Endocrinology Flashcards
give the abnormalities and causes
ALWAYS WORK OUT ANION GAP
HAGMA - DKA, renal failure and lactic acidosis
metabolic acidosis from vomiting causing normal PH
high K from renal failure
type a Lactic acidosis
high creatinine from pre renal failure
DKA management
6 steps
1 - insulin 0.5 units/kg/hr until acidosis resolved. Aim to lower glucose by 1-2mmol/l/hr
2 - IV fluids – N/S (bolus acceptable 1000mL stat) initially 1 litre over 1 hour then replace losses plus maintenance over 24-48hrs, add 5% dextrose when BSL falls to 12-15,
3 - maintain BP >100mmHg and cerebral perfusion
4 - K replacement – will fall with insulin – add 40mmol/L to infusion when K falls to 4.5 – 5.0
only if passing urine (care with chronic renal failure)
5 - Treat cause (eg sepsis, abdominal pathology)
6 - Heparin
what are the explanations for the abnormalities?
HCO3 – high anion gap metabolic acidosis due to renal failure, probably also lactate and ketones Formula: anion gap = Na – (HCO3 + Cl)
Glucose – due to HHS, as a result of poor glycaemic control in the context of sepsis Na – dilutional due to hyperglycaemia, corrects to 139 – normal
Formula: corrected Na = Na + (glucose-5)/3
K – elevated due to intracellular shift from likely acidaemia, and also renal failure
Urea,creat – renal failure, intrinsic as ratio <100, probably due to ATN and maybe pyleonephritis
Give four differentials other than myxodemic coma
neuro - seizure/ICH
endocrinology - addisons
infective - sepsis
hypothermia
tox - opiates, barbituates
other than non compliance to meds what are some causes of myxodemic coma?
trauma
concurrent illness eg pneumonia
Mi events
CVA events
hypothermia
meds eg lithium
how do you treat a myxodemic coma that is caused by medication non compliance?
- Replace T3 and T4
t4 = 200-400mcg IV loading dose
t3 - 5-20mcg IV - Hydrocortisone
- Supportive care - fluids, electrolyte replacement, vasopressors
What is the most likely diagnosis and some differentials?
Thyroid Storm
heat related ilness
SOL
sepsis -meningioencephalitis
toxidrome eg sympathomimetic or anticholinergic
withdrawal - benzos or alcohol
What are four risk factors for thyroid storm?
sepsis
acute MI
DKA
trauma
IV iodine contrast
ingestied thyroid hormone
What are the treatment priorities for thyroid storm?
ABC supportive care and treat underlying cause
Specific meds:
IV benzos
corticosteroids
Beta blockers to stop peripheral effects
Csrbimazole to stop synthesis
consult endocrine
What are the drug treatments for thyroid storm?
- block peripheral effect - 1mg IV propranolol every 5 to 10 minutes
- stop synthesis - carbimazole 1gPO
- ioidine - prevents release of stored hormones - lugols iodine 8-10 drops
- steroids - 100mg hydrocort stops peripheral conversion
What is Pembertons sign?
What causes it?
Triad:
Facial congestion
Cyanosis
Respiratory distress
Usually SVC obstruction from tumour or mass
What are the diagnostic criteria for thyroid storm?
fever
tachycardia disproportionate to fever
CNS disturbance
what the physical exam features of thyrotoxicosis
tachy
sweaty
febrile
tremor
hyperreflexia
goitre
exopthalmos
thin hair
list three causes of thyrotoxicosis and the exam findings
What is the criteria for DKA
- pH < 7.3
- ketosis (ketonemia or ketonuria) OR
HCO3 <15 mmol/L due to high anion gap - -metabolic acidosis (HAGMA) - hyperglycemia (may be mild; euglycemic DKA can occur)
causes of high calcium
C - Cancer
H - Hyperparathyoid
R - Renal
I - Immobility
S - Sarcoid/SLE
T - Thyrotoxicosis
M - Milk alkali syndrome
A - Addisons
S - Some drugs - thiazides
Causes of DIC
H - Heat illness
O - obstetrics
T - Traumaa
M - malignancy
I - immune - SJS
S - Sepsis
S - Snakebite
criteria for SIADH
- Low osmolality in blood
- euvolemic
- raised urine osmolality and urinary na
