Metabolic Emergencies

Thyroid

100

This condition presents with bradycardia, hypothermia, and altered mental status in a patient with untreated hypothyroidism.

Myxedema coma

200

This is the most common cause of primary hypothyroidism.

Hashimoto's thyroiditis

300

This life-threatening condition presents with fever, tachycardia, agitation, and possible atrial fibrillation in a hyperthyroid patient.

Thyroid storm

400

A lab pattern of high TSH and low T4 indicates this type of hypothyroidism.

Primary hypothyroidism

500

This medication both controls heart rate AND decreases peripheral T4 → T3 conversion in thyroid storm.

Propranolol

Endocrine

100

This hormone is deficient in all forms of adrenal insufficiency.

Cortisol

200

This electrolyte abnormality combination is classic in primary adrenal insufficiency.

Hyponatremia and hyperkalemia

300

This is the first-line treatment for suspected adrenal crisis in the ED.

IV Hydrocortisone

400

This diagnostic test helps differentiate primary vs secondary adrenal insufficiency.

ACTH stimulation test

500

This condition presents with refractory hypotension despite fluids and vasopressors, often triggered by infection or steroid withdrawal.

Adrenal crisis

Sodium

100

A sodium level below this value defines hyponatremia.

<135–138 mEq/L

200

Seizures and coma in hyponatremia are most likely when sodium is below this level.

<120 mEq/L

300

This is the initial treatment for severe symptomatic hyponatremia.

3% hypertonic saline

400

Overcorrection of hyponatremia can lead to this neurologic condition.

Osmotic demyelination syndrome

500

This condition causes normovolemic hyponatremia due to excess ADH.

SIADH

Acid-Base

100

This equation is used to calculate the anion gap.

Na - (Cl + HCO₃)

200

This acid-base disorder is caused by vomiting or diuretic use.

Metabolic alkalosis

300

This condition causes respiratory acidosis due to hypoventilation.

COPD or CNS depression (e.g., sedation)

400

Most common cause of high anion gap metabolic acidosis in critically ill patients.

Lactic acidosis

500

This formula is used to determine if respiratory compensation is appropriate in metabolic acidosis.

Winter's formula

- PaCO2 = (1.5 x HCO3) + 8 ± 2)

Diabetes

100

A blood glucose less than this defines hypoglycemia.

<70 mg/dL

200

Hyperglycemia, no ketoacidosis, and severe dehydration.

HHS (Hyperosmolar Hyperglycemic State)

300

This lab triad defines DKA

Glucose >250, anion gap >12, bicarbonate <15 (with acidosis)

400

This breathing pattern helps compensate for metabolic acidosis in DKA.

Kussmaul respirations

500

Before starting insulin in DKA, you must evaluate and correct this electrolyte

Potassium