Non-Diabetes Endo Flashcards
Addisonian Crisis management
Fluid resuscitation
IM hydrocortisone 100mg STAT
Glucose
Continue fluids
IM hydrocortisone every 8h until dexamethasone at 72h
When do Addison’s pt need to increase their hydrocortisone
medical procedures
illness (fever, nausea, vomiting)
strenuous exercise (marathon)
discuss fasting
Daily doses for Addison’s
Hydrocortisone: 15-25mg spread over 3 times
Fludrocortisone: 50-200mcg
Grave’s management (acute and chronic)
propranolol
Anti-thyroid: carbimazole 40mg then reduce
PTU if pregnant
Consider radioiodine and surgery
No radioiodine if eye disease
Management of Thyroid Storm
IV propranolol 60mg +/- digoxin
carbimazole
hydrocortisone IV
iodine after 4h
consider IV fluids, sodium and cooling, abx
management of myxoedema coma
IV T3
IV hydrocortisone
consider warming blanket, fluids (caution), Abx
two philosophies of Grave’s disease
1) titrate for 12-18m
2) block and replace for 6-9m (fixed high dose carbimazole)
management of hypothyroidism
Thyroxine, check TFTs in 8-12w
aim for normal TSH
drugs that interact with thyroxine
iron
CaCO3
leave 4h gap between
Phaeo crisis management
short acting alpha blockade (phentolamine)
then long acting (phenoybenzamine)
then beta blockade for tachycardia
surgery in 4-6w
post-op recheck metanephrines
Management for prolactinoma
dopamine agonist: bromocriptine/cabergoline
consider surgery
Management for acromegaly
1) Transsphenoidal transnasal hypophysectomy
2) octreotide/dopamine agonists
3) irradiation
Management for Cushing’s disease
surgery (ketoconazole first to make them fit for surgery, 3-4w)
radiation
ketoconazole
hydrocortisone after surgery
management for adrenal Cushing’s syndrome
adrenalectomy and steroid replacement to wake other adrenal gland up
Management for ectopic Cushing’s syndrome
ketoconazole, metyrapone, mifepristone
Treat cause
Management for unilateral Conn’s syndrome
Spironolactone/epleronone
SandoK
consider surgery
Management for bilateral Conn’s
spironolactone
cannot consider surgery
management for hypovolaemic hyponatraemia
slow 0.9% saline
management for euvolaemic hyponatraemia
fluid restrict and treat underling cause
management of hypervolaemic hyponatraemia
fluid restrict and treat underlying cause
management for SEVERE hyponatraemia (<120)
150ml IV 3% saline over 20 minutes
check again
150ml IV 3% saline over 20 minutes
repeat if <5mmol increase in Na
once 5mmol increase: stop infusion
switch to 0.9% saline, raising Na MAX 10mmol over 24h
after, aim for 8mmol/24h until 130
check Na 6h/12h/daily until stable
if raised too quick, you get central pontine myelinolysis
What happens if you treat hyponatraemia too quickly
central pontine myelinolysis
management of hyperkalaemia
10 ml 10% calcium gluconate 100ml 20% dextrose 10U insulin actrapid consider nebulised salbutamol consider dialysis
management of mild/moderate hypokalaemia with NO SYMPTOMS
oral sandoK
definition of mild/moderate hypokalaemia
no symptoms, K 2.5-3.5
management of severe hypokalaemia OR symptomatic
IV KCl
3x1L 0.9% saline with 40mmol KCl/24h
cannot exceed 20mmol/h
management of hypercalcaemia
aggressive fluid resuscitation (4-6L in 24h)
bisphosphonates (IV pamidronate)
Consider furosemide if you need to drive urine output for more fluids
Investigation for solitary thyroid nodules
US and FNAC
When to avoid radioiodine
when there is eye disease (makes it worse)
pregnant (avoid pregnancy for 6m after both genders)
must stay away from kids for 2w
Graves: risk with carbimazole/PTU
neutropaenia
management for Paget’s
none may be needed
analgesia
consider calcitonin and IV pamidronate
management of acute hypocalcaemia
10ml 10% calcium gluconate boluses
OR 20-50 in 1L saline over 4h
must also check PTH, magnesium, and cardiac monitoring
signs of hypocalcaemic crisis
signs of tetany (chvostek/trousseau)
OR long QTi
management of primary hyperparathyroidism
stop any thiazides increase fluid intake DEXA +/- renal US for stones check vitamin D ?cinacalcet surgery
management of multinodular goiter
long-term carbimazole usually
can consider radioiodine
management of singular toxic goiter
cytology to exclude malignancy
surgery if pressure symptoms
radioiodine is 1st line
consider long-term carbimazole if old
management of post-partum thyroiditis
supportive
NSAIDs
propranolol
management of SIADH
treat symptomatic hyponatraemia (hypertonic saline boluses, measure every 1-2h and raise slowly to avoid CPM)
Fluid restrict
Consider tolvaptan
Management of diabetes insipidus
fluid resuscitation with hypotonic saline/dextrose
Cranial: desmopressin
Nephrogenic: stop offending drug, drink more fluids (sometimes lithium is irreversible)
Result of DDAVP test
Fluid deprived: nephrogenic and central still low osmolality, psychogenic and normal high osmolality
DDAVP administration: nephrogenic still low osmolality, central now normal high osmolality
