Endocrine Emergencies Flashcards

A patient with type 1 diabetes presents with diaphoresis, tachycardia, and anxiety. Blood glucose is 45 mg/dL. After giving 25 g of D50W IV, glucose rises to 120 mg/dL. What should be done next?

Answer: Provide a complex carbohydrate snack and monitor for recurrence

After correcting acute hypoglycemia with D50W, a complex carbohydrate meal or snack is given to prevent rebound hypoglycemia, and the patient should be monitored because the original insulin or medication effect may outlast the glucose bolus.

Which finding on an arterial blood gas (ABG) is most consistent with diabetic ketoacidosis (DKA)?

Answer: pH 7.22, PaCO2 20 mmHg, HCO3 8 mEq/L

DKA produces an anion-gap metabolic acidosis with low pH, low bicarbonate, and compensatory respiratory alkalosis (low PaCO2 from Kussmaul respirations), making option B the characteristic ABG pattern.

A patient on long-term lithium therapy presents with hypothermia, altered mental status, macroglossia, periorbital edema, and bradycardia. What treatment should be initiated?

Answer: IV thyroid hormone (T4 or T3) replacement and supportive care

Myxedema coma requires IV thyroid hormone replacement (T4 with or without T3) along with supportive care including passive rewarming, airway management, and corticosteroids to address possible concurrent adrenal insufficiency.

Which of the following is the most appropriate initial antihypertensive agent for a hypertensive emergency caused by pheochromocytoma?

Answer: IV phentolamine or IV nicardipine (alpha-blockade first)

In pheochromocytoma, alpha-blockade must precede beta-blockade because giving a beta-blocker first (without alpha-blockade) removes compensatory vasodilation and can cause paradoxical severe hypertension from unopposed alpha-adrenergic stimulation.

Cushing's syndrome results from chronic excess of which hormone?

Answer: Cortisol (glucocorticoid excess)

Cushing's syndrome is caused by chronic excess cortisol, whether from endogenous overproduction (e.g., adrenal tumor, pituitary adenoma) or prolonged exogenous corticosteroid use, leading to central obesity, hypertension, hyperglycemia, and skin changes.

An elderly patient with known type 2 diabetes is found unresponsive with a blood glucose of 950 mg/dL, serum osmolality of 365 mOsm/kg, and no significant ketonuria. What is the priority action?

Answer: IV fluid resuscitation with 0.9% normal saline

HHS requires aggressive IV fluid resuscitation as the first intervention to correct severe hyperosmolality and dehydration before initiating insulin, which can cause dangerous osmotic shifts if given prematurely.

Which of the following patients is at HIGHEST risk for developing hyperosmolar hyperglycemic state (HHS) rather than DKA?

Answer: A 70-year-old with poorly controlled type 2 diabetes and a respiratory infection

HHS predominantly affects older adults with type 2 diabetes, especially during physiologic stress (e.g., infection) that impairs fluid intake and causes profound dehydration, while their residual insulin prevents ketogenesis.