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·  The endocrine system comprises a network of glands that produce and secrete hormones—chemical substances produced by a gland that have special regulatory effects on other organs and tissues.

·  The major components of the endocrine system are the hypothalamus, pituitary, thyroid, parathyroid, adrenal glands, and reproductive organs (gonads). The pancreas is also part of this system; it has a role in hormone production as well as in digestion.

·  The main function of the endocrine system is to maintain homeostasis. Maintaining homeostasis requires a response to any change in the body, such as low glucose levels in the blood.

·  Diabetes is a metabolic disorder caused by the lack of insulin, a hormone that enables glucose to enter the cells, where it can be used for energy. Diabetes is typically characterized by excessive urination and resulting thirst, along with deterioration of body tissues.

·  There are two types of diabetes. Type 1 diabetes usually starts in childhood and requires daily insulin to control the blood glucose level. Type 2 diabetes usually develops in middle-age patients and can often be controlled with diet and oral medications. Both are serious systemic diseases that affect the kidneys, eyes, small arteries, and peripheral nerves, especially if the disease is uncontrolled or poorly controlled.

·  Patients with diabetes have chronic complications that place them at risk for other diseases such as myocardial infarction, stroke, and infections. Most often, however, you will be summoned to treat the acute complications of blood glucose imbalance. These include hyperglycemia (excess blood glucose) and hypoglycemia (low blood glucose).

·  Symptoms of hypoglycemia classically include confusion; rapid respirations; pale, moist skin; diaphoresis; dizziness; fainting; and even coma and seizures. This condition, called hypoglycemic crisis, is rapidly reversible with the administration of glucose in oral or IV form, or glucagon IM. Without treatment, permanent brain damage and death can occur.

·  Hyperglycemia is usually associated with dehydration and diabetic ketoacidosis. It can result in hyperglycemic crisis, marked by rapid (often deep) respirations; warm, dry skin; a weak pulse; and a fruity breath odor. Hyperglycemia must be treated in the hospital with insulin and IV fluid rehydration.

·  Hyperosmolar nonketotic coma (HONK) (or hyperosmolar hyperglycemic nonketotic coma [HHNC]) is a metabolic derangement that may occur, usually in patients with type 2 diabetes. It is characterized by hyperglycemia, hyperosmolarity, and an absence of significant ketosis, and often develops in patients with diabetes who have a secondary illness.

·  Because either too much or too little blood glucose can result in an altered mental status, you must perform a thorough history and patient assessment. Check for an emergency medical identification device—a wallet card, necklace, or bracelet—or ask the patient or a family member.

·  A patient in hypoglycemic crisis (rapid onset of altered mental status, hypoglycemia) needs sugar immediately. A patient in hyperglycemic crisis (acidosis, dehydration, hyperglycemia) needs insulin and IV fluid therapy. These patients need prompt transport to the hospital for appropriate medical care.

·  When you cannot determine the nature of the problem, it is best to treat the patient for hypoglycemia. The risk of increasing the glucose level of a patient who is already hyperglycemic is minimal compared with the benefit of increasing the glucose level of a patient who is hypoglycemic.

·  Be prepared to give oral glucose to a conscious patient who is confused or has a slightly decreased level of consciousness and D50 to an unresponsive patient. Do not give oral glucose to a patient who is unresponsive or otherwise unable to swallow properly or protect his or her own airway.

·  You may administer glucagon intramuscularly when you cannot obtain IV access and therefore cannot administer D50.

·  Hematology is the study and prevention of blood-related diseases, such as sickle cell disease or hemophilia.

·  Blood is made of two main components: plasma and formed elements (cells). The formed elements include red blood cells (RBCs), white blood cells (WBCs), and platelets, which are transported through the body in plasma.

·  RBCs carry oxygen to the tissues. WBCs provide the body with immunity, fight infection, and remove dead cells. Platelets are responsible for clot formation.

·  The bone marrow is the primary site for cell production within the human body. The liver produces clotting factors and breaks down old RBCs. The spleen is also involved in the breakdown of RBCs, production of WBCs, and storing some platelets.

·  Sickle cell disease is an inherited blood disorder that results in the RBCs having an oblong shape instead of a smooth, round shape. This shape inhibits the ability of RBCs to carry oxygen effectively.

·  Symptoms of sickle cell disease are typically characterized by pain in the joints, fever, respiratory distress, and abdominal pain.

·  Patients with sickle cell disease have chronic complications that place them at risk for other diseases, such as heart attack, stroke, and infection. Most often, however, you will be called on to treat the acute complications of severe pain.

·  Thrombophilia and hemophilia are clotting disorders. Thrombophilia is a tendency to develop blood clots, which can lead to thrombosis and obstruct blood flow. Patients with hemophilia are not able to control bleeding because clots do not develop as they should.

·  Obtain a thorough patient history and SAMPLE history with any patient with a potential blood disorder. The history may reveal that the patient has a known blood disorder, or reveal signs and symptoms that could suggest an undiagnosed blood disorder.

·  Do not take a call for a person having a sickle cell crisis lightly. Patients are often in life-threatening situations. They will have signs of inadequate perfusion, hypotension, and may have muscle pain, swelling of the fingers and toes, priapism, and jaundice.

·  Emergency care for patients with sickle cell disease or a clotting disorder includes administering oxygen, administering fluids, pain management, psychological support, and transport.