Red Flags/Emergency Conditions

Question 1

Adrenal Crisis (Hypopituitarism) RF/cause

Answer 1

Hypopituitarism: Acute, sudden withdrawal of corticosteroid therapy

Infections (meningococcal meningitis, causing acute adrenal hemorrhage: Waterhouse-Friderichsen Syndrome)

Sudden worsening of Addison disease

Question 2

Adrenal Crisis (Hypopituitarism) SXS

Answer 2

• Severe hypotension
• Hypovolemic shock
• Fever
• Dehydration, volume depletion
• N/V, anorexia
• Weakness
• Confusion
• Depressed mentation
• Abdominal pain

Question 3

Pituitary Apoplexy causes

Answer 3

Caused by hemorrhage

• Pituitary Adenoma - necrotic/bleeding

Caused by infarction

• Sheehan Syndrome

Idiopathic

No ACTH

Question 4

Pituitary Apoplexy SXS

Answer 4

• Severe headache
• Diplopia/visual field defects
• Hypopituitarism
• Hypoglycemia
• Hypotension
• Adrenal Crisis

Question 5

Myxedema Coma cause/RF/SXS

Answer 5

Affects pts with poorly managed hypothyroidism who undergo a stressful situation (infection or surgery)

• Confusion
• Hypothermia - No shivering
• Bradycardia
• Reduced respiratory rate
• Weakness
• Shock

Question 6

Thyroid Storm causes/RF/SXS

Answer 6

Severe form of hyperthyroidism

High temperature

Confusion → psychosis

Tachycardia

Increased respiratory rate

High mortality rate, even with tx

Question 7

Acute Hyponatremia < 115 causes/RF/SXS

Answer 7

• Syndrome of inappropriate secretion of ADH (SiADH - ADH high)
• Posterior Pituitary Pathology: Head trauma and meningitis
• 50% mortality

Early:

N/V

HA

Late:

Seizure

Coma

Respiratory arrest

Question 8

Acute Hypercalcemia causes/RF

Answer 8

Elevated PTH

• Primary hyperparathyroidism
• PTHrP-secreting tumor (lung, breast, ovarian, renal)
• Lithium Therapy
• Familial hypocalciuric hypercalcemia

Hormone-independent bone resorption

• Osteolytic bone metastases (breast, lung, multiple myeloma)
• Paget’s disease of bone
• Lymphomas (secrete excess calcitriol)
• Hyperthyroidism
• Immobilization

Excess Vitamin D

• Excessive intake
• Ectopic production of calcitriol in granulomatous disease (TB, sarcoidosis)/lymphoma

Excess dietary intake of Ca

Thiazides

Rare causes:

• Adrenal crisis (Addison’s)
• Severe rhabdomyolysis complicated by AKI
• Theophylline toxicity

Question 9

Acute Hypercalcemia SXS

Answer 9

• Stones, Bones, Groans, Thrones, Psychiatric overtones
• Decreased excitability
• Muscle weakness
• Lethargy
• Depression
• HTN
• Bradycardia → asystole
• Shortened QT, elevated ST
• Polyuria
• Kidney stones
• Decreased GFR
• Osteomalacia/rickets, arthritis
• Constipation, anorexia
• N/V
• Pancreatitis
• Band keratopathy

Question 10

Acute Hypocalcemia causes/RF

Answer 10

Decreased serum calcium

• Hypoparathyroidism
  
  • Post-op
  • Autoimmune/idiopathic
  • Congenital
  • Pseudoparathyroidism
• Vitamin D deficiency
• Related electrolyte imbalance
  
  • Hypermagnesemia
  • Hypophosphatemia

Elevated loss of serum calcium

• Hyperphosphatemia
• Acute pancreatitis
• Hungry bone syndrome
• Severe osteoblastic metastases
• Chelation

Other causes:

• Chemotherapy
• Sepsis
• Excessive alcohol/caffeine

Question 11

Acute Hypocalcemia SXS

Answer 11

Increased excitability

CATS go numb

• Convulsions
• Arrhythmias
• Tetany
• Numbness/paresthesias

Paresthesias, esp of lips/mouth

Muscle cramps, spasms, myalgias

Wheezing, laryngospasm

Hyperactive reflexes

Tetany

Seizures

Anxiety, irritability

Personality changes

Fatigue

Decreased HR

Prolonged QT → arrhythmias

Cardiac arrest

Cataracts