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ABIM Critical Care > Endocrine emergencies > Flashcards

Flashcards in Endocrine emergencies Deck (18)
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1
Q

In DKA, below what level of K should you hold insulin?

A

3.3

2
Q

What effect do.steroids or vasopressors have on TSH?

A

Decrease

3
Q

Medications that can cause myxedema coma? (4)

A

Amio, PTU, lithium, solfonamides

4
Q

Dose of hydrocortisone to treat adrenal insufficiency related to myxedema coma?

A

300/d

5
Q

Which form of thyroid hormone (T4 or T3) is more biologically active?

A

T3

6
Q

Inappropriately high rT3 is what disease?

A

Euthyroid Sick Syndrome, or Non-Thyroidal Illness Syndrome.

7
Q

Treatment of thyroid storm?

A
  • FIRST, reduce serum T3/4 levels with PTU or methimazole.
  • THEN, inhibit further hormone release with SSKI or Lugol’s solution.
  • Reduce peripheral T4 -> T3 conversion with PTI, steroids, propranolol.
  • Manage adenergic symptoms with Esmolol, propranolol, metoprolol.
  • Decrease enterohepatic recycling with cholestyramine.
8
Q

Most common cause of Addison’s Dz?

A

autoimmune

-Consider infections (TB, histo). hemorrhage (ACe, meningococcemia), mets, Rx (etomidate, ketoconazole, fluconazole).

9
Q

Addison’s Dz pathophysiology?

A

Primary adrenal (cortisol) insufficiency.

10
Q

Sheehan syndrome pathophysiology?

A

postpartum hypopituitarism caused by necrosis of the pituitary gland.

11
Q

AM cortisol result interpretation when testing for adrenal insufficiency?

A
  • > 15: ruled out
  • 3-15: Need 30-minute ACTH-Stim-Test. If <18, confirmed.
  • <3: Confirmed.
12
Q

Steroid of choice to treat Addison’s Dz? Why?

A

Dexamethasone does not interfere w/ labs testing.

13
Q

Tx (Pituitary Apoplexy)?

A
  • Stress dose steroids.
  • Watch for central DI.
  • NSurg consult for trans-sphenoidal decompression.
  • T34 replacement, eventually.
14
Q

Tx (Central DI)?

A

DDAVP (IV or nasal)

15
Q

Dietary changes or nephrogenic DI?

A

Low salt & protein diet.

16
Q

Most common way pheochromocytoma is diagnosed?

A

incidental-oma.

17
Q

Dx (Pheochromocytoma)?

A

Plasma free metanephrines or urinary fractionated metanephrines.

18
Q

Meds for pheocyromocytoma prior to surgery?

A

Phenoxybenzamine. CCBs as add-on.

  • Avoid BBs alone.
  • Volume expansion.