depression, NM probs Hypocalcemia Neck radiation Secondary: dx causing Laryngeal spasm Lithium (bipolar) EKG changes, HTN hypo-Ca Neuro check – Constipation, peptic ulcer electrolyte imbalance Check voice Tx secondary disease Non-pharm tx Lab studies Nutrition Fluid – kidney stones Fall prevention Rest Analgesics/comfort Addison’s Adrenal gland removal Hypovolemia Sodium, potassium, Adrenal crisis 1º adrenal BUN levels (low Na, high Dehycration, fever, Autoimmune disorder Fluid/electrolyte insufficiency (AI) K, high BUN) hypoNa, hyperK, imbalance Infections/invasive disease vascular collapse, Blood sugar (low) Postural hypotension death Cortisol levels (low) LOC changes IV hydrocortisone Urinary metabolites Hyperkalemia Normal saline ACTH stimulation test Fatigue, weakness Vasopressors GI complaints (slow) Electrolytes (Na) Decreased urine output Hormone replacement (adrenal crisis) Increase Na intake Hyperpigmentation or Treat hypoglycemia 1st orange skin Decreased libido Cushing’s – chronic Obesity Glucose (high) Aldosterone antagonist exposure to cortisol (spironolactone) Moon face, acne High WBC Surgery Hirsutism – facial hair HypoK, HyperNa 1º: excess aldosterone Buffalo hump, striae Serum/salivary cortisol by adrenal cortex Plethora (excess Dexamethasone fluid/blood) suppression test 2º Caused by excess HNT 24-hour urine (cortisol renin and Cr) Fatigue, muscle weakness ACTH stimulation test Hyperglycemia Exogenous: excess Bruising glucocorticoids (COPD, Depression to psychosis RA) Osteoporosis Menstrual disorders,
Secondary: dx causing hypo-Ca Neck radiation Lithium (bipolar) depression, NM probs EKG changes, HTN Constipation, peptic ulcer Hypocalcemia Laryngeal spasm Neuro check – electrolyte imbalance Check voice Tx secondary disease Non-pharm tx Lab studies Nutrition Fluid – kidney stones Fall prevention Rest Analgesics/comfort Addison’s 1º adrenal insufficiency (AI) Adrenal gland removal Autoimmune disorder Infections/invasive disease Hypovolemia Fluid/electrolyte imbalance Postural hypotension LOC changes Hyperkalemia Fatigue, weakness GI complaints (slow) Decreased urine output (adrenal crisis) Hyperpigmentation or orange skin Decreased libido Sodium, potassium, BUN levels (low Na, high K, high BUN) Blood sugar (low) Cortisol levels (low) Urinary metabolites ACTH stimulation test Adrenal crisis Dehycration, fever, hypoNa, hyperK, vascular collapse, death IV hydrocortisone Normal saline Vasopressors Electrolytes (Na) Hormone replacement Increase Na intake Treat hypoglycemia 1st Cushing’s – chronic exposure to cortisol 1º: excess aldosterone by adrenal cortex 2º Caused by excess renin Exogenous: excess glucocorticoids (COPD, RA) Obesity Moon face, acne Hirsutism – facial hair Buffalo hump, striae Plethora (excess fluid/blood) HNT Fatigue, muscle weakness Hyperglycemia Bruising Depression to psychosis Osteoporosis Menstrual disorders, Glucose (high) High WBC HypoK, HyperNa Serum/salivary cortisol Dexamethasone suppression test 24-hour urine (cortisol and Cr) ACTH stimulation test Aldosterone antagonist (spironolactone) Surgery