NURS 283: ENDOCRINE DISORDERS STUDY GUIDE NOTES
Acute Complication: Diabetic ketoacidosis (DKA, diabetic coma)
a) Definition:
• A serious diabetes complication where the body produces excess blood acids (ketones).
•
• This condition occurs when there isn't enough insulin in the body. It can
be triggered by infection or other illness.
b) Risk factors:
Ketoacidosis usually develops over a few days and may be initiated by an infection or stress,
which increases the demand for insulin in the body. It may also result from an error in dosage
or overindulgence in food or alcohol
c) Symptoms:
The signs and symptoms of diabetic ketoacidosis are related to dehydration, metabolic acidosis,
and electrolyte imbalances (Table 16-3).
•Signs of dehydration include thirst; dry, rough oral mucosa; and a warm, dry skin. The pulse is
rapid but weak and thready, and the blood pressure is low as the vascular volume decreases.
Oliguria (decreased urine output) indicates that compensation mechanisms to conserve fluid in
the body are taking place.
•Ketoacidosis leads to rapid, deep respirations (Kussmaul's respirations) and acetone breath
(a sweet, fruity smell). Lethargy and decreased responsiveness indicate depression of the
central nervous system owing to acidosis and decreased blood flow.
FIGURE 16-4 Development of diabetic ketoacidosis.
•Metabolic acidosis develops as ketoacids bind with bicarbonate ions in the buffer, leading
to decreased serum bicarbonate levels and decreased serum pH (see Chapter 2). As
dehydration progresses, renal compensation is reduced, acidosis becomes decompensated,
and serum pH falls, resulting in loss of consciousness.
•Electrolyte imbalances include imbalances of sodium, potassium, and chloride. Signs include
,NURS 283: ENDOCRINE DISORDERS STUDY GUIDE NOTES
primarily abdominal cramps, nausea, and vomiting, as well as lethargy and weakness. Actual
serum values of electrolytes may be misleading because the proportion of water lost can affect
the serum level even though the electrolytes were lost in the urine. Serum sodium is often low,
but the potassium concentration may be elevated because of acidosis (see Chapter 2). If the
condition remains untreated, central nervous system depression develops owing to the acidosis
and dehydration, leading to coma.
Treatment of diabetic ketoacidosis involves administration of insulin as well as replacement of
fluid and electrolytes. Serum potassium levels may decrease when insulin is administered
because insulin promotes transport of potassium into cells. Bicarbonate administration is
essential to reverse the acidosis, as well as specific treatment to resolve the causative factor of
the diabetic ketoacidosis episode.
What are the chronic complications of DM and their cause?
Text book p. 411: If the condition remains untreated, central nervous system depression
develops owing to the acidosis and dehydration, leading to coma.
Online: Although long-term complications of diabetes develop gradually, they can eventually be
disabling or even life-threatening. Some of the potential complications of diabetes include:
• Heart and blood vessel disease. Diabetes dramatically increases the risk of various
cardiovascular problems, including coronary artery disease with chest pain (angina), heart
attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels
(capillaries) that nourish your nerves, especially in the legs. This can cause tingling,
numbness, burning or pain that usually begins at the tips of the toes or fingers and
gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose
all sense of feeling in the affected limbs. Damage to the nerves that control digestion can
cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile
dysfunction may be an issue.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel
clusters that filter waste from your blood. Diabetes can damage this delicate filtering
system. Severe damage can lead to kidney failure or irreversible end-stage kidney
disease, which often eventually requires dialysis or a kidney transplant.
, NURS 283: ENDOCRINE DISORDERS STUDY GUIDE NOTES
• Eye damage. Diabetes can damage the blood vessels of the retina (diabetic
retinopathy), potentially leading to blindness. Diabetes also increases the risk of
other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk
of various foot complications. Left untreated, cuts and blisters can become serious
infections, which may heal poorly. Severe damage might require toe, foot or leg
amputation.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Skin conditions. Diabetes may leave you more susceptible to skin problems,
including bacterial and fungal infections.
• Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The
poorer your blood sugar control, the greater the risk appears to be. The exact connection
between these two conditions still remains unclear.
1. What is the difference between steroidal and non-steroidal hormones? (p. 403)
• Steroids are lipids that enter the cell and nucleus and act directly in the nucleus to
engage in transcription (messenger RNA).
• Non-steroidal needs a second messenger system to finally activate the formation
of mRNA.
2. How are hormones most frequently controlled? (p. 403-404)
• They are controlled by a negative feedback mechanism.
• For example, as levels of glucose increase the secretion of insulin increases.
