Non-dm Endocrine Emergencies

Question 1

Treatment of myxoedema coma

Answer 1

Correct any hypoglycaemia 
Give t3 - liothyronine IV - slowly!! 
Give hydrocortisone IV 
Antibiotics if infection suspected 
Warming if hypothermia

Question 2

Signs of thyrotoxic Storm

Answer 2

Severe hyperthyroidism - high temp, agitation, confusion, coma, tachycardia , AF, D&V, goitre, thyroid bruit

Question 3

Management of thyrotoxic storm

Answer 3

Fluids if dehydrated

Sedate if necessary - chlorpromazine

If CO okay - propranolol
If CO not okay or asthma - ultra short acting = esmolol

High dose digoxin

Antithyroid drugs - carbimazole then 4hr later give lugols solution - aqueous iodine - diluted in water for 7-10 days to block thyroid

Hydrocortisone or Dexamethasone to prevent peripheral conversion of t4 to t3

Question 4

Signs of Addisonian crisis

Answer 4

Shock

Tachycardia, vasoconstriction, postural hypotension, oliguria, weak, confused, comatose

Question 5

Management of Addisonian crisis

Answer 5

100mg hydrocortisone stat
IV fluid
Hypoglycaemia is a danger - will need IV glucose

Question 6

What is myxoedema coma?

Answer 6

Looks hypothyroid, often >65
Hyporeflexia, low glucose, bradycardia, coma and seizures

May seem psychotic - myxoedema madness - before coma