Exam 3 Metabolic Emergencies

Question 1

Hypoglycemia glucose level?

Answer 1

<70 mg/dL

Question 2

Hypoglycemia caused by? (7)

Answer 2

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

Question 3

Hypoglycemia mgmt?

Answer 3

Oral carbs
IV dextrose or glucagon
OBSERVE/recheck sugars

Question 4

Hypoglycemia mgmt if caused by sulfonylurea?

Answer 4

ADMIT

very long 1/2 life so will keep crashing until out of system

Question 5

Hyperglycemic crisis in DM? (2)

Caused by? (4)

Answer 5

DKA or
Hyperosmolar hyperglycemic state (HHS)

Illness/infection
Trauma/surgery
MI
Insulin omission

Question 6

DKA seen in who?

When?

P presentation? (7)

Answer 6

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

Question 7

DKA labs? (12)

Answer 7

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

Question 8

DKA studies? (2)

Answer 8

CXR = P infection
EKG = P MI, e- abn, arrhy

Question 9

DKA tx goals? (6)

Answer 9

↑ vol
↓ glu
Correct serum osmo
Clear serum ketones
Correct e-/ion gap
Treat cause

Question 10

DKA mgmt? (3)

Do NOT give what?

Answer 10

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

Question 11

HHS seen in who?

When? (3)

Pathophys?

Answer 11

DM II

w/ infection, MI, other stressors

Hyperglycemia -> glycosuria -> dehydration -> worse hypergly (glu >500 and plasma osmo > 320)

Question 12

HHS presentation? (7)

Answer 12

Insidious onset (days/wks)
Weakness
Polydipsia
Polyuria
Dehydration
∆ LOC
NO ACIDOSIS (insulin still suff to prevent ketones)

Question 13

HHS tx?

Answer 13

IV NS then .45% saline
IV D5 in .5NS when glu < 250

Add IV insulin if NS not working

Question 14

Thyroid Storm is?

Answer 14

Thyrotoxicity from high thyroid hormone ->

↑ heart/nn sensitivity to catecholamines (Epi/Nor/DA)

Question 15

Thyroid storm presentation?

Answer 15

Hyperthy sxs w/ wgt loss/diarr
Confusion
Fever
Afib
Shock/Coma/Death

Question 16

Thyroid Storm labs? (5)

Answer 16

TSH = Low
FT4/3 = High
CBC = N
CMP = N
UA = N

Question 17

Thyroid Storm tx? (8)

Answer 17

β-block (tachy/afib)
PTU (block T4 synth, 4/3 convert)
Methimazole (block T4 synth)
ASA/Tylenol
Fluids
e-
Nutritional supp
Cool

Question 18

Myxedema Coma is?

Precipitated by? (5)

Answer 18

Severe thyroid deficiency leading to encephalophy

Precipitating:
Cold temp
CVA
Surgery/Trauma
Meds
Infection

Question 19

Myxedema Coma presentation? (7)

Answer 19

Hypothyroid sxs
Hypothermia
Hyporeflex
CNS depression
Bradycardia
Hypovent
Slow verbal response
Rapid or slow onset
U old people

Question 20

Myxedema Coma labs? (5)

Answer 20

CBC = N
CMP = P hypogly/Na+
TSH = High
FT4/3 = Low or none
ABG = hypoxemia w/ hypercarb

Question 21

Myxedema Coma studies? (3)

Answer 21

CXR = N u/l PNA is cause
CT head = N
EKG = Brady, flat or invert T

Question 22

Myxedema Coma tx? (5)

Answer 22

IV NS w/ e-
T4
Glucocort until adrenal insuff r/o
Warming
Slow recovery

Question 23

Adrenal Insuff is?

Answer 23

Low cortisol from
Primary (adrenal gland insuff): Addisons
Secondary (pituitary ACTH insuff)
Tertiary (hypothal suppression): U quick w/d of steroids

Question 24

Acute Adrenal Crisis presentation? (8)

Answer 24

N/V/D
Abd pain
Confusion/Coma
Fever
HypoNa+
Hypogly
HypoTN
Wgt loss

Question 25

Waterhouse-Friderichsen synd?

Answer 25

Adrenal infarct from meningococcal infection

Question 26

Acute Adrenal Crisis mgmt?

Answer 26

IV NS w/ e-
Hydrocortisone
Mineralcortision

Question 27

Think Adrenal Crisis when?

Answer 27

Unexplained shock or doesn’t respond to vasopressor/vol replacement