Endocrine emergencies

Question 1

Management of a patient with hyponatraemia brought on by ingesting too much water during a marathon?

Answer 1

Give strong saline solution IV over 4 hours

Question 2

Management of patient with hyponatraemia of which you don’t know the cause?

Answer 2

Don’t give strong saline as this can be very dangerous

If you don’t know how long or why they’ve been hyponatraemic, give small doses of saline and keep reassessing

Question 3

Why is it dangerous to give strong saline to hyponatraemic patients?

Answer 3

While their brain has been starved of sodium, it will have slowly lost its osmolytes and will have a low osmolality

If you try to replace the sodium quickly you’ll cause irreversible osmotic demyelination

Question 4

What will you see on blood tests of people with adrenal deficiency?

Answer 4

Low blood sodium
High blood urea
Normal blood potassium

High urine sodium
High urine osmolality
High TSH

Question 5

Management of a patient with signs of adrenal dysfunction?

Answer 5

100mg hydrocortisone quickly

Don’t wait for diagnosis as hydrocortisone doesn’t do any harm in patients without adrenal insufficiency, but it will save the lives of the ones that do

Question 6

A patient with Addison’s disease presents at A+E with a possible chest infection, what should you do?

Answer 6

Give him extra cortisol at double the dose to help him get through the stress of the situation

Question 7

You see a young patient with extremely high blood pressure and pulse rate, what do you need to rule out?

Answer 7

Phaeochromocytoma

Question 8

Management of Phaeochromocytoma?

Answer 8

Alpha blockers, because when adrenaline binds to alpha receptors, BP rises and you don’t want that!

Question 9

Management of a patient with prolactinoma?

Answer 9

Dopamine agonists work very well

Cabergoline