AG-ACNP – Endocrine Questions and
Answers
What lab is ordered to rule out Addison's Disease? Correct Ans-Cosytropin
What is the outpatient management for Addison's Disease? Correct Ans-Glucocorticoid
replacement
- Hydrocortisone
Mineralcorticoid replacement
- Fludrocortisone acetate (Florinef)
Explain the pathology of SIADH. Correct Ans-Release of ADH occurs independent of
osmolality or volume dependent stimulation.
INAPPROPRIATE WATER RETENTION
What are the hallmark signs and symptoms of SIADH? Correct Ans-Neurological changes -
hyponatremia - seizures, coma
Weight gain
Edema
Decreased UOP
What is the diagnostic profile in determining SIADH? Correct Ans-Hyponatremia -
euvolemic
,Decreased serum osmolality <280
Increased urine osmolality >100
Urine sodium > 20
Patient has been diagnosed with SIADH. What is the management if serum Na > 120 mEq/L?
Correct Ans-Restrict total fluids to 1000 mL/24 hrs
What is the management of a patient diagnosed with SIADH and demonstrating neurological
symptoms with serum Na < 110 mEq/L? Correct Ans-Hypertonic Saline 3% NS IVF slow
administration and furosemide (Lasix) at 1-2 mEq/hr.
When would you restrict fluids to 500 mL/24 hr in a patient diagnosed with SIADH? Correct
Ans-Serum Na <110-120 mEq/L and no neurological symptoms
Define central Diabetes Inspidius and identify the causes. Correct Ans-Central DI - Damage
of pituitary or hypothalamus that causes ADH deficiency.
Surgical damage
Trauma
Infection
Nephrogenic Diabetes Insipidus is caused by: Correct Ans-Defect in the renal tubules
resulting in renal insensitivity to ADH
, What are the hallmark signs and symptoms of Diabetes Insipidus? Correct Ans-
Thirst/cravings for water - intake 5-20 L/day
Polyuria - 6-20 L/day
Tachycardia
Hypotension
Altered mental status
What are the significant labs associated with Diabetes Insipidus? Correct Ans-Hypernatremia
Increased serum osmolality > 290
Decreased urine osmolality <100
Decreased urine specific gravity <1.005
Increased BUN/Cr
Explain the management of a patient with DI and serum Na of > 150 mEq/L. Correct Ans-
Give D5W IV to replace 1/2 FVD in 12-24 hours
Identify the major complication associated with rapid lowering of serum sodium? Correct
Ans-Cerebral edema.
What is used for acute management of DI? Correct Ans-DDAVP 1-4 ug IV or SQ q 12-24 hrs
What is the maintenance dose of DDAVP and indication? Correct Ans-DI maintenance dose -
DDAVP 10 ug q 12-24 hrs INTRANASALLY
Answers
What lab is ordered to rule out Addison's Disease? Correct Ans-Cosytropin
What is the outpatient management for Addison's Disease? Correct Ans-Glucocorticoid
replacement
- Hydrocortisone
Mineralcorticoid replacement
- Fludrocortisone acetate (Florinef)
Explain the pathology of SIADH. Correct Ans-Release of ADH occurs independent of
osmolality or volume dependent stimulation.
INAPPROPRIATE WATER RETENTION
What are the hallmark signs and symptoms of SIADH? Correct Ans-Neurological changes -
hyponatremia - seizures, coma
Weight gain
Edema
Decreased UOP
What is the diagnostic profile in determining SIADH? Correct Ans-Hyponatremia -
euvolemic
,Decreased serum osmolality <280
Increased urine osmolality >100
Urine sodium > 20
Patient has been diagnosed with SIADH. What is the management if serum Na > 120 mEq/L?
Correct Ans-Restrict total fluids to 1000 mL/24 hrs
What is the management of a patient diagnosed with SIADH and demonstrating neurological
symptoms with serum Na < 110 mEq/L? Correct Ans-Hypertonic Saline 3% NS IVF slow
administration and furosemide (Lasix) at 1-2 mEq/hr.
When would you restrict fluids to 500 mL/24 hr in a patient diagnosed with SIADH? Correct
Ans-Serum Na <110-120 mEq/L and no neurological symptoms
Define central Diabetes Inspidius and identify the causes. Correct Ans-Central DI - Damage
of pituitary or hypothalamus that causes ADH deficiency.
Surgical damage
Trauma
Infection
Nephrogenic Diabetes Insipidus is caused by: Correct Ans-Defect in the renal tubules
resulting in renal insensitivity to ADH
, What are the hallmark signs and symptoms of Diabetes Insipidus? Correct Ans-
Thirst/cravings for water - intake 5-20 L/day
Polyuria - 6-20 L/day
Tachycardia
Hypotension
Altered mental status
What are the significant labs associated with Diabetes Insipidus? Correct Ans-Hypernatremia
Increased serum osmolality > 290
Decreased urine osmolality <100
Decreased urine specific gravity <1.005
Increased BUN/Cr
Explain the management of a patient with DI and serum Na of > 150 mEq/L. Correct Ans-
Give D5W IV to replace 1/2 FVD in 12-24 hours
Identify the major complication associated with rapid lowering of serum sodium? Correct
Ans-Cerebral edema.
What is used for acute management of DI? Correct Ans-DDAVP 1-4 ug IV or SQ q 12-24 hrs
What is the maintenance dose of DDAVP and indication? Correct Ans-DI maintenance dose -
DDAVP 10 ug q 12-24 hrs INTRANASALLY
