Emergency Medicine - Endocrine/electrolyte emergencies

Question 1

Management for DKA

Rewatch - DKA Armando

Answer 1

ABCs - IV fluids 
Vitals 
Bloods - CHECK K+ before giving insulin 
VBG, FBC, U+E
Urine ketones 
ECG
Insulin IV

Monitor - pH, K+, glucose, urine output, ketones

Can switch to 0.45% saline + 5% dextrose (when BG has reduced to 14mmol/L)

Question 2

Symptoms of DKA

5 Underlying causes of DKA (5 I’s)

Answer 2

-N&V, abdo pain, polyuria, polydypsia, hyperventilation, weight loss

Underlying causes (5 I’s)

• infection
• infarction
• insulin - not taking
• intoxication
• illness

Question 3

Symptoms HHS

What are common underlying causes

Answer 3

Fatigue, weight loss, thirst, frequent urination, dehydration, AMS

dehydration -tachy, fever, low BP

Associated w - renal insufficiency, gram negative sepsis/pneumonia, GI bleed

• NEED TO FIND underlying CAUSE ALWAYS!!
• similar management to DKA

Question 4

hypoglycemia symptoms

Answer 4

Symptoms (adrenaline symptoms)
-sweating, tremor, nervous, tachy, AMS, coma, seizure

Causes - diet, meds, exercise

Treatment - sugar

• Oral
• Sublingual
• IM
• IV

Monitor

Question 5

Hyperkalaemia causes

Answer 5

MATCHA 
Meds
Acidosis
Testing error 
Cell breakdown/rhabdo
Hypoaldosteronism
AKI 

Drugs - spirinolactone, BBs, ACE/ARB, K+supplements

Question 6

ECG - hyperkalaemia

Answer 6

Peaked T waves, prolonged PR interval
Widened QRS, flattened p waves
Sine wave pattern

Question 7

Hyperkalaemia treatment

and how they work

Answer 7

Follow Hospital Protocol

1. IV calcium gluconate
2. D50 + insulin
   salbutamol, sodium bicarb
3. Calcium resonium, Hemodialysis, fruesemide, lactulose