Endocrine and Metabolic Emergencies Flashcards
Most common cause of hospitalization, mortality, and morbidity in children with established type 1 DM
DKA
Whyis there hypotension with DKA if fluid is being pulled into the vascular with the osmotic load?
Initially there’s increase in volume of vasculature but as glucose spills into urine it carries H20 with it
What is your first step in the management of a patient with DKA even prior to receiving lab results?
aggressive fluid therapy (NS)
After initial resuscitation of patient with DKA, what should you alternate NS administration with?
0.45% NS
What is the ideal way to administer insulin therapy when treating DKA?
continuous intravenous infusion of small doses of regular insulin through an infusion pump (0.1 units/kg per hour)
What electrolyte needs replacement therapy with DKA due to combination of acidosis, osmotic diuresis, and vomiting?
potassium
potentially the most life-threatening electrolyte derangement during treatment of DKA if treatment causes changes to occur too rapidly
severe hypokalemia
When should you consider phosphate replacement during the management of DKA?
Should be withheld unless concentration less than 1 mg/dL
Occurs in patients with poorly controlled or undiagnosed type II DM. Includes Severe hyperglycemia, hyperosmolality, RELATIVE LACK of ketonemia
hyperosmolar hyperglycemic state (also referred to as nonketotic hyperosmolar state)
A patient’s lab results come back as follows: serum glucose > 600mg/dL, plasma osmolality > 315 mOsm/kg, bicarb > 15, and pH > 7.3. Serum ketones are negative to mildly positive. What is your suspected diagnosis?
hyperosmolar hyperglycemic state (also referred to as nonketotic hyperosmolar state)
Why are mortality rates higher with hypersomolar hyperglycemic state than DKA?
usually occurs in older diabetic patients who are unable to compensate for fluid losses
Often precipitates hyperosmolar hyperglycemic state
acute illness such as pneumonia or UTI
Symptoms include: HA, drowsiness, mental dullness, amnesia, seizures, coma when due to hypoglycemia
neuroglyopenic
At what glucose levels do symptoms of hypoglycemia become noticeable?
54 mg/dL
Difficulty with recognizing symptoms during the stage where hypoglycemia can easily be managed
hypoglycemia unawareness
What is the preferred treatment fo hypoglycemia on an outpatient basis?
15-20g of glucose
When should you re-check glucose levels in hypoglycemic patient after they’ve ingested 15-20g of glucose?
after 15 minutes
should be prescribed for all patients at significant risk for severe hypoglycemia
glucagon
What is the initial management of hypoglycemia in the ED?
D50W in adults followed by infusion of D10W at a rate to maintain serum glucose above 100 mg/dL
How often should you check glucose levels in ED hypoglycemic patient?
q 30 minutes for 2 hours
can be given after initial glocuse therapy has been initiated in the patient with sulfonylurea ingestion
Octreotide (somatostatin analogue)
What are other underlying etiologies of hypoglycemia if patient is not a diabetic?
ETOH use and sepsis
Failure of adrenal glands to produce essential BASAL secretion of steroids. Insidious wasting disease
adrenal insufficiency
Failure to RESPOND to the increased demands caused by stress or SUDDEN INABILITY to secrete essential steroids. Life-threatening condition
adrenal crisis
Adrenal insufficiency that results from destruction or dysfunction of the adrenal cortex
Addison’s
Results from inadequate stimulation of adrenal cortex by ACTH (***By far the most common cause is chronic administration of exogenous steroids!)
Secondary adrenal insufficiency
what are the effects of decreased cortisol from adrenal insufficiency?
decreased blood glucose
what are the effects of decreased aldosterone from adrenal insufficiency?
hyperkalemia, hyponaturemia
How can you tell if severe hypotension is due to adrenal crisis?
resistant to catecholamine and IV fluid administration. Need to replace cortisol
Why might an adrenal crisis be confused with an AAA?
both present with marked hypotension and abdominal flank pain
What is the primary treament of an adrenal crisis?
IV glucocorticoids
Surgically correctable form of HTN. Usually located in adrenal medulla. Presents with palpitations, sweating, headaches, fainting spells, and hypertensive emergencies
pheochromocytoma
What is the rule of 90s that goes with a pheo?
90% of the time they arise in adrenal medulla, is unilateral, not malignant, occurs in adults
How is the diagnosis of a pheo made?
Demonstrating elevated urinary excretion of catecholamines or their metabolites DURING a period of hypertension
What should be initiated in a patient with a pheo who is going to undergo surgery?
initiate an alpha blockage first followed by beta blocker 3-4 days after
Occurs in individuals with long-standing preexisting hypothyroidism presents with life-threatening decompensation
Myxedema Coma
Major difference in vital signs with myxedema coma compared to other life-threatening endocrine disorders
bradycardia
What is pharmacological treatment for a myxedema coma?
IV levothyroxine followed by reduced daily dose until orals tolerated. administration of glucocorticoid
What is the most common cardiographic finding of hyperthryroidism?
a. fib
What are the two primary symptoms that differentiate thyriod storm from hyperthyroidism?
fever and CNS dysfunction
What is the pharmacological treatment of a thyroid storm?
beta blockers, PTU/Methimazole, iodine
