Endocrine

Question 1

initial approach to potassium balance in DKA

Answer 1

If K+ is ≥3.3 mmol/L, start insulin infusion
If K+ is <3.3 mmol/L, replenish potassium before initiating insulin infusion

Question 2

when is sodium bicarb indicated in DKA?

Answer 2

severe hyperkalemia (K+ >6.5 mmol/L)
cardiac arrest
profound shock due to circulatory collapse from acidosis (pH of <6.9)

Question 3

main tenets of DKA management

💵💵💵💵 MONEY SLIDE 💵💵💵💵

Answer 3

A
Airway, breathing, circulation
Commence fluid resuscitation (plasma-lyte or LR)
Treat potassium
Replace insulin (blood glucose should not be corrected by >3 mmol/L per hour)
Acidosis management (bicarb for pH <6.9)
Prevent complications (too fast a reversal of the hyperglycaemia/osmolarity)

Question 4

treatment pathway for HHS

Answer 4

Airway, breathing, circulation
Commence fluid resuscitation (be careful in fluid administration, because patients are commonly older and more likely to have resultant kidney or cardiac compromise)
Treat potassium
Replace insulin (blood glucose should not be corrected by >3 mmol/L per hour)
Acidosis management (bicarb for pH <6.9)
Prevent complications (too fast a reversal of the hyperglycaemia/osmolarity)

Question 5

primary treatment for adrenal crisis

Answer 5

Treatment is steroid replacement
Hydrocortisone is first-line treatment because of its glucocorticoid and mineralocorticoid effects
Dexamethasone is an alternative

Question 6

emergency treatment for Pheochromocytoma

Answer 6

Alpha blockade should be given first (phentolamine)
beta blockers
calcium channel blockers
blood pressure control agents as needed for resistant hypertension (Nicardipine, clevidipine, sodium nitroprusside)

Question 7

thyroid storm treatment algorithm

Answer 7

ABC’s
Beta blockers
Anti-thyroid medications
Iodine
Hydrocortisone
prevent hyperthermia with passive cooling and tylenol

Question 8

3 basic tenets of treating thyroid storm

Answer 8

Block the effects of thyroid hormone
Decrease the levels of circulating thyroid hormone
Treating the inciting event and providing supportive care

Question 9

myxoedema coma treatment algorithm

Answer 9

ABC’s
IV thyroid hormone (Levothyroxine)
High dose Hydrocortisone
Vasopressors for shock
Electrolyte replacement
Passive warming

Question 10

2 basic tenets of treating decompensated hypothyroidism

Answer 10

supportive care
2. thyroid hormone replacement therapy