Endocrinology in ED It’s not just diabetes, but it’s mostly diabetes

Glands we care about Pancreas – DKA/HHS Adrenal glands – Cushing’s, Addison’s Thyroid – Hyper/hypo Parathyroid – Not really

DKA – on an ABG High anion gap metabolic acidosis Incomplete respiratory compensation Hi glucose – but not always Low sodium – pseudohyponatraemia May have high potassium but watch pH total K likely low

HHS Less acidotic Glucose more elevated Ketones less elevated Osmolality higher Sicker patient – Different trigger – Different patient

Cushings

Adrenal insufficiency Abdo pain, vomiting Hypotension – not responsive to pressors or fluid Hyponatraemia Hyperkalaemia +/-hypoglycaemia Look for exogenous steroids, other endocrine problems and stress stimulus as trigger If known Addison’s give 3x daily dose for three days or longer depending on trigger

Hyperthyroidism Causes: Graves, toxic goitre, thyroiditis, drugs Symptoms: Weight loss, heat intolerance, palpitations, tremor, axiety, fatigue May be absent in older patients AF common Definitive Dx high free T4 and undetectable TSH

Thyroid storm May have fever, tachycardia with AF, ALOC Occurs in exacerbation poorly controlled thyroid disease Treat as emergency Beta blockers, antipyretics for symptoms PTU or methimazole (talk to endocrinology) Consider intubation, active cooling if very altered.