Endocrine EM

Question 1

diabetic ketoacidosis (DKA) - clinical presentation

Answer 1

*nonspecific sx: N/V, generalized abd pain
*fruity breath odor
*polydipsia, polyuria, polyphagia
*volume depletion (orthostatic hypotension, tachycardia, skin tenting)
*Kussmaul respirations (rapid, deep breathing)

Question 2

diabetic ketoacidosis (DKA) - diagnostic criteria

Answer 2

1. hyperglycemia - usually 350-500 mg/dL
2. anion gap metabolic acidosis
3. positive serum/urine ketones - confirmed with UA or ketone test (acetoacetate, acetone, and/or beta hydroxybutyrate)

Question 3

hyperosmolar hyperglycemic syndrome (HHS) - diagnostic criteria

Answer 3

1. diabetic pt with altered mental status
2. severely elevated glucose - usually > 600
3. minimal ketonuria or ketonemia
4. serum osmolality > 320
5. bicarb > 15 or pH > 7.3

Question 4

DKA & HHS - management

Answer 4

1. IV crystalloid boluses (LR > NS)
2. IF HYPOKALEMIC (K < 3.5): replace K+ FIRST using potassium chloride (KCl)
3. correct blood glucose using *IV regular insulin at 0.1 units/kg/hr**
4. continue to monitor potassium levels

Question 5

thyrotoxicosis (thyroid storm) - clinical presentation

Answer 5

*hyperpyrexia: temp often > 102 F
*skin: erythematous, warm to touch, thinning of hair
*eyes: exophthalmos (if Grave’s)
*neck: goiter (if Grave’s)
*cardio: tachycardia with wide pulse pressure
*pulm: tachypnea
*neuro/psych: agitation, restlessness, emotional lability

Question 6

thyrotoxicosis (thyroid storm) - treatment overview

Answer 6

*must occur without delay and MUST OCCUR IN ORDER:
1. beta blockers - PROPRANALOL
2. thionamides - propylthiouracil > methimazole
3. iodine (KI or Lugol’s solution)
4. glucocorticoids - IV hydrocortisone