METABOLIC

DISORDERS
Instructor:
ROSELILY COQUILLA, RN
SIADH
VS
DI
Function of ADH
Pitressin (Vasopressin)
retain water and constrict blood
vessels.
CAUSES
SIADH ( Syndrome of
Inaapriate Antidiuretic Hormone) DI ( Diabetes Insipidus)
• ADH = urinary output • ADH = excessive urinary
output

• Lung cancer  • Kidneys not receptive to ADH

• Damaged to the hypothalamus
or pituitary gland
• Infection/germs Central
neuro issues: strokes, gullian-
barre syndrome
• Drugs (Diabinese aka
Chlorpropamide)
• Damage to the pituitary gland
and/or hypothalamus
• Brain trauma through stroke or
head trauma
• Tumors
• Drugs ( Declomycin)
Signs and symptoms
SIADH ( Syndrome of
DI ( Diabetes Insipidus)
Antidiuretic Hormone)
• Fluid retention • Polyuria
• Signs of dehydration
a. Hypertension a. Adult: thirst
b. Edema b. Agitation
c. Poor Skin turgor
c. Weight gain d. Dry mucous membrane
• Water intoxication • Weakness and fatigue
• Hypotension
• Fast HR • Weight loss
• If left untreated results to
hypovolemic shock (sign is anuria)
Diagnostic Procedure
SIADH ( Syndrome of Antidiuretic
Hormone)
• Urine specific gravity is
increased
• Serum Sodium is decreased
DI ( Diabetes Insipidus)
• Urine Specific Gravity
• Normal value: 1.015 –
1.030
• Ph 4 – 8
• Serum Sodium
• Increase resulting to
hypernatremia
Nursing Management
SIADH ( Syndrome of
•Antidiuretic
Restrict fluidHormone)
• Administer medications as
ordered
a. Loop diuretics (Lasix)
b. Osmotic diuretics (Mannitol)
• Monitor strictly vital signs, intake
and output and neuro check
• Weigh patient daily and assess
for pitting edema
• Provide meticulous skin care
• Prevent complications
DI ( Diabetes Insipidus)
Force fluids
•
• Strictly vital signs and intake and
output
• Administer medications as ordered
a. Pitressin (Vasopresin
Tannate) –
administered IM Z tract
• Prevent complications –
HYPOVOLEMIC SHOCK is the
most feared complication
•
HYPOTHYROIDISM
VS
HYPERTHYROIDISM
Function of Thyroid Gland
produces thyroid hormones
• T3 (Tri iodothyronine) - 3 molecules of iodine (more
potent) – normal value: 100-200ng/dl
• T4 (tetra iodothyronine, Thyroxine) – Normal
value:5.0-12.0 μg/dL
• calcitonin – antagonizes the effects of parathormone
to promote calcium resorption.
Function of T3 & T4
• burning calories
• how new cells replace dying cells
• how fast we digest food
• Responsible for alertness, quick responsiveness/reflexes)
• increases body temperature and heart rate
• brain development
• muscle contraction
• fertility
• regulates TSH (thyroid-stimulating hormones through the
negative feedback loop)
Other hormones
Thyroid stimulating hormone (TSH)- produced
from the anterior pituitary gland that stimulates
T3 and T4 production

Thyrotropin releasing hormone (TRH) - this causes

the Anterior Pituitary Gland to produce
CAUSES
HYPOTHYROIDISM HYPERTHYROIDISM
  • increase in T3 and T4
• hyposecretion of thyroid hormone • Grave’s Disease or
Thyrotoxicosis
• Iatrogenic Cause – disease caused
by medical intervention such as
surgery
• Related to atrophy of thyroid
gland due to trauma, presence of
• Autoimmune
tumor, inflammation • Excessive iodine intake
• Iodine deficiency • Related to hyperplasia
• Autoimmune (Hashimotos Disease)
Signs and symptoms
HYPOTHYROIDISM
(Early Signs)
• Weakness and fatigue
• Loss of appetite but with
weight gain which promotes
lipolysis leading to
atherosclerosis and MI
• Dry skin
• Cold intolerance
• Constipation
HYPERTHYROIDISM
• Increase appetite
(hyperphagia) but there is
weight loss
• Moist skin
• Heat intolerance
• Diarrhea
• All vital signs are increased
Signs and symptoms
HYPERTHYROIDISM
HYPOTHYROIDISM
(Late Signs) • CNS involvement
• Brittleness of hair and nails a. Irritability and agitation
• Non pitting edema (Myxedema) b. Restlessness
• Hoarseness of voice c. Tremors
• Decrease libido d. Insomnia
• Decrease in all vital signs – e. Hallucinations
hypotension, bradycardia, • Goiter
bradypnea, hypothermia
• Exophthalmos
• CNS changes
• Amenorrhea
Diagnostic Procedure
HYPOTHYROIDISM
HYPERTHYROIDISM
• Serum T3 and T4 is • Serum T3 and T4 is
decreased increased
• Serum Cholesterol is • RAIU (Radio Active Iodine
increased Uptake) is increased
• RAIU (Radio Active Iodine • Thyroid Scan- reveals an
Uptake) is decreased enlarged thyroid gland
Nursing Management
HYPOTHYROIDISM
• Monitor for Myxedema Coma
Presents with everything
shutting down (or slowing
down to the point of death)
HYPERTHYROIDISM
• Keep the patient
comfortable:
• Obtain daily weights
• Monitor EKG, heart rate,
blood pressure
• Educate about medications
and treatment (radioactive
iodine therapy and
thyroidectomy)
Nursing Management
HYPOTHYROIDISM
HYPERTHYROIDISM
• Monitor vitals sign: HR, BP, • Monitor for Thyroid Storm:
EKG life-threatening that presents
with exaggerated
• Monitor weight signs/symptoms of
• Keep patient warm and assess hyperthyroidism, such as
for constipation fever, fast heart rate, HTN

