- Acid-Base Disorders
- Metabolic Acidosis
- Metabolic Alkalosis
- Respiratory Acidosis
- Respiratory Alkalosis
- Mixed Acid-Base Disorder
- Adrenal Disorders
- Adrenal Crisis
- Adrenal Insufficiency
- Cushing Syndrome
- Electrolyte Disorders
- Hyperkalemia
- Hypokalemia
- Hypermagnesemia
- Hypomagnesemia
- Hypernatremia
- Hyponatremia
- Hypercalcemia
- Hypocalcemia
- Glucose Disorders
- Diabetes Mellitus
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic State (HHS)
- Hypoglycemia
- Nutritional Disorders
- Vitamin Deficiencies
- Wernicke-Korsakoff Syndrome
- Malnutrition
- Parathyroid Disorders
- Hyperparathyroidism
- Hypoparathyroidism
- Pituitary Disorders
- Diabetes Insipidus
- Panhypopituitarism
- Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
- Thyroid Disorders
- Hyperthyroidsim
- Thyroid Storm
- Hypothyroidism
- Myxedema Coma
- Tumors of Endocrine Glands
- Adrenal Tumor (Pheochromocytoma)
- Pituitary Tumor
- Thyroid Tumor
Acid-Base Disorders
Metabolic Acidosis
Rapid Review
Pearls
Keep Learning
Metabolic Alkalosis
Rapid Review
Pearls
Keep Learning
Respiratory Acidosis
Rapid Review
Pearls
Keep Learning
Respiratory Alkalosis
Rapid Review
Pearls
Keep Learning
Mixed Acid-Base Disorder
Rapid Review
Pearls
Keep Learning
Adrenal Disorders
Adrenal Crisis
Rapid Review
Pearls
Keep Learning
Adrenal Insufficiency
Rapid Review
Pearls
Keep Learning
Cushing Syndrome
Rapid Review
Pearls
Keep Learning
Electrolyte Disorders
Hyperkalemia
Rapid Review
Pearls
Keep Learning
Hypokalemia
Rapid Review
Pearls
Keep Learning
Hypermagnesemia
Rapid Review
Pearls
Keep Learning
Hypomagnesemia
Rapid Review
Pearls
Keep Learning
Hypernatremia
Rapid Review
Pearls
Keep Learning
Hyponatremia
Rapid Review
Pearls
Keep Learning
Hypercalcemia
Rapid Review
Pearls
Keep Learning
Hypocalcemia
Rapid Review
Pearls
Keep Learning
Glucose Disorders
Diabetes Mellitus
Rapid Review
Pearls
Keep Learning
Diabetic Ketoacidosis (DKA)
Rapid Review
Pearls
Keep Learning
Hyperosmolar Hyperglycemic State (HHS)
Rapid Review
Pearls
Keep Learning
Hypoglycemia
Rapid Review
Pearls
Keep Learning
Nutritional Disorders
Vitamin Deficiencies
Rapid Review
Pearls
Keep Learning
Wernicke-Korsakoff Syndrome
Rapid Review
Pearls
Keep Learning
Malnutrition
Rapid Review
Pearls
Keep Learning
Parathyroid Disorders
Hyperparathyroidism
Rapid Review
Pearls
Keep Learning
Hypoparathyroidism
Rapid Review
Pearls
Keep Learning
Pituitary Disorders
Diabetes Insipidus
Rapid Review
Pearls
Keep Learning
Panhypopituitarism
Rapid Review
Pearls
Keep Learning
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
Rapid Review
Pearls
Keep Learning
Thyroid Disorders
Hyperthyroidism
Rapid Review
Pearls
Keep Learning
Thyroid Storm
Rapid Review
Pearls
Keep Learning
Hypothyroidism
Rapid Review
Pearls
Keep Learning
Myxedema Coma
Rapid Review
Pearls
Keep Learning
Tumors of Endocrine Glands
Adrenal Tumor (Pheochromocytoma)
Rapid Review
Pearls
Keep Learning
Pituitary Tumor
Rapid Review
Pearls
Keep Learning
Thyroid Tumor
Rapid Review
Pearls
Keep Learning
Addison Disease
Rapid Review
- Background
- Addison disease is an insidious, usually progressive hypofunctioning of the adrenal cortex causing a deficiency in cortisol and aldosterone.
- Signs/Symptoms
- Abdominal pain, N/V, fever, confusion. May present with hyperpigmentation of skin/mucous membranes and hypotension.
- Diagnosis
- Clinical diagnosis; BMP will show hyponatremia, hypoglycemia, and hyperkalemia. Plasma cortisol and aldosterone levels will be low. ACTH (cosyntropin) stimulation test helps confirm diagnosis.
- Treatment
- Hydrocortisone, supportive care.
