Endocrine Emergencies

Question 1

Target glucose for patient’s in the ICU

Answer 1

140-180

Question 2

Medication for diabetes that places patient at risk for euglycemic DKA

Answer 2

SGLT2 inhibitors

Question 3

Condition where patient appears to have DKA but has a low glucose (< 250)

Answer 3

Euglycemic DKA

Question 4

Serum osmolarity cut off for HHNK

Answer 4

> 320

Question 5

Range of potassium where you would give insulin but start on potassium replacement

Answer 5

> 3.3 but < 5.0

Question 6

Amount of potassium to put in IV fluids when treating DKA

Answer 6

20-40 mEq per liter

Question 7

Level of phosphorus where replacement is required in DKA

Answer 7

< 0.32

Question 8

2 largest symptoms found in myxedema coma

Answer 8

CNS depression and hypothermia

Question 9

2 things that can blunt the TSH elevation in myxedema coma

Answer 9

Vasopressers

Steroids

Question 10

T4 treatment dose for myxedema coma

Answer 10

IV thyroxine 200-500 mcg loading dose

daily 50-100 mcg/day

Question 11

T3 treatment dose for myxedema coma

Answer 11

10-20 mcg load

10 mcg q4h x 24 hrs, then q6h till improved

Question 12

Medication that should be given in addition to thyroid hormone in myxedema coma

Answer 12

Hydrocortisone 300mg/day

Question 13

Suggested diagnosis by fever with wide pulse pressure and tachycardia/afib

Answer 13

Thyroid storm

Question 14

Score that quantifies risk of thyroid storm

Answer 14

Burch and Wartofsky score
(> 45 suggestive)

Question 15

2 drugs for treatment of thyroid storm

Answer 15

PTU or methimazole

Question 16

Drug recommended in pregnancy for thyroid storm

Answer 16

PTU in the first trimester ONLY
Methimazole in 2nd and 3rd trimesters

Question 17

Steps to treating thyroid storm

Answer 17

1. Reduce serum T4/T3 levels (PTU or MMI)
2. Inhibit further hormone release (iodine or lugol’s solution)
3. Reduce peripheral conversion from T4 to T3 (PTU, propranolol, glucocorticoids)
4. Manage adrenergic symptoms (BB’s)
5. Decrease enterohepatic recycling (cholestyramine)

Question 18

Treatment for refractory thyroid storm

Answer 18

Plasmapheresis or emergent thyroidectomy

Question 19

Potassium abnormality in addison’s disease

Answer 19

Hyperkalemia

Question 20

Best test for adrenal insufficiency in the ICU?

Answer 20

AM cortisol level

Question 21

Level of cortisol on AM cortisol test that confirms insufficiency

Answer 21

< 3

Question 22

Level of cortisol on AM cortisol test that rules out insufficiency

Answer 22

> 15

Question 23

Treatment regimen for adrenal insufficiency

Answer 23

Dexamethasone 4mg IV bolus (won’t interfere with testing)

Hydrocortisone 100 mg IV x 1, then 200 mg/day continuous infusion for 24 hours, then 100 mg/day continuous infusion

Question 24

Diagnosis when there is a sudden infarction or hemorrhage to the pituitary gland

Answer 24

Pituitary apoplexy

Question 25

Drug given in patients with pheochromocytoma undergoing surgery

Answer 25

Alpha blockers for 10-14 days before surgery (phenoxybenzamine)

Question 26

Drug for thyroid storm that blocks the peripheral conversion of T3 into T4

Answer 26

PTU

Question 27

Diagnostic threshold for cort stim test after ACTH?

Answer 27

Increase of < 9 or peak < 18