Gastrointestinal, Genitourinary, and Endocrine Care
Fluid Balance, Elimination, and Hormone Regulation
This domain rewards linking symptoms to fluid and hormone shifts. For gastrointestinal care, know signs of dehydration and obstruction: vomiting, distension, absent bowel sounds, and inability to pass gas or stool. For genitourinary care, monitor urine output (at least 0.5 mL/kg/hour in adults), color, and concentration, and recognize urinary tract infection signs, especially in older adults with new confusion. For endocrine care, know diabetic ketoacidosis (hyperglycemia, ketones, anion gap acidosis, Kussmaul breathing) versus hyperosmolar hyperglycemic state (very high glucose, profound dehydration, minimal ketones). Know thyroid storm and myxedema coma as emergencies, and monitor calcium after thyroid surgery for hypocalcemia.
Traps to Watch
Potassium is the classic trap in DKA: total body potassium is depleted even when serum potassium looks normal or high, so insulin is given with potassium replacement per protocol. Another trap is treating hypoglycemia with oral glucose in an unresponsive patient - use IV dextrose or glucagon instead. Also, do not give a laxative when obstruction is suspected.
Rule of Thumb
In DKA, insulin drives potassium into cells, so check potassium before and during insulin infusion.
Worked Example
An unresponsive patient with a glucose of 40 mg/dL receives IV dextrose, not oral juice, because airway protection is uncertain. Glucose is rechecked after treatment.