CH 07. Endocrine, GI, Renal

① Diabetes Mellitus (Insulin Safety)

• Hypoglycemia (< 70 mg/dL):
  - Signs: Cold, Clammy, Irritable, Shaky.
  - Action (Awake): 15g simple carb (4oz juice/soda).
  - Action (Unconscious): IM Glucagon or IV Dextrose (D50).
• Mixing Insulin:
  "Clear before Cloudy" (Regular first, then NPH).
  Never mix Long-acting (Glargine) with anything.

② Addison's vs. Cushing's

• Cirrhosis (Liver Failure):
  - Ammonia Buildup: Causes confusion (Hepatic Encephalopathy) and flapping tremors (Asterixis).
  - Tx: Give Lactulose (Oral/Enema) to poop out ammonia.
  - Risk: Esophageal Varices (Bleeding) -> Avoid straining!
• Pancreatitis (Acute):
  - Autodigestion: Enzymes eat the pancreas. Pain radiates to back.
  - Priority: NPO (Nothing by mouth) to rest the gut. NG tube for suction.
  - Cullen's Sign: Blue color around belly button (Bleeding).

① The Renal Diet

• Avoid High Potassium:
  No Bananas, Oranges, Potatoes, Spinach.
  (High K+ stops the heart!)
• Other Restrictions:
  - Low Protein (unless on dialysis).
  - Low Sodium.
  - Low Phosphorus (Take Phosphate Binders with meals).

② Hemodialysis Access (AV Fistula)

The patient's lifeline. Protect the arm!

• Assessment:
  - Feel the Thrill (Vibration).
  - Hear the Bruit (Swishing sound).
  (If absent -> Clotting -> Emergency!)
• Restrictions (On Fistula Arm):
  - NO BP readings.
  - NO IV insertions.
  - NO heavy lifting or carrying bags.