endocrine emergencies Flashcards
what is the triad of DKA ?
blood glucose above 250
arterial ph 7.3
bicarb 15
moderate ketonuria
what is the management of DKA ?
Iv access and fluids
what is the most common cause of DKA ?
discontinuation of insulin in type 1 DM
what is the most common precipitating factor of DKA ?
infection
what is the cause of hyperosmolar nonketotic syndrome ?
insulin deficiency
what is the common presentation of HNS ?
happens usually in older patients
altered mental status
dry mucous membranes
fatigue, anorexia
what is the management for diabetic ketoacidosis ?
1- Iv fluids , add 5% dextrose only when the serum glucose is below 250 mg/dl
2- give bicarb until the pH is above 7
3- Insulin give through IV route until BG is below 250 then switch to subcutaneous
4- potassium - if hypokalemic then hold the insulin and give potassium until its above 3.3
when do we switch from IV insulin to SC insulin in the management of DKA ?
when the anion gap is less than 18 within a 1 hour overlap
what two medications are most commonly associated with hypoglycemia ?
insulin and sulfonylurea
what is the management of a patient with hypoglycemia ?
if mild or moderate and the patient is able to swallow give dextrosol until the BG reaches above 4 mmol
if severe then give Iv glucose
1- do not omit insulin in type 1 DM
2- hyperglycemia initially is expected do not give an additional dose to correct
what is the management of myxoedema coma ?
extreme hypothyroidism :
patient is to be treated in an ICU setting
warming blankets
L-thyroxine 0.2-0.5 mg IV bolus, followed by 0.1 mg IV OD until oral therapy is tolerated
give hydrocortisone for adrenal insufficiency
what is the management for thyroid storm ?
ICU admission
give propranolol initially 20-40 mg
high dose of PTU 1000 mg then give 250-500 mg
then give 5 drops of SSKI after the PTU
then give dexamethasone or hydrocortisone
what is the clinical picture of addisonian crisis ?
increased pigmentation
hyperkalemia
hypokalemia
anorexia
postural hypotension
what are the causes of addison’s disease ?
( primary chronic hypoadrenalism )
autoimmune
TB
amyloid
what is the main autoantigen in idiopathic autoimmune adrenocortical insufficiency ?
21 hydroxylase