• Cause of thyroid storm:

complication from
uncontrolled
hyperthyroidism or due to
thyroidectomy
 Nursing Management
HYPOTHYROIDISM
HYPERTHYROIDISM
• Medications for Hypothyroidism • Medications for
Thyroid hormone Hyperthyroidism
replacement: • Antithyroid medication
Cytomel “Liothyronine
sodium” • Methimazole “Tapazole
Thyrolar “Liotrix” • PTU “Propylthiouracil” 
Synthroid “Levothyroxine”
MOST COMMON
• Patient education:
ADDISON’S DISEASE
VS
CUSHING’S
SYNDROME
Role of Adrenal Cortex, Steroid
Hormone and Corticosteroids
Role of Adrenal Cortex: releases steroid hormones
and sex hormones

Role of Aldosterone: (balances sodium and potassium

levels).

Role of Cortisol: “STRESS Hormone”

 CAUSES
ADDISON’S DISEASE CUSHING’S SYNDROME
• Hyposecretion of adreno • Hypersecretion of adenocortical
cortical hormone leading to hormones
a. metabolic disturbance –
Sugar
b. fluid and electrolyte
imbalance – Salt
c. deficiency of
neuromuscular
function
Signs and symptoms
ADDISON’S DISEASE
Remember “ Low STEROID
Hormones ”
• Sodium & Sugar low (due to low
levels of cortisol which is
responsible for retention
sodium and increases blood
glucose), Salt cravings
• Tired and muscle weakness
• Electrolyte imbalance of high
Potassium and high Calcium
CUSHING’S SYNDROME
Remember “ STRESSED”
• Skin fragile
• Truncal obesity with small arms
• Rounded face (appears like
moon), Reproductive issues
amennorhea and ED in male(due to
adrenal cortex’s role in secreting
sex hormones)
• Ecchymosis, Elevated blood
pressure
• Striae on the extremities and
abdomen (Purplish)
Signs and symptoms
ADDISON’S
• Reproductive DISEASE
changes…irregular
menstrual cycle and ED in men
• lOw blood pressure (at risk for
vascular collapse)….aldosterone
plays a role in regulating BP
• Increased pigmentation of the skin
(hyperpigmentation of the skin)
• Diarrhea and nausea, Depression
CUSHING’S SYNDROME
Remember “ STRESSED”
• Sugar extremely high
(hyperglycemia)
• Excessive body hair
especially in women…and
Hirsutism Electrolytes
imbalance: hypokalemia
• Dorsocervical fat pad
(Buffalo hump), Depression
Diagnostic Procedure
ADDISON’S DISEASE CUSHING’S SYNDROME

• FBS is decreased (normal • FBS is increased

value: 80 – 100 mg/dl) • Plasma Cortisol is increased
• Plasma Cortisol is decreased • Serum Sodium is increased
• Serum Sodium is decrease • Serum Potassium is
(normal value: 135 – 145 decreased
meq/L)
• Serum Potassium is
increased (normal value: 3.5
– 4.5 meq/L)
Nursing Management
CUSHING’S DISEASE
ADDISON’S DISEASE
 Watching glucose and K+  Prep patient for Hypophysectomy
level to remove the pituitary tumor
 Prep patient for Adrenalectomy:
 Administer medications to
replace the low hormone  Risk for infection and skin
levels of cortisol and breakdown
aldosterone  Monitor electrolytes blood sugar,
potassium, sodium, and calcium
 For replacing cortisol:
levels
Nursing Management
ADDISON’S DISEASE

 For replacing aldosterone:

o ex: Fludrocortisone aka Florinef

 Wearing a medical alert bracelet

 Eat diet high in proteins and carbs, and make sure to

consume enough sodium
 Avoid illnesses, stress, strenuous exercise
Nursing Management
ADDISON’S DISEASE

 NEED IV Cortisol STAT:

o Solu-Cortef and IV fluids (D5NS to keep blood sugar and sodium
levels good and fluid status)

 Watch for risk for infection, neuro status  

PANCREAS

• Consist of islets of langerhans

• Has alpha cells that secretes glucagons
• Beta cells secretes insulin
• Delta cells secretes somatostatin (function: antagonizes the
effects of growth hormones)
Key Players
Glucose – fuel the cells in the body.
- sored in the liver in the form of glycogen.
Insulin - hormone that regulates the amount of glucose in the
blood.