- Disposition
- New or acute presentations of adrenal insufficiency should be admitted (floor or ICU depending on severity)
- Patients with established chronic insufficiency can be discharged with endocrinology if stable and no significant electrolyte abnormalities.
Pearls
- Acute adrenal insufficency can be a life-threatening presentation. If suspicious for it, do not delay treatment with steroids while awaiting for lab results.
- Hydrocortisone is the steroid of choice given it’s combination of glucocorticoid and mineralcorticoid effects, but may interfere with cosyntropin testing. Dexamethasone is a second line option that will not interfere with this test.
Deep Dive
Adrenal Crisis
Rapid Review
Pearls
Deep Dive
Diabetic Ketoacidosis
Rapid Review
- Background
- Diabetic ketoacidosis is caused by a relative lack of insulin in patients with type 1 diabetes who lack insulin production, typically in the setting of an acute illness or missed insulin dosing.
- Signs/Symptoms
- Abdominal pain, nausea/vomiting, fatigue, altered mental status.
- May be dehydrated, tachycardic, and have a fruity-smelling breath.
- Diagnosis
- Diagnosis requires anion gap metabolic acidosis (pH < 7.3), ketonemia (elevated beta-hydroxybutyrate), and hyperglycemia (glucose > 250 mg/dL)
- Patients on SGLT2-inhibitors may be euglycemic
- Treatment
- IV fluids, insulin infusion, and electrolyte repletion (especially potassium)
- Disposition
- Most patients will require admission (placement depends on acuity). Severe cases must go to ICU.
- Stable patients with resolution of DKA can be discharged with close follow-up with endocrinologist or PCP.
Pearls
- Insulin causes potassium to shift intracellulary, which can cause hypokalemia. Avoid giving insulin unless serum potassium is at least > 3.3 mEq/L
- Cerebral edema is a rare, but deadly complication of DKA, especially in children. Do not be overly aggressive with fluid resuscitation.
Hyperosmolar Coma
Rapid Review
Pearls
Deep Dive
Hypoglycemia
Rapid Review
Pearls
Deep Dive
Hypokalemia
Rapid Review
Pearls
Deep Dive
Hyperkalemia
Rapid Review
Pearls
Deep Dive
Hypomagnesemia
Rapid Review
Pearls
Deep Dive
Hypermagnesemia
Rapid Review
Pearls
Deep Dive
Hyponatremia
Rapid Review
Pearls
Deep Dive
Hypernatremia
Rapid Review
Pearls
Deep Dive
Hypocalcemia
Rapid Review
Pearls
Deep Dive
Hypercalcemia
Rapid Review
Pearls
Deep Dive
Hypothryoidism
Rapid Review
Pearls
Deep Dive
Hyperthyroidism
Rapid Review
- Background
- Hyperthyroidism refers to an increase in the production and release of the thyroid hormone thyroxine. Most commonly caused by Grave’s disease
- Signs/Symptoms
- Palpitations, sweating, heat intolerance, and high blood pressure.
- Goiter, exophthalmos, pretibial edema
- Diagnosis
- Low TSH, Elevated T4 and T3
- Treatment
- No treatment in ED required if symptoms are mild
- If suspect thyroid storm, treat with “ABCWI” (antithyroid durg, beta-blocker, corticosteroids, wait 1 hour, iodine)
- Disposition
- Asymptomatic or mild cases can be safely discharged with PCP follow up and endocrinology referral.
- Admit if signs/symptoms of thyroid storm.
Pearls
- Both methimazole and propylthiouracil are equally effective for hyperthyroidism, though methimazole is not recommended for first trimester pregnancy.
- Certain medications, such as amiodarone and lithium, can precipitate hyperthyroidism as well.
Hypoparathyroidism
Rapid Review
Pearls
Deep Dive
Myxedema Coma
Rapid Review
Pearls
Deep Dive
Thyroid Storm
Rapid Review
- Background
- Thyroid storm is caused by an acute increase in the production and release of the thyroid hormone thyroxine
- Typically precipitated by acute event (surgery,infection, trauma)
- Signs/symptoms
- Confusion, tachycardia, sweating, and high blood pressure.
- Goiter, tremors, lid lag
- Diagnosis
- Decreased TSH, Elevated T3/T4
- Treatment
- Treat with “ABCWI” (antithyroid drug, beta-blocker, corticosteroids, wait 1 hour, iodine)
- Disposition
- Admission with continuous cardiac monitoring. Most cases of thyroid storm will require ICU care.
Pearls
- Remember to block hormone synthesis with methimazole or PTU prior to giving iodine. This will prevent the Jod-Basedow effect (worsening hyperthyroidism following iodine administration)
- Thyroid storm carries a high mortality (as high a 80-100% without treatment). If suspicious for it, do not delay treatment for confirmatory lab testing.
Deep Dive
