Endocrine Emergency Flashcards
How many types of diabetes are there?
3
Gestational
Type 1- childhood (makes too much insulin)
Type 2 - Adulthood ( insulin resistance)
What is DKA (diabetic ketoacidosis)
Elevated glucose, elevated keytones, metabolic acidosis, respiratory alkalosis
DKA commonly exceeds a blood glucose level of higher than ?
350 mg/dl
Occasionally exceeds 800
What type of breathing pattern is common find in DKA?
Kussmaul’s respirations
What is a typical fluid deficit in patient’s with DKA?
3-6 Liters
What electrolyte commonly needs replacement prior to treatment of DKA?
Potassium
Do not lower glucose levels more than _____ mg/dl per hour?
100
What could happen if you lower the blood glucose level faster than 100 mg/dl an hour?
Cerebral edema, headache and obtundation (reduced level of consciousness)
What is the most common DKA treatment?
Short acting insulin- bolus of 0.1 unit/kg and infusion 0.1 units/kg/hr
Lower the serum glucose till it gets to 200 and then switch to D5 with 0.02-0.05 units/kg/hr
What is Hyperosmolar non-Ketosis (HHNK)?
Common in type 2 diabetes
Extremely elevated glucose >600 sometimes >1000
Normal keytones, non-acidotic, and no Kussmaul’s respiration
What is the treatment for HHNK?
Fluid replacement
Correct potassium if needed
Short acting insulin- Bolus 0.1 unit /kg and infusion 0.1 unit/kg/hr
Switch to D5 once serum glucose is 250-300 at 0.02-0.05 units/kg/hr
What is the typical fluid deficits in patient’s with HHNK?
7-10 Liters
What is Diabetes Insipidus?
A condition that occurs when the kidneys are unable to conserve water.
Diabetes insipidus primarily affects what hormone within the body?
Antidiuretic hormone (ADH)
How is Diabetes Insipidus diagnosed?
Urine Osmolality <200
polydipsia (excessive thirst)
Polyuria (excessive urination)
Polyphagia (excessive hunger)
What is the treatment for diabetes insipidus?
IV fluid replacement
Vasopressin/Desmopressin (DDAVP)-vasopressin without significant cardiac response
What is Syndrome of increased anti-diuretic hormone (SIADH)?
Too much ADH in the body caused by disease, tricyclic antidepressants, narcotics, oral hypoglycemic meds, and lesions.
What is the primary concern with SIADH?
Hyponatremia
Hyponatremia of less than ______ causes mentation changes/seizures. Further decline of sodium of less than ______ results in coma.
<130 mEq mentation changes
<120 coma
If the patient is hyponatremic and symptomatic, what should you treat with? What is the maximum you want to raise the sodium per hour?
Hypertonic Saline
No faster than 0.5 mEq/L/hr
What can happen if you correct sodium too quickly?
Central Pontine Myelinolysis (CPM)
Irreversible brain damage
What is a “Thyroid Storm”? (Hyperthyroidism, Grave’s disease, thyrotoxicosis)
Increased thyroid hormone in the body due to autoimmune antibodies that bind to the thyroid cells, increasing stimulation of the thyroid gland.
What are some common signs of Thyroid Storm?
HR >140 Bulging eye weight loss palpitations Hyperthermia unexplained jaundice Pulmonary edema
How do you treat thyroid storm?
Give IV fluid first
Beta blocker (propranolol
Steroids
Tylenol for fever
What is hypothyroidism/Myxedema Coma?
Decreased level of thyroid hormone, slowing down basic body functions and metabolism.
What differentiates Myxedema Coma from Hypothyroidism?
Mental status. Myxedema Coma happens once there is a decrease in mental status.
What are some symptoms of hypothyroidism/Myxedema Coma?
Fatigue Cold Intolerance weight gain puffy eyelids sparse hair goiter
How do you treat Hypothyroidism/Myxedema Coma?
Treat with IV Levothyroxine or Triostat
IV fluids for hypotension
Glucocorticoid support
Passive external warming
What is Adrenal insufficiency/Adrenal crisis?
Decreased hormonal output from the adrenal glands, causing a decrease in cortisol.
What are symptoms of Adrenal insufficiency/Addison’s disease?
Depression malaise Salt craving bronze colored skin Can also present with AMS, shock, severe pain in lower extremities, severe vomiting, diarrhea, dehydration.
What is the treatment for Adrenal insufficiency/Addison’s disease?
Oral steroids (prednisone) IV fluid
What drug may have poor outcomes during RSI if they are Adrenal insufficient?
Etomidate
What is Cushing’s Syndrome?
Increased level of stress hormone or cortisol over a prolonged period of time.
Caused by excessive use of corticosteroids or adrenal gland tumor.
What are signs/symptoms of Cushing’s syndrome?
Buffalo Hump
Moon face
thing arms and legs
purple stripe on abdomen
Treatment for Cushing’s syndrome?
Usually resolves when corticosteroids are stopped or tumor removed.