Glucagon – hormone that causes the liver to turn glycogen into

glucose

* They operate on Glucagon and Insulin Feedbacl Loop

DIABETES MELLITUS
• metabolic disorder characterized by non
utilization of carbohydrates, protein and
fat metabolism
Classification of DM

Type 1 (IDDM) Type 2 (NIDDM)

• Juvenile onset type
• - Brittle disease
Incidence Rate
- 10% general population has
type 1 DM
• - Adult onset
• - Maturity onset type
• - Obese over 40 years old
Incidence Rate
- 90% of general population
has type 2 DM
Causes

Type 1 (IDDM) Type 2 (NIDDM)

Beta Cells destruction Insulin Resistance
Genetic Lifestyle
Auto-immune
Signs and Symptoms

Type 1 (IDDM) Type 2 (NIDDM)

Polyuria . Usually asymptomatic
2. Polydypsia 2. Polyuria
3. Polyphagia 3. Polydipsia
4. Glucosuria 4. Polyphagia
5. Weight loss
6
Signs and Symptoms

Type 1 (IDDM) Type 2 (NIDDM)

Anorexia, nausea and Glucosuria
vomiting Weight gain
Blurring of vision
Increase susceptibility
to infection
Delayed/poor wound
healing
Treatment

Type 1 (IDDM) Type 2 (NIDDM)

Insulin therapy Diet
 Diet Exercise
Exercise Oral Hypoglycemic
agents
Note: Need insulin during
stress, surgery or
infection
Complications

Type 1 (IDDM) Type 2 (NIDDM)

Hyperosmolar
Diabetic Ketoacidosis Nonketotic Coma
Complications of DM
• Hypoglycemia
Complications of DM
Signs and Symptoms: Sweating, clammy, confusion,
light headedness, double vision, tremors

Treatment: Need simple carbs if they can eat, or if

unconscious IV D50

Simple carbs include: hard candies, fruit juice,

graham crackers, honey
Complications of DM
• Organ Problems:
Hardens the vessel heart disease, strokes,
hypertension, neuropathy, poor wound healing (FROM
DECREASE circulation), eye trouble, infection.
Complications of DM
HHNS
DKA • Affects mainly Type 2 diabetics
• Affects mainly Type 1 • No ketones or acidosis present
diabetics
• EXTREME Hyperglycemia (remember
• Ketones and Acidosis
heavy-duty hyperglycemia) >600 mg/dL
present
sometimes four digits
• Hyperglycemia presents
>300 mg/dL • High Osmolality (more of an issue in
HHNS than DKA)
• Variable osmolality
• Happens Suddenly • Happens Gradually
Causes

DKA HHNS
• no insulin present in the body or • mainly illness or infection
illness/infection • Main problems are
dehydration & heavy-duty
• Seen in young or undiagnosed hyperglycemia and
diabetics hyperosmolarity
• Main problems are
hyperglycemia, ketones, and
acidosis (blood pH <7.35)
Signs and Symptoms
DKA
• Kussmaul breathing, fruity
breath, abdominal pain
HHNS
• More likely to have mental status
changes due to severe dehydration
due to hyperosmolarity
• Blood pH will be normal (remember
no acidosis as in DKA)
• No Kussmaul breathing and fruity
breath
Treatment

DKA
• Goal: Hydrate, decrease
blood glucose, monitor
Potassium level and cerebral
edema (esp. in children),
correct acid-base imbalance
HHNS
• Goal: Hydrate, decrease
blood glucose, monitor
potassium levels and for
cerebral edema, correct
acid-base imbalance (similar
to the treatment of DKA)
Treatment

DKA HHNS
• Administering IV fluids: • The same with DKA
(depending on MD order)
such as 0.9% normal saline
(start out with a bolus of
this) and progress with
0.45% NS
Treatment

DKA HHNS
• 5% dextrose may be added
to the 0.45% NS when
glucose is around 250 to
300 mg/dL.
Treatment

DKA
• Administered insulin:
REGULAR (only type given
IV) and make sure K+ is
normal >3.3
CAUTION!
• if you rapidly bring a patient’s blood glucose down (or up) the
brain can’t cope and water will be moved from the blood to
the CSF and you will get cerebral edema and increased
intracranial pressure
CAUTION!
• Tip for insulin administration: when priming tubing for insulin
infusion waste 50cc to 100cc (per institution protocol)
because insulin absorbs into the plastic lining of the tubing.

• Watch potassium levels

• Administer Potassium solution IV to combat this….note renal

function before administering.
TYPES OF INSULIN AND THEIR ACTIONS