Endocrine Emergencies Flashcards
Diabetic Ketoacidosis (DKA) Lab Parameters
pH < 7.3
Bicarbonate < 15 mmol/L
Glucose > 300
Presence of urine Ketones
Serum Potassium in DKA
False low due to electrolyte shift of K
DKA Treatment
Short acting insulin 0.1 u/kg or drip 0.1u/kg/hr
Lower glucose to 200 then switch to D5W
Do not lower glucose > 100 mg/dL per hour
Fluids if needed
Correct K if needed
What happens if glucose lowered to quickly or too much fluid in DKA?
Cerebral Edema (especially in pediatrics)
Rapid decrease in osomolatity
Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNK)
Common in type II diabetes
Normal Ketones
Non Acidotic
Elevated glucose > 600 mg/dL
HHNK Treatment
Fluid replacement 7-10 L deficient
Correct K if needed
Short acting insulin 0.1 u/kg or drip 0.1u/kg/hr
Lower glucose to 250-300 then switch to D5W and lower insulin drip.
Do not lower glucose > 100 mg/dL per hour
Diabetes Insipidus ( DI)
Condition that occurs when the kidneys are unable to conserve water
Diabetes Insipidus ( DI)
Central Neurogenic Causes
ADH no produced in posterior pituitary
head trauma
surgery
Dilantin
Diabetes Insipidus ( DI)
Nephrogenic Causes
Kidneys do not respond to ADH
Disease
Drugs
Hypokalemia
Hypercalcemia
Sickle Cell
Diabetes Insipidus ( DI)
Treatment
Fluid Resuscitation
Vasopressin
Desmopressin (DDAVP)
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
Too much ADH in body
Causes:
DiseaseTricyclic antidepressants
Narcotics
Oral hypoglycemic meds
Lesions
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
Treatment
Correction of Dilutional hyponatremia
Correct with hypertonic saline
No more than 0.5 mEq/L/hr
Central Pontine Myelinolysis
Occurs when hyponatremia corrected to quickly. Can cause irreversible brain damage.
Hyperthyroid Diseases
Grave’s Disease
Thyrotoxicosis
(Thyroid Storm)
Signs and Symptoms Thyroid storm
Marked tachycardia > 140
Palpitations
Heat intolerance
Anxiety
Nervousness
Sweating
GI upset
Weight loss
Thyroid storm treatment
IV fluids
Beta Blockers
Steroids
Tylenol
ASA contraindicated as it prevents binding of thyroglobulin making problem worse.
Hypothyroid
Cause
Decreased level of thyroid hormone-slowing down of body function and metabolism
Hypothyroid
Signs and Symptoms
Fatigue
Cold intolerance
Weight gain
Puffy eyelids
Sparse hair
Goiter
Myxedema Coma
Exacerbation of hypothyroidism
ALOR
Failure of thermoregulatory system
Usually precipitating event-cold exposure, trauma, stroke, drugs
Hypothyroid/myxedema coma
Treatment
Levothyroxine (Synthroid)
Fluids for hypotension
Glucocorticoid support (helps hypothalamus secrete more thyroid stimulating hormone (TSH)
Rewarming
Adrenal Insufficiency/Adrenal Crisis
Known as….
Addison’s Disease
Adrenal Insufficiency/Adrenal Crisis
Causes
Decreased hormonal output from adrenal glands
Decreased cortisol
Acute cause- TBI, steroid use
Adrenal Insufficiency/Adrenal Crisis
Signs and symptoms
AMS, shock, severe pain lower extremities, severe vomiting, diarrhea, dehydration
**Negative Adrenocorticotropic Hormone ( ACTH) test
(Corticotropin or cosyntropin test)
Adrenal Insufficiency/Adrenal Crisis
Treatment
Oral steroids (Prednisone)
Cortisol
Cushings Syndrome
Increased level of stress hormone or cortisol over prolong period of time.
Cushings Syndrome
Causes
Excessive use of corticosteroids
Adrenal gland tumor
Cushings Syndrome
Treatment
Usually resolves when corticosteroids stopped or tumor removed
