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ER > 7) Immune, Endocrine, Electrolyte > Flashcards

7) Immune, Endocrine, Electrolyte Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What type of run is anaphylaxis

A

Type I; IgE antibodies bind to mast cells or basophils

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2
Q

Tx of Anaphylaxis

A

Secure airway
IV Epi
IV fluids
pressors
**all patients should receive corticosteroids to prevent late phase reactions
**everyone should also receive antihistamines both H1 and H2 blockers (diphenhydramine and ranitidine)
**must monitor for at least 6hrs

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3
Q

Angioedema causes

A

IgE mediated, also can occur with ACEI, hereditary, idiopathic

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4
Q

Tx of Angioedema

A

Same as anaphylaxis

**known hereditary angioedema should also receive C1 esterase inhibitor or FFP

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5
Q

Predisposing factors to DKA

A
  • noncompliance w/ insulin
  • infectious process
  • stress
  • pregnancy
  • trauma
  • alcohol use
  • MI
  • new onset DM
  • CVA
  • GI bleeding
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6
Q

Labs dx of DKA

A
  • glucose >250
  • HCO3 less than 15
  • pH <7.3
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7
Q

Tx of DKA

A
  • 0.8% normal saline
  • Insulin drip to revers ketogenesis and allow glucose to be used
  • *once the glucose level is below 250 switch to glucose containing solutions to avoid hypoglycemia
  • *insulin drip can be tapered once vicar increases and anion gap resolves
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8
Q

labs dx of Hyperosmolar hyperglycemic nonketotic syndrome

A

glucose >600
osmolarity >320
Prerenal azotemia in the absence of ketoacidosis

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9
Q

Tx of HHS

A
  • fluid resuscitation w/ NS
  • insulin drip
  • once glucose is <250 switch to glucose continuing solutions and reduce insulin accordingly
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10
Q

Tx of thyroid storm

A
  • suppress thyroid hormone synthesis w/ PTU
  • inhibit thryoid hormone release w/ potassium iodine
  • block peripheral effects w/ Beta blockers
  • prevent conversion of T4 to T3 with dexamthasone
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11
Q

Presentation of myxedema coma

A
  • altered mental status
  • respiratory insufficiency
  • myxedema (non pitting dry, waxy swelling of skin caused by deep of mucopolysaccarides in the dermis)
  • **hyponatremia, hyopchloremia, hypoglycemia
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12
Q

Tx of myxedema

A
  • cardiac monitor
  • IV fluids
  • rewarming as indicated
  • hydrocrotisone to avoid precipitating and/or exacerbating possible underlying adrenal insufficiency
  • IV levothyroxine
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13
Q

What is primary adrenal insufficiency

A

aka Addison’s Dz
-due to disease of destruction of adrenal cortex (no cortisol or aldosterone so no feedback to pituitary gland and thus HIGH levels of ACTH)

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14
Q

What is secondary adrenal insufficiency

A

disease or destruction of pituitary gland (LACK OF ACTH secretion)

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15
Q

Presentation of adrenal insufficiency

A

weakness, fatigue, nausea, vomiting, diarrhea, abdominal pain, weight loss

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16
Q

Labs in adrenal insufficiency

A

hyponatremia, hyperkalemia, hypoglycemia

***cortisol and ACTH to confirm adrenal insufficiency are not readily available to should treat based on suspicion

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17
Q

Test for adrenal insufficiency

A

ACTH stimulation test

-24hr urine smaple for 17-hydroxycorticosteroid

18
Q

Tx of adrenal insufficiency

A

rapid infusion of 5% dextrose and isotonic saline

  • tx hypotension w/ IV fluids and pressors as needed
  • Tx hyperkalemia as indicated
  • Glucocorticosteroid and mineralocorticoid replacement w/ hydrocortisone = mainstay (use dexamethasone if doing concurrent ACTH stim test)
19
Q

Hypokalemia findings

A
  • areflexia, paralysis, arrhythmias, orthostatic hypotension, ileus
  • U waves, t-wave flattening or inverse, ST segment depression
20
Q

