Endocrine and Metabolic Crises Flashcards

A patient with DKA has an arterial blood gas showing pH 7.18, HCO3 8 mEq/L. This represents which acid-base disturbance?

Answer: High anion gap metabolic acidosis

Accumulation of ketoacids in DKA produces a high anion gap metabolic acidosis with low pH and low bicarbonate.

Kussmaul respirations observed in a DKA patient represent what compensatory mechanism?

Answer: Respiratory compensation to blow off CO2 and reduce acidosis

Deep, rapid Kussmaul breathing is the lungs compensating for metabolic acidosis by eliminating CO2.

Which patient is at highest risk for hyperosmolar hyperglycemic state (HHS)?

Answer: An elderly patient with type 2 diabetes and an acute infection

HHS classically occurs in older type 2 diabetics with a precipitating illness such as infection causing severe dehydration and hyperglycemia.

A patient receiving an insulin infusion for HHS requires careful glucose lowering primarily to prevent which complication?

Answer: Cerebral edema from rapid osmotic shifts

Lowering glucose and osmolality too quickly causes rapid fluid shifts into the brain, risking cerebral edema.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) would be expected to have which sodium and fluid status?

Answer: Hyponatremia with fluid retention

Excess ADH causes water retention and dilutional hyponatremia with concentrated urine.

Which treatment is appropriate for symptomatic SIADH with severe hyponatremia?

Answer: Fluid restriction and possibly hypertonic saline

SIADH is managed with fluid restriction, and severe symptomatic hyponatremia may require cautious hypertonic saline.

A patient with diabetes insipidus (DI) typically presents with which findings?

Answer: Polyuria with dilute urine and hypernatremia

DI results from ADH deficiency or resistance, causing massive output of dilute urine, dehydration, and hypernatremia.