Endo Emergencies

Question 1

Describe the etiology of myxedema coma

Answer 1

Question 2

Describe the presentation of myxedema coma

Answer 2

Question 3

Describe the diagnostics for myxedema coma

Answer 3

clinical diagnosis, don’t wait for labs!

Question 4

Describe the treatment for myxedema coma

Answer 4

Question 5

Describe the etiology of thyroid storm

Answer 5

Question 6

Describe the presentation of thyroid storm

Answer 6

Question 7

Describe the diagnostics for thyroid storm

Answer 7

Question 8

Describe the treatment of thyroid storm

Answer 8

Question 9

Describe some functions of glucocorticoids (cortisol)

Answer 9

• enhances gluconeogenesis
• induces insulin secretion to counterbalance hyperglycemia
• anti-inflammatory effects
• supports cell-mediated immunity
• suppresses ACTH synthesis to facilitate free water clearance

Question 10

Describe the etiology of adrenal crises (addisonian crisis)

Answer 10

Question 11

Describe the presentation of an adrenal crisis

Answer 11

Question 12

Describe the diagnostics for an adrenal crisis

Answer 12

Question 13

Describe the treatment for an adrenal crisis

Answer 13

Question 14

Describe the physiology of insulin in response to glucose

Answer 14

• serum glucose rises after eating
• glucose enters pancreatic beta cells
• insulin released from beta cells
• insulin restores normoglycemia (diminishes hepatic glucose production & increases uptake by muscle & adipose tissue)
• insulin-induced inhibition of glucagon secretion contributes to decline in hepatic glucose production

Question 15

What assay can be used to monitor DKA to resolution & trends with pts clinical status

Answer 15

beta-hydroxybutyrate: most predominant ketone present in DKA

Question 16

Describe the etiology of DKA

Answer 16

Question 17

Describe the etiology of HHS

Answer 17

Insulin deficiency/resistance (infection, infarction, non med compliance)

Question 18

Compare/Contrast the presentation of DKA & HHS

Answer 18

Question 19

Describe the PE for hyperglycemic crises (DKA & HHS)

Answer 19

Question 20

Compare & contrast the labs for DKA & HHS

Answer 20

Question 21

Describe the treatment for hyperglycemic crises

Answer 21

Question 22

Describe ketosis resolution

Answer 22

• normalized AG & beta-hydroxybutyrate
• mentally alert
• plasma osmolality fallen under 315 mOsmol/kg
• when pt can eat & transition from IV to SQ insulin

Question 23

Describe the etiology & pathophysiology of alcoholic ketoacidosis

Answer 23

Question 24

What is the predominant ketone body in alcoholic ketoacidosis

Answer 24

beta-OH (not included in regular assay!)

Question 25

Describe the treatment of alcoholic ketoacidosis

Answer 25

Question 26

Describe the etiology of hypoglycemia

Answer 26

Question 27

Describe the presentation of hypoglycemia

Answer 27

Question 28

Describe the treatment of hypoglycemia

Answer 28