Endocrine Emergencies

Posted: May 17, 2016 | Author: Dr Sean Scott | Filed under: Tuesday Tutorials |Leave a commentCollaborate on SlackThis BMJ review article gives a nice overview of endocrine emergencies.DKA

Origen: Endocrine Emergencies

 

This BMJ review article gives a nice overview of endocrine emergencies.

DKA & HHS

You are asked to review a 27 year old female, a known diabetic, admitted following a 48 hour illness characterised by nausea, vomiting and shortness of breath.  She has been unable to eat or drink and has not taken her regular insulin.  On examination she has a heart rate of 137/min, respiratory rate of 36 breaths/min, O2 sats of 99% on room air, blood pressure of 92/34mmHg.  She weights 80kg and her blood sugar level is 32mmol/L.

Outline your plan of management for the first 24 hours.

List the features which distinguish diabetic ketoacidosis (DKA) from the hyperosmolar hyperglycaemic state (HHS).

Describe your specific treatment for a 62-year-old female presenting with a decreased conscious state secondary to HHS.

Emergency Management of DKA

Acid–Base Problems in Diabetic Ketoacidosis. NEJM 2015: 372

Thyroid storm

You are called to ED to review a 43 year old woman with shortness of breath and palpitations, worsening over the past few weeks.  Her ECG shows new atrial fibrillation at at rate of 160.

What features on history, examination and investigation would make you suspect thyroid storm in this patient?

Outline your approach to the management of thyrotoxic crises. Include in your answer the rationale for each drug used.

The role of thyroid dysfunction in the critically ill: a review of the literature. Minerva Anesthesiologica 2010: 76(11)

EMCrit on Thyroid Storm

Myxoedema Coma

A 38 year old man presents with bradycardia, hypotension and a GCS of 14.

HR 45     BP 90/40    Sats 98% on RA   Temp 35.9

What is you differential diagnosis?

What features on history, examination and investigation would make you consider hypothyroidism as an underlying cause

Outline your management of this patient if hypothyroidism is a likely cause of his presentation.

Myxoedema Coma: a new look at an old crisis. Journal of Thyroid Research 2011

Adrenal Insufficency

A 50-year-old Scottish male tourist presents with a three-day history of nausea, vomiting, general lethargy and dizziness.

HR 106    BP 90/55   Sats 99% on RA  Temp 37.8

The results of his investigations are as follows:

cicm-2013_2_7fig2

Describe and interpret these results.

Outline the causes, consequences and management of adrenal insufficiency in the critically ill.

Phaeochromocytoma

A 43 year old female presents with a severe episode of palpitations, sweating, vomiting and breathlessness after taking a dose of propranolol prescribed by her General Practitioner for panic attacks. She gives a history of similar symptoms occurring episodically over the preceding three months and her past medical history includes medullary thyroid cancer.

Vital signs:
SaO2 88% on oxygen 15 L/min via mask Heart rate: 150, Atrial Fibrillation BP 175/100 mm Hg
Chest X-Ray: Consistent with acute pulmonary oedema.

You suspect phaeochromocytoma outline your immediate management of at this patient.

Which signs and symptoms make you suspect this diagnosis?

What investigations will help you confirm the diagnosis?

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