Endocrine Emergencies

Question 1

Diabetic Ketoacidosis (DKA) Lab Parameters

Answer 1

pH < 7.3
Bicarbonate < 15 mmol/L
Glucose > 300
Presence of urine Ketones

Question 2

Serum Potassium in DKA

Answer 2

False low due to electrolyte shift of K

Question 3

DKA Treatment

Answer 3

Short acting insulin 0.1 u/kg or drip 0.1u/kg/hr
Lower glucose to 200 then switch to D5W
Do not lower glucose > 100 mg/dL per hour
Fluids if needed
Correct K if needed

Question 4

What happens if glucose lowered to quickly or too much fluid in DKA?

Answer 4

Cerebral Edema (especially in pediatrics)
Rapid decrease in osomolatity

Question 5

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNK)

Answer 5

Common in type II diabetes
Normal Ketones
Non Acidotic
Elevated glucose > 600 mg/dL

Question 6

HHNK Treatment

Answer 6

Fluid replacement 7-10 L deficient
Correct K if needed
Short acting insulin 0.1 u/kg or drip 0.1u/kg/hr
Lower glucose to 250-300 then switch to D5W and lower insulin drip.
Do not lower glucose > 100 mg/dL per hour

Question 7

Diabetes Insipidus ( DI)

Answer 7

Condition that occurs when the kidneys are unable to conserve water

Question 8

Diabetes Insipidus ( DI)
Central Neurogenic Causes

Answer 8

ADH no produced in posterior pituitary
head trauma
surgery
Dilantin

Question 9

Diabetes Insipidus ( DI)
Nephrogenic Causes

Answer 9

Kidneys do not respond to ADH
Disease
Drugs
Hypokalemia
Hypercalcemia
Sickle Cell

Question 10

Diabetes Insipidus ( DI)
Treatment

Answer 10

Fluid Resuscitation
Vasopressin
Desmopressin (DDAVP)

Question 11

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

Answer 11

Too much ADH in body
Causes:
DiseaseTricyclic antidepressants
Narcotics
Oral hypoglycemic meds
Lesions

Question 12

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
Treatment

Answer 12

Correction of Dilutional hyponatremia
Correct with hypertonic saline
No more than 0.5 mEq/L/hr

Question 13

Central Pontine Myelinolysis

Answer 13

Occurs when hyponatremia corrected to quickly. Can cause irreversible brain damage.

Question 14

Hyperthyroid Diseases

Answer 14

Grave’s Disease
Thyrotoxicosis
(Thyroid Storm)

Question 15

Signs and Symptoms Thyroid storm

Answer 15

Marked tachycardia > 140
Palpitations
Heat intolerance
Anxiety
Nervousness
Sweating
GI upset
Weight loss

Question 16

Thyroid storm treatment

Answer 16

IV fluids
Beta Blockers
Steroids
Tylenol

ASA contraindicated as it prevents binding of thyroglobulin making problem worse.

Question 17

Hypothyroid
Cause

Answer 17

Decreased level of thyroid hormone-slowing down of body function and metabolism

Question 18

Hypothyroid
Signs and Symptoms

Answer 18

Fatigue
Cold intolerance
Weight gain
Puffy eyelids
Sparse hair
Goiter

Question 19

Myxedema Coma

Answer 19

Exacerbation of hypothyroidism
ALOR
Failure of thermoregulatory system
Usually precipitating event-cold exposure, trauma, stroke, drugs

Question 20

Hypothyroid/myxedema coma
Treatment

Answer 20

Levothyroxine (Synthroid)
Fluids for hypotension
Glucocorticoid support (helps hypothalamus secrete more thyroid stimulating hormone (TSH)
Rewarming

Question 21

Adrenal Insufficiency/Adrenal Crisis
Known as….

Answer 21

Addison’s Disease

Question 22

Adrenal Insufficiency/Adrenal Crisis
Causes

Answer 22

Decreased hormonal output from adrenal glands
Decreased cortisol

Acute cause- TBI, steroid use

Question 23

Adrenal Insufficiency/Adrenal Crisis
Signs and symptoms

Answer 23

AMS, shock, severe pain lower extremities, severe vomiting, diarrhea, dehydration

**Negative Adrenocorticotropic Hormone ( ACTH) test
(Corticotropin or cosyntropin test)

Question 24

Adrenal Insufficiency/Adrenal Crisis
Treatment

Answer 24

Oral steroids (Prednisone)
Cortisol

Question 25

Cushings Syndrome

Answer 25

Increased level of stress hormone or cortisol over prolong period of time.

Question 26

Cushings Syndrome
Causes

Answer 26

Excessive use of corticosteroids
Adrenal gland tumor

Question 27

Cushings Syndrome
Treatment

Answer 27

Usually resolves when corticosteroids stopped or tumor removed