Endocrine

Question 1

Goal Glu reduction in DKA

Answer 1

50-70/hr

Question 2

Most active thyroid hormone

Answer 2

T3

Question 3

Thyroid testing in sick euthyroid

Answer 3

TSH dec or low; Low serum T3 (inc rev T3); Free T4 normal

Question 4

Treatment of Thyroid Storm

Answer 4

1. MMA (PTU if pregnant)
2. Lugol Iodine (after MMA or PTU)- Wolff-Chaikoff effect
3. Hydrocortisone and Propranolol
4. APAP for fever (ASA can displace thyroid hormone and increase free hormone)

Question 5

Cortisol Levels:

1. In absence of stress
2. In setting of stress

Cort Stim Test:

Which steroid doesn’t effect cosyntropin stim

Answer 5

1. > 15 rules out AI
2. <25 may be insufficient
3. 0min <3, 30-60min level <20 AND delta cortisol <9
4. Dexamethasone (10mg or less)

Question 6

Expected Uosm in complete central DI

Answer 6

<300

Question 7

Treatment for hypertensive emergency with Pheo (mech)

Answer 7

1. Phentolamine mesylate (alpha receptor blocker)

2. Phenoxybenazmine (noncompet alpha blockage)

Question 8

Recommended cortisol values for AI in critical care:

Answer 8

Abs level <10

Change of <9 or peak <18 30 or 60 min after 1-2 or 250mcg ACTH

Question 9

Tx for HTN with Pheo

Answer 9

Phentolamine (alpha blocker)- very short acting (T1/2 19 min)
Phenoxybenazmine (noncompet alpha blockage of postganglionic synapses)- T1/2 24h
-Never beta blocker–> alpha crisis, worsen HTN