MEDSURG | DM & Endocrine Primer

🧪 DIABETES MELLITUS (DM)Patho: • T1DM: Autoimmune β-cell loss → absolute insulin ↓ → ketosis prone. • T2DM: Insulin resistance + relative insulin ↓; ketosis rare (stress/infection). • Prediabetes: IFG 100–125; IGT 140–199 (OGTT).Acute priorities: • Hypoglycemia (<70): Rule of 15 → 15 g fast CHO, recheck 15 min; repeat PRN. If NPO/LOC: IM glucagon or IV D50. • DKA (T1): Kussmaul, fruity breath, ketones. • HHS (T2): Glu >600, severe dehydration, neuro changes. → 1st: fluids (0.9% NS), then IV regular insulin; replace K⁺ as indicated; add D5 when BG ≈250 (DKA)/300 (HHS).🔥 HYPERTHYROIDISM (Graves)Patho: TSH-receptor antibodies → ↑T3/T4; ↑metabolic/SNS activity. Meds: Methimazole/PTU (PTU for storm/1st trimester); β-blockers for symptoms; RAI (non-pregnant) with radiation precautions (response up to 3 mo). Diet: High-cal (4–5k/day); avoid caffeine/highly seasoned/high-fiber. Key signs: Heat intolerance, weight loss ↑ appetite, tremor, palpitations, exophthalmos. Thyroid storm: Tachyarrhythmias & hyperthermia → cool/calm room, β-blockers, antithyroid, fluids, treat triggers. Teach: Watch for hypothyroid after RAI/surgery.🧊 HYPOTHYROIDISMPatho: ↓T3/T4 (primary ↑TSH); causes: Hashimoto, iodine lack, post-therapy. Meds: Levothyroxine—lifelong. Start low, go slow (cardiac risk). Signs: Cold intolerance, weight gain, dry coarse skin/hair, bradycardia, hyperlipidemia, constipation, fatigue; ↑ sensitivity to sedatives/opioids. Myxedema coma: Airway/vent, IV levothyroxine, warm, hemodynamic support. Diet: Low-cal until euthyroid. Teach: Daily AM empty-stomach dosing; don’t stop; report chest pain/palpitations.🐯 CUSHING SYNDROMEPatho: Excess glucocorticoids (often exogenous) ± mineralocorticoids → hyperglycemia, HTN, hypokalemia, protein catabolism, osteoporosis. Signs: Moon face, truncal obesity, thin skin/easy bruising, poor healing, weakness. Care: Treat cause (surgery if tumor); infection/VTE precautions; glucose/BP/weight/skin monitoring. Steroids: Never stop abruptly—taper to avoid adrenal crisis. Teach: Sick-day plans; infection signs may be masked.🧂 ADDISON’S DISEASE (Primary adrenal insufficiency)Patho: ↓ cortisol and aldosterone → Na↓, K⁺↑, volume↓. Meds: Hydrocortisone (↑ dose with stress; split dosing) + fludrocortisone AM. Signs: Hyperpigmentation, weight loss, fatigue, salt craving, hypotension. Addisonian crisis: Triggered by stress/abrupt steroid stop → shock, severe N/V/D, Na↓, K⁺↑. Tx (crisis): High-dose IV hydrocortisone, rapid 0.9% NS + D5, monitor K⁺/glucose; ECG. Teach: Medical ID, stress-dose steroids, IM hydrocortisone kit use, ↑ dietary salt.