DKA
The three defining features of DKA includes what three features? Include the values
What is a pH < 7.3, glucose > 200, and ketonemia (or ketonuria)
This lab value should always be checked prior to initiating insulin therapy for hyperglycemia (esp in DKA).
Potassium - Total body depletion can lead to severe arrhythmia. Don't give if less than 3.3, start simultaneous potassium repletion if 3.3-5.3.
First line therapy medication and dosing for myxedema coma?
levothyroxine (T4) 100 mcg
Which medication and endocrine pathology should be considered in a patient who is hypotensive and not responding to fluid resuscitation and high doses of peripheral vasopressors?
Hydrocortisone 100 mg IV, adrenal crisis (deficiency of cortisol)
Contains both glucocorticoid and mineralocorticoid properties
EKG finding associated with hypercalcemia?
Proper dosing of insulin for DKA?
0.1 U/kg/hr CONTINUOUS infusion, NO Bolus dosing.
Hypoglycemia caused by this class of medications (and name 1 of them require 24 hours of observation due to their duration of action.
sulfonylureas - glyburide, glipizide, glimepride
Mortality in myxedema coma is proportional to which vital sign abnormality?
Hypothermia - <95.5
Most common secondary cause of adrenal insufficiency?
Steroid withdrawal
Patient with multiple myeloma presents to ED with symptomatic hypercalcemia of 15.5 - what treatments are indicated?
normal saline + BISPHOSPHONATES (indicated in malignancy associated hypercalcemia - inhibit bone release of calcium)
This class of medications are associated with euglycemic DKA due to impaired gluconeogenesis.
SGLT-2 inhibitors
Diagnostic criteria for HHS?
Hyperosmolar hyperglycemic state
-glucose > 600
-osmolarity > 320
-bicarb > 15 or pH > 7.3 (no acidosis)
-altered mental status in 25-50% cases
Commonly used medication for treating atrial fibrillation which can precipitate myxedema coma?
Amiodarone - (contains iodine) - avoid if history of hypothyroidism
Treatment of hypertensive crisis secondary to pheochromocytoma?
Alpha blockade - phentolamine or phenoxybenzamine
-Beta blockade first can cause unopposed alpha activity
Most common presenting symptom associated with a pituitary tumor?
Visual changes
classically - bitemporal hemianopsia due to compression of the optic chiasm
In pediatrics, altered mental status in DKA is concerning for what neurologic problem?
Cerebral Edema - Give 20 mL/kg NS in pediatrics (less associated with cerebral edema)
2 adjunct therapies to dextrose/glucose (and their adult doses) for treating hypoglycemia?
Glucagon - increases hepatic gluconeogenesis - associated with vomiting - 1 mg subcutaneous/IM - onset of action 7-10 mins
Octreotide - reduces risk of recurrent hypoglycemia - hyperpolarizes beta cells and inhibits insulin release - 50-100 mcg subcutaneous
Which medication commonly given to cardiac patients is contraindicated in a patient with thyroid storm?
Aspirin - displaces T4 from binding proteins increasing levels of T4/T3
You are considering procedural sedation for shoulder reduction in a patient with a history of pheochromocytoma - which medication should be avoided?
Ketamine - can result in hypertensive crisis and cardiac arrythmias
What is the most common presenting symptom for a prolactinoma in women?
Oligomenorrhea or amenorrhea (NOT lactation) - inhibits gonadotropin releasing hormone - which stimulates ovulation
The three serum ketones the body produces that become elevated in DKA.
What are beta hydroxybutyrate, aceto-acetate, and acetone?
Proper dextrose dosing in adult?
In a child?
In a neonate?
Adult - 1 mL/kg or 50 mL D50W - 1 ampule = 25 g glucose
Child - 2 mL/kg D25W
Neonate - 5 mL/kg D10W
They multiply to 50. Smaller veins with higher glucose associated with thrombophlebitis and venous sclerosis.
What is the proper order of medications to be given in thyroid storm?
Beta blockers first (propranolol) - Decrease sympathetic hyperactivity and partially block peripheral conversion of T4 to T3
Propylthiouracil - Blocks synthesis of thyroid hormone
Steroids - decrease peripheral conversion of T4 to T3
Iodine last - Inhibits release of stored thyroid - MUST BE GIVEN AFTER SYNTHETIC PATHWAY BLOCKED
Most common worldwide cause of primary adrenal insufficiency?
Tuberculosis
What clinical pituitary syndrome is associated with post partum patients who experience severe blood loss during delivery?
Sheehan syndrome - pan-hypopituitarism due to pituitary apoplexy (infarct/hemorrhage of pituitary gland)