Endocrine Emergencies

Question 1

DKA criteria

Answer 1

BM >11
Ketonaemia > 3 or ketonuria
Acidosis pH < 7.3

Question 2

Mx DKA

Answer 2

500ml bolus of saline 
NBM, consider NGT
Abx if infection 
Catheterise 
FRII 50 units actrapid made up to 50ml with saline, 0.1 units/kg/hr 
Continue BG insulin at normal times

Question 3

What is average fluid deficit in DKA?

Answer 3

~100ml/kg

Question 4

How would you manage K+ in DKA?

Answer 4

If serum > 5.5 do not replace
3.5 - 5.5 give 40mmol KCl in each L saline
< 3.5 needs extra KCl, CVC

Question 5

Complications of HHS?

Answer 5

M.I
Stroke
Peripheral artery thrombosis
Seizures, cerebral oedema, central pontine myelinosis

Question 6

Features of HHS?

Answer 6

Marked hyperglycemia without ketonaemia or acidosis
Serum osmolality > 320
Hypovolaemia

Question 7

Mx of HHS?

Answer 7

1L NaCl over an hour
IV insulin only if capillary ketones > 1mmol or ketonuria
Stop metformin
Precipitant? 
Catheterise
Prophylactic LMWH

Question 8

Fluid losses in HHS?

Answer 8

100 - 220 ml/kg

Use osmolality to guide replacement, aim 3-8 osmol/kg/hr

Question 9

What blood results would you expect in addisonian crisis?

Answer 9

Low sodium, high potassium, urea raised in proportion to Cr if volume depleted
Macrocytosis, pernicious anaemia
Cortisol may be undetectable, low or normal
Hypoglycaemia (reduced glycogen stores)
ACTH always elevated in addison’s

Question 10

What causes addison’s?

Answer 10

Primary adrenocortical failure which leads to aldosterone and cortisol insufficiency

Question 11

What causes acute circulatory compromise in addisonian crisis?

Answer 11

Aldosterone insufficiency

Question 12

Precipitants of thyroid storm?

Answer 12

Infection
Post surgery (post thyroidectomy, or general)
Post iodine therapy
Birth
Trauma