Exam 3 Metabolic Emergencies Flashcards
Hypoglycemia glucose level?
<70 mg/dL
Hypoglycemia caused by? (7)
High dose of insulin Insulin + sulfonylurea (pancr b-cell stim) Delay in eating post insulin Glucagon/epi/cortsol don't kick-in Poor calorie intake (diet, vomiting) Physical exertion Infection, trauma, stress
Hypoglycemia mgmt?
Oral carbs
IV dextrose or glucagon
OBSERVE/recheck sugars
Hypoglycemia mgmt if caused by sulfonylurea?
ADMIT
very long 1/2 life so will keep crashing until out of system
Hyperglycemic crisis in DM? (2)
Caused by? (4)
DKA or
Hyperosmolar hyperglycemic state (HHS)
Illness/infection
Trauma/surgery
MI
Insulin omission
DKA seen in who?
When?
P presentation? (7)
DM I
insulin insuff + precepitant (hrs/days)
N/V Abd pain Hypervent HypoTN/Shock/Dehydration Met acidosis w/ ↑ ion gap ↑ glu/ketones Polyuria/dipsia, wgt loss
DKA labs? (12)
Glu > 250 Ketones: urine and serum K+ = U low (continues to fall w/ tx) Na+ = Falsely low Cl- = Low Bicarb = Low BUN/Cr = High (dehyd) Anion gap = High Serum osm = High WBC = High w/o infection (stress rxn) ABG = Acidosis UA = infection
DKA studies? (2)
CXR = P infection EKG = P MI, e- abn, arrhy
DKA tx goals? (6)
↑ vol ↓ glu Correct serum osmo Clear serum ketones Correct e-/ion gap Treat cause
DKA mgmt? (3)
Do NOT give what?
IV NS w/ K+, PO4, watch Na+
IV insulin (until gap normalizes)
IV D5 when glu < 250 to clear ketones
NO BICARBS -> hyperNa+, hypoK+, CSF acidosis, alkalosis
= cerebral edema/damage
UNLESS significant hyperK+, then bicarb is critical to push K+ back into cells
HHS seen in who?
When? (3)
Pathophys?
DM II
w/ infection, MI, other stressors
Hyperglycemia -> glycosuria -> dehydration -> worse hypergly (glu >500 and plasma osmo > 320)
HHS presentation? (7)
Insidious onset (days/wks) Weakness Polydipsia Polyuria Dehydration ∆ LOC NO ACIDOSIS (insulin still suff to prevent ketones)
HHS tx?
IV NS then .45% saline
IV D5 in .5NS when glu < 250
Add IV insulin if NS not working
Thyroid Storm is?
Thyrotoxicity from high thyroid hormone ->
↑ heart/nn sensitivity to catecholamines (Epi/Nor/DA)
Thyroid storm presentation?
Hyperthy sxs w/ wgt loss/diarr Confusion Fever Afib Shock/Coma/Death
Thyroid Storm labs? (5)
TSH = Low FT4/3 = High CBC = N CMP = N UA = N
Thyroid Storm tx? (8)
β-block (tachy/afib) PTU (block T4 synth, 4/3 convert) Methimazole (block T4 synth) ASA/Tylenol Fluids e- Nutritional supp Cool
Myxedema Coma is?
Precipitated by? (5)
Severe thyroid deficiency leading to encephalophy
Precipitating: Cold temp CVA Surgery/Trauma Meds Infection
Myxedema Coma presentation? (7)
Hypothyroid sxs Hypothermia Hyporeflex CNS depression Bradycardia Hypovent Slow verbal response Rapid or slow onset U old people
Myxedema Coma labs? (5)
CBC = N CMP = P hypogly/Na+ TSH = High FT4/3 = Low or none ABG = hypoxemia w/ hypercarb
Myxedema Coma studies? (3)
CXR = N u/l PNA is cause
CT head = N
EKG = Brady, flat or invert T
Myxedema Coma tx? (5)
IV NS w/ e- T4 Glucocort until adrenal insuff r/o Warming Slow recovery
Adrenal Insuff is?
Low cortisol from
Primary (adrenal gland insuff): Addisons
Secondary (pituitary ACTH insuff)
Tertiary (hypothal suppression): U quick w/d of steroids
Acute Adrenal Crisis presentation? (8)
N/V/D Abd pain Confusion/Coma Fever HypoNa+ Hypogly HypoTN Wgt loss
Waterhouse-Friderichsen synd?
Adrenal infarct from meningococcal infection
Acute Adrenal Crisis mgmt?
IV NS w/ e-
Hydrocortisone
Mineralcortision
Think Adrenal Crisis when?
Unexplained shock or doesn’t respond to vasopressor/vol replacement
