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Critical Care Exam II – Questions And Answers
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Critical Care Exam II – Questions And Answers
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Critical Care Exam II – Questions And AnswersDiabetes Insipidus Correct Ans - TYPES:
1) Central
a. primary - from innate ADH deficiency
*b. secondary - from damage to h-h system via trauma, infection, neoplasms*
2) Nephrogenic - kidneys cant respond to circulating ADH
3) Psychogenic - from h2o tox
CAUSES: (central) neurosurgery, head trauma, infection
*LABS:*
*- sodium > 145 meq/l = hypernaturemia*
*- serum Osmo > 300 mos/l*
* - urine Osmo < 100*
DX EXAMS:
- water deprevation test, vasopressin test, skull XR, ct, mri
CLINICAL PRESENTATION/WHY:
- *sharp increase in dilute urine*
- free water eliminated, hypoT and hypovolemic shock, seizures
- stachy
HEMODYNAMIC PRESENTATION: - low BP
TX:
- replace fluids via D5W or hypotonics (.9NS, .45NS, d5NS, D5.45)
- replace ADH
- treat underlying cause
MEDS:
- desmopressin/DDAVP - synthetic ADH. strong diuretic, little impact on BP
- vasopressin/pitressin - hits V1 receptor so htn can result
* if ADH leads to htn or overhydration, restrict fluids until urine spec grav <
1.015
- mild gets diabenase, orinase, tegretol.......psychogenic gets anxiolytics
,COMPLICATION: htn and arterial vasospasm from ADH rx. also constipation or
diarrhea
SIADH Correct Ans - CAUSES:
- head trauma, CNS diseases
- tumors that produce ADH, pulm disease
- neurogenic stimuli, endocrine disturbances
- drugs: hypoglycemics, diuretics, phenothiazine, thioxanthenes, opiates,
carbmazepine, tylonol, ocy, vasopressin, anesthetics
LABS:
*- hypo Na <130*
*- hypo serum osmo < 270*
- increased urine osmo
- increased specific gravity >1.030
CLINICAL PRESENTATION/WHY:
- overhydration, low sodium, concentrated urine
- edema not usually present but slight weight gain
- early s/s: anorexia, n/v, may not have s/s
- severe: when Na is less than 120 = tetany. confusion, seizures, coma, death
TX:
- treat underlying cause
- restrict fluid (500ml < output)
- replace sodium (hypertonic solution slowly)
MEDS: to increase h2O excretion
- demeclocycline/declomycin - Li carbonate
- Conivaptan/vaprisol - blocks V1 (vessels) and V2 (kidney) = vassodilation
ETC
- no water/hypotonic enemas
- seizure precautions <125 na
Addison's Disease Correct Ans - = hyposecretion of cortisol and some
ALD
LABS:
, *- Na < 130*
*- K > 4.5*
*- Glu < 70*
DX EXAMS:
ACTH stimulation test
primary - give ATCH but doesnt improve
secondary - give ATCH and does improve
CLINICAL PRESENTATION/WHY:
- low ALD: hyperK, hypoNa, HypoVol
- low cortisol: hypoG, slow GI, low vascular tone, hyperCa
- other: anorexia, n/v/ tachy,
HEMODYNAMIC PRESENTATION:
hypoT, fatigue, hyperK on ECG, bronzing
CONSEQUENCES IF UNTREATED:
Addisonian Crisis nonfunctional adrenal gland from trauma. Pt has hypoT,
hyperK, hyopG, hypoNA. TX: fluid replacement, no stimuli
TX:
- 5 S's: sugar, salt, steroid, support, serch
- IV fluids D5NS
MEDS: hormone replacement
- hydrocortisone, solucortef (must be tapered)
- take with snack or antacid, watch for hypoK
- monitor glu
- may need more rx when stressed
Cushing's Syndrome Correct Ans - TYPES:
Primary - excess cortisol release (rare)
Secondary/iatrogenic - chronic steroids
LABS:
DX EXAMS:
CLINICAL PRESENTATION/WHY:
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