When the glucose levels decrease, insulin secretion decreases
3. For each hormone, list the secreting organ or gland and the primary action: (p. 404)
a. Adrenocorticotropic hormone (ACTH)
• Secreting gland: Pituitary
Acute Complication: Diabetic ketoacidosis (DKA, diabetic coma)
a) Definition:
• A serious diabetes complication where the body produces excess blood acids (ketones).
•
• This condition occurs when there isn't enough insulin in the body. It can
be triggered by infection or other illness.
b) Risk factors:
Ketoacidosis usually develops over a few days and may be initiated by an infection or stress,
which increases the demand for insulin in the body. It may also result from an error in dosage
or overindulgence in food or alcohol
c) Symptoms:
The signs and symptoms of diabetic ketoacidosis are related to dehydration, metabolic acidosis,
and electrolyte imbalances (Table 16-3).
•Signs of dehydration include thirst; dry, rough oral mucosa; and a warm, dry skin. The pulse is
rapid but weak and thready, and the blood pressure is low as the vascular volume decreases.
Oliguria (decreased urine output) indicates that compensation mechanisms to conserve fluid in
the body are taking place.
•Ketoacidosis leads to rapid, deep respirations (Kussmaul's respirations) and acetone breath
(a sweet, fruity smell). Lethargy and decreased responsiveness indicate depression of the
central nervous system owing to acidosis and decreased blood flow.
FIGURE 16-4 Development of diabetic ketoacidosis.
•Metabolic acidosis develops as ketoacids bind with bicarbonate ions in the buffer, leading
to decreased serum bicarbonate levels and decreased serum pH (see Chapter 2). As
dehydration progresses, renal compensation is reduced, acidosis becomes decompensated,
and serum pH falls, resulting in loss of consciousness.
•Electrolyte imbalances include imbalances of sodium, potassium, and chloride. Signs include
,NURS 283: ENDOCRINE DISORDERS STUDY GUIDE NOTES
primarily abdominal cramps, nausea, and vomiting, as well as lethargy and weakness. Actual
serum values of electrolytes may be misleading because the proportion of water lost can affect
the serum level even though the electrolytes were lost in the urine. Serum sodium is often low,
but the potassium concentration may be elevated because of acidosis (see Chapter 2). If the
condition remains untreated, central nervous system depression develops owing to the acidosis
and dehydration, leading to coma.
Treatment of diabetic ketoacidosis involves administration of insulin as well as replacement of
fluid and electrolytes. Serum potassium levels may decrease when insulin is administered
because insulin promotes transport of potassium into cells. Bicarbonate administration is
essential to reverse the acidosis, as well as specific treatment to resolve the causative factor of
the diabetic ketoacidosis episode.
What are the chronic complications of DM and their cause?
Text book p. 411: If the condition remains untreated, central nervous system depression
develops owing to the acidosis and dehydration, leading to coma.
Online: Although long-term complications of diabetes develop gradually, they can eventually be
disabling or even life-threatening. Some of the potential complications of diabetes include:
• Heart and blood vessel disease. Diabetes dramatically increases the risk of various
cardiovascular problems, including coronary artery disease with chest pain (angina), heart
attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels
(capillaries) that nourish your nerves, especially in the legs. This can cause tingling,
numbness, burning or pain that usually begins at the tips of the toes or fingers and
gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose
all sense of feeling in the affected limbs. Damage to the nerves that control digestion can
cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile
dysfunction may be an issue.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel
clusters that filter waste from your blood. Diabetes can damage this delicate filtering
system. Severe damage can lead to kidney failure or irreversible end-stage kidney
disease, which often eventually requires dialysis or a kidney transplant.
, NURS 283: ENDOCRINE DISORDERS STUDY GUIDE NOTES
• Eye damage. Diabetes can damage the blood vessels of the retina (diabetic
retinopathy), potentially leading to blindness. Diabetes also increases the risk of
other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk
of various foot complications. Left untreated, cuts and blisters can become serious
infections, which may heal poorly. Severe damage might require toe, foot or leg
amputation.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Skin conditions. Diabetes may leave you more susceptible to skin problems,
including bacterial and fungal infections.
• Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The
poorer your blood sugar control, the greater the risk appears to be. The exact connection
between these two conditions still remains unclear.
1. What is the difference between steroidal and non-steroidal hormones? (p. 403)
• Steroids are lipids that enter the cell and nucleus and act directly in the nucleus to
engage in transcription (messenger RNA).
• Non-steroidal needs a second messenger system to finally activate the formation
of mRNA.
2. How are hormones most frequently controlled? (p. 403-404)
• They are controlled by a negative feedback mechanism.
• For example, as levels of glucose increase the secretion of insulin increases.
When the glucose levels decrease, insulin secretion decreases
3. For each hormone, list the secreting organ or gland and the primary action: (p. 404)
a. Adrenocorticotropic hormone (ACTH)
• Secreting gland: Pituitary
