DKA
Glycemic Emergencies
Thyroid Disorders
Adrenocorticotropic Disorders
Other Hormone Disorders
100

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)

100

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.

100

First line therapy medication and dosing for myxedema coma?

levothyroxine (T4) 100 mcg

100

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

100

EKG finding associated with hypercalcemia?

shortened QT interval
200

Proper dosing of insulin for DKA?

0.1 U/kg/hr CONTINUOUS infusion, NO Bolus dosing.

200

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

200

Mortality in myxedema coma is proportional to which vital sign abnormality? 

Hypothermia - <95.5

200

Most common secondary cause of adrenal insufficiency?

Steroid withdrawal

200

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)

300

This class of medications are associated with euglycemic DKA due to impaired gluconeogenesis. 

SGLT-2 inhibitors

300

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 

300

Commonly used medication for treating atrial fibrillation which can precipitate myxedema coma?

Amiodarone - (contains iodine) - avoid if history of hypothyroidism

300

Treatment of hypertensive crisis secondary to pheochromocytoma?

Alpha blockade - phentolamine or phenoxybenzamine

-Beta blockade first can cause unopposed alpha activity

300

Most common presenting symptom associated with a pituitary tumor?

Visual changes

classically - bitemporal hemianopsia due to compression of the optic chiasm

400

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)

400

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 

400

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

400

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

400

What is the most common presenting symptom for a prolactinoma in women?

Oligomenorrhea or amenorrhea (NOT lactation) - inhibits gonadotropin releasing hormone - which stimulates ovulation

500

The three serum ketones the body produces that become elevated in DKA.

What are beta hydroxybutyrate, aceto-acetate, and acetone?

500

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.

500

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

500

Most common worldwide cause of primary adrenal insufficiency?

Tuberculosis

500

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)