Endocrine Emergency

Question 1

How many types of diabetes are there?

Answer 1

3
Gestational
Type 1- childhood (makes too much insulin)
Type 2 - Adulthood ( insulin resistance)

Question 2

What is DKA (diabetic ketoacidosis)

Answer 2

Elevated glucose, elevated keytones, metabolic acidosis, respiratory alkalosis

Question 3

DKA commonly exceeds a blood glucose level of higher than ?

Answer 3

350 mg/dl

Occasionally exceeds 800

Question 4

What type of breathing pattern is common find in DKA?

Answer 4

Kussmaul’s respirations

Question 5

What is a typical fluid deficit in patient’s with DKA?

Answer 5

3-6 Liters

Question 6

What electrolyte commonly needs replacement prior to treatment of DKA?

Answer 6

Potassium

Question 7

Do not lower glucose levels more than _____ mg/dl per hour?

Answer 7

100

Question 8

What could happen if you lower the blood glucose level faster than 100 mg/dl an hour?

Answer 8

Cerebral edema, headache and obtundation (reduced level of consciousness)

Question 9

What is the most common DKA treatment?

Answer 9

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

Question 10

What is Hyperosmolar non-Ketosis (HHNK)?

Answer 10

Common in type 2 diabetes
Extremely elevated glucose >600 sometimes >1000
Normal keytones, non-acidotic, and no Kussmaul’s respiration

Question 11

What is the treatment for HHNK?

Answer 11

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

Question 12

What is the typical fluid deficits in patient’s with HHNK?

Answer 12

7-10 Liters

Question 13

What is Diabetes Insipidus?

Answer 13

A condition that occurs when the kidneys are unable to conserve water.

Question 14

Diabetes insipidus primarily affects what hormone within the body?

Answer 14

Antidiuretic hormone (ADH)

Question 15

How is Diabetes Insipidus diagnosed?

Answer 15

Urine Osmolality <200
polydipsia (excessive thirst)
Polyuria (excessive urination)
Polyphagia (excessive hunger)

Question 16

What is the treatment for diabetes insipidus?

Answer 16

IV fluid replacement

Vasopressin/Desmopressin (DDAVP)-vasopressin without significant cardiac response

Question 17

What is Syndrome of increased anti-diuretic hormone (SIADH)?

Answer 17

Too much ADH in the body caused by disease, tricyclic antidepressants, narcotics, oral hypoglycemic meds, and lesions.

Question 18

What is the primary concern with SIADH?

Answer 18

Hyponatremia

Question 19

Hyponatremia of less than ______ causes mentation changes/seizures. Further decline of sodium of less than ______ results in coma.

Answer 19

<130 mEq mentation changes

<120 coma

Question 20

If the patient is hyponatremic and symptomatic, what should you treat with? What is the maximum you want to raise the sodium per hour?

Answer 20

Hypertonic Saline

No faster than 0.5 mEq/L/hr

Question 21

What can happen if you correct sodium too quickly?

Answer 21

Central Pontine Myelinolysis (CPM)

Irreversible brain damage

Question 22

What is a “Thyroid Storm”? (Hyperthyroidism, Grave’s disease, thyrotoxicosis)

Answer 22

Increased thyroid hormone in the body due to autoimmune antibodies that bind to the thyroid cells, increasing stimulation of the thyroid gland.

Question 23

What are some common signs of Thyroid Storm?

Answer 23

HR >140
Bulging eye
weight loss
palpitations
Hyperthermia
unexplained jaundice
Pulmonary edema

Question 24

How do you treat thyroid storm?

Answer 24

Give IV fluid first
Beta blocker (propranolol
Steroids
Tylenol for fever

Question 25

What is hypothyroidism/Myxedema Coma?

Answer 25

Decreased level of thyroid hormone, slowing down basic body functions and metabolism.

Question 26

What differentiates Myxedema Coma from Hypothyroidism?

Answer 26

Mental status. Myxedema Coma happens once there is a decrease in mental status.

Question 27

What are some symptoms of hypothyroidism/Myxedema Coma?

Answer 27

Fatigue
Cold Intolerance
weight gain
puffy eyelids
sparse hair
goiter

Question 28

How do you treat Hypothyroidism/Myxedema Coma?

Answer 28

Treat with IV Levothyroxine or Triostat
IV fluids for hypotension
Glucocorticoid support
Passive external warming

Question 29

What is Adrenal insufficiency/Adrenal crisis?

Answer 29

Decreased hormonal output from the adrenal glands, causing a decrease in cortisol.

Question 30

What are symptoms of Adrenal insufficiency/Addison’s disease?

Answer 30

Depression
malaise
Salt craving
bronze colored skin
Can also present with AMS, shock, severe pain in lower extremities, severe vomiting, diarrhea, dehydration.

Question 31

What is the treatment for Adrenal insufficiency/Addison’s disease?

Answer 31

Oral steroids (prednisone) 
IV fluid

Question 32

What drug may have poor outcomes during RSI if they are Adrenal insufficient?

Answer 32

Etomidate

Question 33

What is Cushing’s Syndrome?

Answer 33

Increased level of stress hormone or cortisol over a prolonged period of time.
Caused by excessive use of corticosteroids or adrenal gland tumor.

Question 34

What are signs/symptoms of Cushing’s syndrome?

Answer 34

Buffalo Hump
Moon face
thing arms and legs
purple stripe on abdomen

Question 35

Treatment for Cushing’s syndrome?

Answer 35

Usually resolves when corticosteroids are stopped or tumor removed.