Endocrine emergencies Flashcards
In DKA, below what level of K should you hold insulin?
3.3
What effect do.steroids or vasopressors have on TSH?
Decrease
Medications that can cause myxedema coma? (4)
Amio, PTU, lithium, solfonamides
Dose of hydrocortisone to treat adrenal insufficiency related to myxedema coma?
300/d
Which form of thyroid hormone (T4 or T3) is more biologically active?
T3
Inappropriately high rT3 is what disease?
Euthyroid Sick Syndrome, or Non-Thyroidal Illness Syndrome.
Treatment of thyroid storm?
- FIRST, reduce serum T3/4 levels with PTU or methimazole.
- THEN, inhibit further hormone release with SSKI or Lugol’s solution.
- Reduce peripheral T4 -> T3 conversion with PTI, steroids, propranolol.
- Manage adenergic symptoms with Esmolol, propranolol, metoprolol.
- Decrease enterohepatic recycling with cholestyramine.
Most common cause of Addison’s Dz?
autoimmune
-Consider infections (TB, histo). hemorrhage (ACe, meningococcemia), mets, Rx (etomidate, ketoconazole, fluconazole).
Addison’s Dz pathophysiology?
Primary adrenal (cortisol) insufficiency.
Sheehan syndrome pathophysiology?
postpartum hypopituitarism caused by necrosis of the pituitary gland.
AM cortisol result interpretation when testing for adrenal insufficiency?
- > 15: ruled out
- 3-15: Need 30-minute ACTH-Stim-Test. If <18, confirmed.
- <3: Confirmed.
Steroid of choice to treat Addison’s Dz? Why?
Dexamethasone does not interfere w/ labs testing.
Tx (Pituitary Apoplexy)?
- Stress dose steroids.
- Watch for central DI.
- NSurg consult for trans-sphenoidal decompression.
- T34 replacement, eventually.
Tx (Central DI)?
DDAVP (IV or nasal)
Dietary changes or nephrogenic DI?
Low salt & protein diet.
