The Sugars
These three lab values define diabetic ketoacidosis
What is hyperglycemia, elevated BHB(ketones) and acidosis (pH <7.3 or bicarb <18)?
This medication blocks thyroid hormone synthesis and peripheral T4 to T3 conversion.
What is PTU (propylthiouracil)?
This vitamin deficiency causes night blindness and dry eyes (xerophthalmia).
What is Vitamin A deficiency?
Phentolamine and Phenoxybenzamine are alpha antagonists used as first-line treatment for this disease.
What is Pheochromocytoma?
This medication inhibits osteoclast-mediated bone resorption and lowers serum calcium levels.
What are bisphosphonates?
What is potassium?
22 y/o F presents with palpitations and anxiety. T is 101.0°F (38.3°C), BP is 122/82 mm Hg, HR is 142 bpm, RR is 20/min, and SpO2 is 100% on room air. Physical exam reveals an anxious-appearing woman with nontender thyroid enlargement. EKG shows sinus tachy. Most likely 1st line treatment?
What is propranolol?
Hashimoto's is the most common cause of hypothyroidism. Patient is in a transient hyperthyroid state (early in the course of Hashimoto thyroiditis), which will resolve on its own, followed by lifelong hypothyroidism. Once hypothyroid, the patient will require lifelong levothyroxine supplementation. While she is in this acute hyperthyroid state, it is appropriate to prescribe a short course of propranolol to mitigate the symptoms of hyperthyroidism and control her HR, but she will not need this medication long term, as she will likely convert to sinus rhythm once euthyroid.
This vitamin deficiency presents with dermatitis, diarrhea, and dementia.
What is niacin (Vitamin B3) deficiency — pellagra?
This steroid (& dose) is used in new-onset acute adrenal crisis because it will not interfere with cortisol/ACTH testing
Decadron 4 mg IV q12h
versus Hydrocortisone 100 mg IV q6h may otherwise be given to patients with a history of adrenal insufficiency or to severely unstable patients.
Classic EKG finding in hypercalcemia.
What is shortened QT interval?
Unlike DKA, HHS typically does not present with this metabolic derangement.
What is significant ketoacidosis?
This is the most likely diagnosis in a postpartum woman who develops agalactia, amenorrhea, and hypotension.
What is Sheehan's Syndrome?
A rare but serious complication caused by pituitary infarction due to hypovolemic shock during childbirth. In pregnancy, the pituitary gland enlarges and becomes vulnerable to ischemia. Damage can range from mild to severe, affecting the secretion of one or multiple hormones. Common symptoms include failure to lactate and postpartum amenorrhea, but other signs of hypopituitarism, such as hypotension, hyponatremia, and hypothyroidism, may develop immediately or years later.
A patient with an MCV > 100 fL, hypersegmented neutrophils, elevated homocysteine, and elevated methylmalonic acid likely has this vitamin deficiency
Vitamin B12 (Cobalamin) Deficiency
This classic electrolyte abnormality combination is seen in adrenal crisis.
What are hyponatremia and hyperkalemia?
What is the safe correction rate for chronic hyponatremia to avoid osmotic demyelination syndrome?
What is <8–10 mEq/L in 24 hours?
These are the most likely etiologies for a patient with persistent hypoglycemia despite glucose repletion who has elevated insulin and C-peptide levels.
What is sulfonylurea overdose or insulinoma (if not overdose)?
A 48M w/ hypothyroidism presents with bradycardia, hypothermia, and hypotension. These two medications are first-line treatment for this condition
What is hydrocortisone and levothyroxine?
IV corticosteroids should be given before replacement of thyroid hormone, as initiation of thyroid hormone can precipitate adrenal crisis by increasing cortisol metabolism.
Refeeding syndrome is characterized by a sudden drop in this electrolyte.
What is phosphate (hypophosphatemia)?
Refeeding syndrome is a constellation of electrolyte derangements that occurs during rapid refeeding after a period of prolonged underfeeding or starvation.
Deficiencies in thiamine, potassium, magnesium, and phosphorus require aggressive and careful correction.
You suspect adrenal insufficiency in a patient with hypotension, weakness, and hyponatremia. Which lab finding can distinguish between primary and secondary adrenal insufficiency?
What is hyperkalemia (present in primary due to aldosterone deficiency, absent in secondary)?
This is the immediate treatment for severe cardiac toxicity or cardiac arrest due to hypermagnesemia
What is calcium gluconate?
intravenous calcium gluconate, 15–30 mL of a 10% solution over 2–5 minutes. For less severe but life-threatening cardiorespiratory symptoms, a smaller initial dose of 10 mL of a 10% solution is recommended. Furosemide may be given intravenously to promote magnesium excretion.
A 65-year-old patient presents with altered mental status, glucose of 720 mg/dL, serum osmolality of 340 mOsm/kg, and no significant ketones. Despite 3 liters of IV fluids and insulin, the patient remains obtunded. What key electrolyte abnormality may be preventing neurologic improvement?
What is sodium — pseudohyponatremia from severe hyperglycemia? Due to osmotic water shift, which may cause cerebral dysfunction even when serum sodium appears normal.
Corrected sodium = measured Na⁺ + [1.6 mEq/L × (glucose − 100)/100]. Failure to correct for this may lead to underestimation of true hypernatremia and contribute to persistent neurologic symptoms.
Beta-blockers should be avoided in thyroid storm with underlying heart failure or asthma for this reason.
What is increasing the risk of decompensation or bronchospasm?
Use short-acting beta-blockers (e.g., esmolol) or avoid if contraindicated.
A patient with a history of alcohol use presents with macrocytic anemia, glossitis, and peripheral neuropathy. These two vitamin deficiencies should be considered.
What are folate (Vitamin B9) and thiamine (Vitamin B1) deficiencies?
Name the condition:
A 40-year-old woman presents because of a 30-pound weight gain in the past six months and the development of reddish-purple stretch marks on her abdomen, hips, and breasts. She has also noticed muscle weakness in her arms and thighs. Temperature is 37ºC (98.6ºF), pulse rate is 88/min, respirations are 18/min, blood pressure is 152/92 mmHg, and BMI is 32.
What is a pituitary microadenoma? What is Cushing disease?
Cushing disease, a cause of Cushing syndrome, is characterized by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. This is most often due to pituitary microadenoma. Patients often complain of proximal muscle weakness, easy bruising, weight gain, and hirsutism. Individuals can develop hypertension, moon facies, facial plethora, supraclavicular fat pads, buffalo hump, truncal obesity, and purple striae.
68-year-old man with a history of restrictive lung disease, obstructive sleep apnea, and elevated BMI presents with 24 hours of somnolence.
Relevant laboratory results are as follows:
Sodium: 142 mEq/L
Chloride: 95 mEq/L
Bicarbonate: 40 mEq/L
Arterial blood gas
pH: 7.32
PCO2: 85 mm Hg
What is Chronic compensated respiratory acidosis?
In chronic compensated states, bicarbonate will rise by 3.5 mEq/L for each 10 mm Hg of increased carbon dioxide above baseline.
Winter's formula: expected respiratory compensation for metabolic acidosis: (bicarbonate × 1.5) + 8 ± 2