Tx of hypokalemia

A
  • if 2.5 to 3.5 can be managed outpatient w/ gradual potassium repletion (follow up w/in 48h)
  • If <2.5 should be admitted to th hospital
21
Q

Hyperkalemia findings

A
  • paralysis, areflexia, focal neuro deficits, respiratory insufficiency, cardiac arrest
  • 1st: t waves peak, then PR prolongation, then loss of Ps and widening of QRS complex
22
Q

Tx of hyperkalemia

A

-Administer calcium chloride and sodium bicarb
-cardiac monitor
-IV access
give insulin and IV glucose to shift potassium into the cells
-albuterol neb and sodium bicarb can additionally cause shift
-consider furosemide or kayexalate (K binding resin) to remove potassium from body
**if severe and renal filure or severe refractory hyperkalemia = consider dialysis

23
Q

isotonic hyponatremia

A

falsely low serum sodium due to hyperproteinemia or hyperlipidemia

24
Q

hypertonic hypernatremia

A

low serum sodiu level due to high levels of osmotically active substance (like glucose) that cause water to move into the extracellular space

25
Q

Hypotonic hyponatremia

A

divided into hypovolemic, isovolemic, and hypervolemic

26
Q

hyponatremia symp

A

<120 is almost always symptomatic

  • disorientation and confusion, agitiation, ataxia, altered consciousness, seizures and coma
  • other: HA, muscle cramps, anorexia, nausea, vomiting, and weakness
27
Q

Causes of hypotonic hypovolemic hyponatremia

A

-GI losses (vomiting, diarrhea)
-Excessive sweating
-Renal losses (salt wasting nephropathies, diuretics)
-Addisons disease
-CF
-Third spacing (burns, peritonitis, pancreatitis)
(Tx w/ isotonic saline)

28
Q

Causes of hypotonic isovolemic hyponatremia

A

-SiADH
-psychogenic polydipsia
-water intoxication
-hypothyroidism
-cortisol deficiency
(Tx w/ free water restriction)

29
Q

Causes of hypotonic hypervolemic hyponatremia

A

-CHF
-Cirrhosis
-Nephrotic syndrome
-renal failure
(Tx w/ sodium and free water restriction)

30
Q

Calculating Serum Osmolality

A

2Na + glucose /18 + Bun/2.8
(normal = 290)
**helps to separate isotonic, hypertonic, hypotonic

31
Q

Tx of hyponatremia

A
  • give hypertonic 3% saline

- correcting hyponatremia too aggressively can lead to central pontine myelinolysis or cerebral edema

32
Q

Hypernatremia

A

results from free water deficit compared to sodium levels

-hypovolemic hypernatremia is the most common and due to loss of water and sodium but >water loss than sodium loss

33
Q

Tx of hypernatremia

A
  1. 9% normal saline to improve BP and restore tissue perfusion
    - once volume is restored change to D5W or hypotonic saline (0.45%)
34
Q

Tx of DI

A

parenteral or intranasal vasopressin in addition to water deficit replacement

35
Q

Hypocalcemia should be considered in

A

renal failure, chronic malabsorption, neck surgery and irradiation

36
Q

Manifestations of hypocalcemia

A
  • circumoral and distal extremity paresthesias
  • weakness, irritability, muscle cramps
  • tetany and seizures
  • *QT prolongation
  • ***careful in patients on digoxin
37
Q

Trousseaus sign

A

-carpal spasm in response to inflation of BP cuff to 20mmHg above SBP for 3 min

38
Q

Chvostek sign

A

-twitching of the facial muscles after tapping over the facial nerve

39
Q

Hypercalcemia causes

A

primary hyperparathyroidism and malignancy

40
Q

Manifestations of hyercalcemia

A

weakness, fatigues, confusion, obtundation, coma
nausea, vomiting, abdominal pain, constipationTx: IV fluids, furosemide, hydrocortisone, dialysis if refractory to other tx
**QT shortening, PR prolongation, widened QRS on EKG

ER (11 decks)

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