Endocrine and Metabolic Emergencies

Question 1

Most common cause of hospitalization, mortality, and morbidity in children with established type 1 DM

Answer 1

DKA

Question 2

Whyis there hypotension with DKA if fluid is being pulled into the vascular with the osmotic load?

Answer 2

Initially there’s increase in volume of vasculature but as glucose spills into urine it carries H20 with it

Question 3

What is your first step in the management of a patient with DKA even prior to receiving lab results?

Answer 3

aggressive fluid therapy (NS)

Question 4

After initial resuscitation of patient with DKA, what should you alternate NS administration with?

Answer 4

0.45% NS

Question 5

What is the ideal way to administer insulin therapy when treating DKA?

Answer 5

continuous intravenous infusion of small doses of regular insulin through an infusion pump (0.1 units/kg per hour)

Question 6

What electrolyte needs replacement therapy with DKA due to combination of acidosis, osmotic diuresis, and vomiting?

Answer 6

potassium

Question 7

potentially the most life-threatening electrolyte derangement during treatment of DKA if treatment causes changes to occur too rapidly

Answer 7

severe hypokalemia

Question 8

When should you consider phosphate replacement during the management of DKA?

Answer 8

Should be withheld unless concentration less than 1 mg/dL

Question 9

Occurs in patients with poorly controlled or undiagnosed type II DM. Includes Severe hyperglycemia, hyperosmolality, RELATIVE LACK of ketonemia

Answer 9

hyperosmolar hyperglycemic state (also referred to as nonketotic hyperosmolar state)

Question 10

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?

Answer 10

hyperosmolar hyperglycemic state (also referred to as nonketotic hyperosmolar state)

Question 11

Why are mortality rates higher with hypersomolar hyperglycemic state than DKA?

Answer 11

usually occurs in older diabetic patients who are unable to compensate for fluid losses

Question 12

Often precipitates hyperosmolar hyperglycemic state

Answer 12

acute illness such as pneumonia or UTI

Question 13

Symptoms include: HA, drowsiness, mental dullness, amnesia, seizures, coma when due to hypoglycemia

Answer 13

neuroglyopenic

Question 14

At what glucose levels do symptoms of hypoglycemia become noticeable?

Answer 14

54 mg/dL

Question 15

Difficulty with recognizing symptoms during the stage where hypoglycemia can easily be managed

Answer 15

hypoglycemia unawareness

Question 16

What is the preferred treatment fo hypoglycemia on an outpatient basis?

Answer 16

15-20g of glucose

Question 17

When should you re-check glucose levels in hypoglycemic patient after they’ve ingested 15-20g of glucose?

Answer 17

after 15 minutes

Question 18

should be prescribed for all patients at significant risk for severe hypoglycemia

Answer 18

glucagon

Question 19

What is the initial management of hypoglycemia in the ED?

Answer 19

D50W in adults followed by infusion of D10W at a rate to maintain serum glucose above 100 mg/dL

Question 20

How often should you check glucose levels in ED hypoglycemic patient?

Answer 20

q 30 minutes for 2 hours

Question 21

can be given after initial glocuse therapy has been initiated in the patient with sulfonylurea ingestion

Answer 21

Octreotide (somatostatin analogue)

Question 22

What are other underlying etiologies of hypoglycemia if patient is not a diabetic?

Answer 22

ETOH use and sepsis

Question 23

Failure of adrenal glands to produce essential BASAL secretion of steroids. Insidious wasting disease

Answer 23

adrenal insufficiency

Question 24

Failure to RESPOND to the increased demands caused by stress or SUDDEN INABILITY to secrete essential steroids. Life-threatening condition

Answer 24

adrenal crisis

Question 25

Adrenal insufficiency that results from destruction or dysfunction of the adrenal cortex

Answer 25

Addison’s

Question 26

Results from inadequate stimulation of adrenal cortex by ACTH (***By far the most common cause is chronic administration of exogenous steroids!)

Answer 26

Secondary adrenal insufficiency

Question 27

what are the effects of decreased cortisol from adrenal insufficiency?

Answer 27

decreased blood glucose

Question 28

what are the effects of decreased aldosterone from adrenal insufficiency?

Answer 28

hyperkalemia, hyponaturemia

Question 29

How can you tell if severe hypotension is due to adrenal crisis?

Answer 29

resistant to catecholamine and IV fluid administration. Need to replace cortisol

Question 30

Why might an adrenal crisis be confused with an AAA?

Answer 30

both present with marked hypotension and abdominal flank pain

Question 31

What is the primary treament of an adrenal crisis?

Answer 31

IV glucocorticoids

Question 32

Surgically correctable form of HTN. Usually located in adrenal medulla. Presents with palpitations, sweating, headaches, fainting spells, and hypertensive emergencies

Answer 32

pheochromocytoma

Question 33

What is the rule of 90s that goes with a pheo?

Answer 33

90% of the time they arise in adrenal medulla, is unilateral, not malignant, occurs in adults

Question 34

How is the diagnosis of a pheo made?

Answer 34

Demonstrating elevated urinary excretion of catecholamines or their metabolites DURING a period of hypertension

Question 35

What should be initiated in a patient with a pheo who is going to undergo surgery?

Answer 35

initiate an alpha blockage first followed by beta blocker 3-4 days after

Question 36

Occurs in individuals with long-standing preexisting hypothyroidism presents with life-threatening decompensation

Answer 36

Myxedema Coma

Question 37

Major difference in vital signs with myxedema coma compared to other life-threatening endocrine disorders

Answer 37

bradycardia

Question 38

What is pharmacological treatment for a myxedema coma?

Answer 38

IV levothyroxine followed by reduced daily dose until orals tolerated. administration of glucocorticoid

Question 39

What is the most common cardiographic finding of hyperthryroidism?

Answer 39

a. fib

Question 40

What are the two primary symptoms that differentiate thyriod storm from hyperthyroidism?

Answer 40

fever and CNS dysfunction

Question 41

What is the pharmacological treatment of a thyroid storm?

Answer 41

beta blockers, PTU/Methimazole, iodine