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Emergency medicine > Emergency endocrinology > Flashcards

Emergency endocrinology Flashcards

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1
Q

What are some causes of Addison’s (primary adrenal insufficiency)?

A

Autoimmune destruction
Adrenal glands removed surgically
Adrenal gland trauma
TB
Haemorrhage
Infarction
Cancer

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2
Q

What are some causes of secondary adrenal insufficiency?

A

Congenital disorders
Fracture of the base of skull
Pit or hypothalamic surgery
Infiltration or infection of brain
Def of CRH

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3
Q

What are the CF of Addison’s disease?

A

Reduced cortisol and aldosterone:
- Fatigue
- Muscle weak and cramps
- Dizzy - postural hypotension
- Thirst and craving salt
- Weight loss
- Abdo pain
- Depresison
- Reduced libido
- Bronze hyperpigmentation esp in skin creass

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4
Q

What are the CF of Addisonian crisis?

A

Reduced conc/coma
Hypotension
Hypoglycaemia
Hyponatraemia and hyperkalaemia
N+V, abdo pain

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5
Q

What are the ix in adrenal insufficiency?

A

Bloods - Na low, K high, BM low, cortisol low, ACTH high in primary, renin high in primary, aldosterone low

Short synacthen test

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6
Q

What is the short synacthen test?

A

ACTH stim test
Give synthetic ACTH
Cortisol checked at 0mins, 30 mins and 60 mins
A failure of cortisol to double = Addison’s disease

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7
Q

What is the management of Addisonian crisis?

A

AtoE
Fluid resus
100 mg IV hydrocortisone STAT, then infusion
IV dextrose if hypoglycaemic
Monitor electrolytes
Oral steroids after 3 days

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8
Q

What is the maintenance management of Addison’s?

A

Hydrocortisone for cortisol
Fludrocortisone for aldosterone
Steroid card, ID tag and emergency letter
Doses are doubled during acute illness - sick day rules
Have a STAT dose of hydrocortisone IM

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9
Q

What are some complications of Addisonian crisis?

A

Hypotension
V+D
Dehydration
Shock
Coma
Death

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10
Q

What is the triad of DKA?

A
  1. Hyperglycaemia - >11mmol
  2. Blood ketones >3mmol
  3. Acidosis - pH <7.35
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11
Q

What are some causes of DKA?

A

First presentation of T1DM
Acute illness - infection, dehydration
Not taking insulin

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12
Q

What are the CF of DKA?

A

N+V, abdo pain
Hypotension
Acetone breath
Reduced conc
Kussmaul breathing
Polyuria, polydipsia, weight loss

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13
Q

What are some DKA mimics?

A

Alcoholic ketoacidosis
Starvation ketosis
Lactic acidosis
HHS

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14
Q

What are the ix into DKA?

A

BM >11mmol/l
Blood ketones >3 mmol/l
U+E
ABG
ECG
Cultures if worried about infection

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15
Q

What are the principles of treating DKA?

A
  1. IV fluids - 0.9% NaCl 1L bolus then bags continuously, getting slower every time
  2. Replace K, after first bolus can start to give K
  3. Insulin fixed rate infusion
    Once <14mmol/L can add in glucose
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16
Q

When is DKA resolved?

A

pH >7.35
Ketones < 0.6 mmol
Bicarb >15

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17
Q

What are some complications of DKA?

A

Cerebral oedema !!! = suspect if pt rapidly deteriorating
More common in paeds
Involve senior

18
Q

What is HHS?

A

Hyperosmolar hyperglycaemic sate
- Hyperglycamia, severe >30mmol
- Hypotension
- Hyperosmolality = >320 mosmol/kg
- No significant ketosis or acidosis
- Normally in T2DM

19
Q

What are the main causes of HHS?

A

Infection
Medications that cause fluid loss ??
Surgery
Impaired renal func

20
Q

What are the CF of HHS?

A

N+V
Lethargy
Weakness
Confusion
Dehydration
Coma
Seizure

21
Q

What is the management of HHS?

A
  1. FLuid resus
  2. Insulin but only if ketones >1mmol or glucose fails to fall
  3. VTE prophylaxis
22
Q

What are some RF of hypoglycaemia?

A

Drugs
Acute liver failure
Sepsis
Adrenal insuff
Alcoholism

23
Q

What are some of the hypoglycaemic drugs?

A

Insulin
SUs
GLP-1
DPP-4

24
Q

What are the CF of hypoglycaemia?

A

Shaking
Sweating
Palpitations
Hunger
Difficulty conc
Slurred speech
Confusion and irritability

25
Q

What is the management of hypoglycaemia when pt conc?

A

AtoE
Glucose gel or tablet
Sweets, fizzy pop

26
Q

What is the management of hypoglycaemia where the pt is unconc?

A

AtoE
75ml 10% dextrose IV over 15mins
1mg glucagon IM if not IV access
Manage seizures

27
Q

What is a myxoedema coma?

A

Severe decompensated hypothyroidism - severe and life threatening
- Hypothermia
- Decreased mental status
- Systemic manifestations of severe hypothyroidism

28
Q

What are some causes of myxoedema coma?

A

Severe/untreated hypothroidism
Infection
MI
Stroke
Trauma
HF
Drugs
Cold temps

29
Q

What are the CF of myxoedema coma?

A

Lethargy or coma
Hypothermai <35degrees
Hypoventilation leading to resp failure
Bradycardia and hypotension
Hypoglycaemia
Hyponatraemia
Myxoedema - swelling??*8

30
Q

What are the ix into myxoedema coma?

A

Raised TSH and low T4
FBC to see in infection
U+Es
BM
ABG - hypoventilation and resp failure

31
Q

What is the management of myxoedema coma?

A
  1. ITU
  2. IV T3/T4
  3. 50-100mg IV hydrocortisone
  4. Mechanical ventilation and O2 if hypoventilation
  5. IV fluids
  6. Correction of hypothermia
  7. Correction of hypoglycaemia
  8. Treat HF
32
Q

What are the CF of pheochromocytoma?

A

HTN
Anxiety
Weight loss
Fatigue
Palpitations
Sweating, headaches, flushing, fever
Dyspnea
Abdo pain

33
Q

What is o/e in pheochromocytoma?

A

HTN
Postural hypotension
Tremor
HTN retinopathy

34
Q

What are the ix into pheochromocytoma?

A

Raised catecholamine - plasma and urine
Adrenal imaging CT CAP

35
Q

What is the management of peochromocytoma?

A

A blockers w phenoxybenzamine to prevent HTN crisis
B blocker added if needed but only secondary to a blocker

36
Q

What is thyrotoxic storm?

A

Hyperthyroidism (rare) complication but is life threatening, too much T3/T4

37
Q

What are the CF of hyperthyroidism?

A

Tachycardia
Fever
Alt mental status
Sweating
Tremor
N+V

38
Q

What are the ix into thyrotoxic storm?

A

TFTs
Cardiac monitoring
Sepsis 6

39
Q

What is the management of thyrotoxic storm?

A
  1. IV propanolol - control sx
  2. Propylthiouracil to reduce thyroid activity, IV hydrocortisone
  3. Treat complications eg. hyperthermia, HF
40
Q
A

Emergency medicine (8 decks)

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