MINOR SURGERY

A
17
Q

Management for periopertive steroids in patients receiving chronic prednisone 5 mg daily

MODERATE SURGERY

A
18
Q

Management for periopertive steroids in patients receiving chronic prednisone 5 mg daily

MAJOR SURGERY

and

Critically ill

A
19
Q

What is the maximum hydroctortisone treatment can you have if you are in septic shock and steroid naive

A

200 mg/ daily

  • If you have been chronically exposed >200 probably 300
20
Q

Surviving sepsis campaign

How much steroid is recommended

What about random cortisol level

Optimal duration of therapy?

A
21
Q

What are the adverse effects of glucocorticoids?

A
  • Suppression of the HPA axis
  • Hypergylycemia
  • Skeletal muscle myopathy
  • Leukocytosis / infection
  • Infection
  • Decrease wound healing
  • Psychosis
22
Q

How is insulin delivery affected?

A
23
Q

What is type 1 diabetes?

What is type 2?

A
24
Q

Side effects of insulin

A
  • Insulin resistance
    • Defined as the daily need for > 100 units of exogenous insulin
    • Acute insulin resistance is associated with trauma from infection or surgery
25
Q

What do you need to know for Sulfonylureas?

A
26
Q

What is the SE of Metformin?

what does it cause?

A

* common diabetic preOp

*** metformin should be held.

LACTIC ACID CAN BE SEE

27
Q

What are the commonly used Sulfonylureas

A

If the patient has AKI and they have taken Sulfonylureas– then they are likely to experience hypoglycemia POST-OP

28
Q

T/F

Tighter glucose control in critically ill patients has been independently associated with increased ICU mortality

A

true

§ Some studies show no difference in mortality

29
Q

What is the presentation of DKA?

who commonly has it?

A

Diabetic ketoacidosis (DKA)

  • Combination of hyperglycemia (BG >250 mg/dL) + ketosis (positiveurine or serum ketones) + acidosis (pH <7.30 with serum bicarbonate <18 mmol/L and anion gap >10)

if you add depressed mental status then its SEVERE DKA

they have to gave 3

– COMMONLY PRESENT WITH TYPE 1

30
Q
A
31
Q

What is the presentation of HHS?

A

hyperglycemia is much higher.

often occurs with type 2 dm

32
Q

Management of DKA and HHS

A
  1. Massive amount of fluid resuscitation
  2. Insulin IV
  3. Electrolyte replacement –> be careful with potassium

the patient may be hyperkalemic at first because they are volume down.

–> REPLACE K if hypokalemic before you start insulin

  1. Correction of acidemia–> BICARB should not be given.