Endocrine and Metabolic Emergencies Flashcards

A 12-year-old presents with polyuria, polydipsia, weight loss, and fruity breath. Blood glucose is 530 mg/dL, pH 7.16, and bicarbonate 9 mEq/L. After establishing IV access, what is the priority first intervention?

Answer: Begin IV fluid resuscitation with isotonic saline

In pediatric DKA, isotonic fluid resuscitation must precede insulin therapy. Administering insulin before adequate hydration risks worsening hypokalemia and hemodynamic instability. Sodium bicarbonate is not recommended in pediatric DKA due to risks of paradoxical CNS acidosis and cerebral edema. Insulin infusion begins only after fluids are running.

A 3-week-old infant presents with prolonged jaundice, poor feeding, hypotonia, and a bulging anterior fontanelle. TSH is elevated at >150 mIU/L and free T4 is undetectable. What is the diagnosis?

Answer: Congenital hypothyroidism

Congenital hypothyroidism presents with prolonged jaundice, large fontanelles, poor feeding, hypotonia, and constipation. An extremely elevated TSH with undetectable T4 confirms the diagnosis. Early levothyroxine treatment is critical to prevent irreversible intellectual disability. This condition is targeted by newborn screening (heel-stick), but some infants present clinically before results return.

A 6-year-old with type 1 diabetes is found unresponsive with a blood glucose of 24 mg/dL. IV access cannot be established. What is the most appropriate intervention?

Answer: Administer glucagon intramuscularly or intranasally

For severe hypoglycemia with altered consciousness when IV access is unavailable, glucagon (IM or intranasal) is the priority intervention. It stimulates hepatic glycogenolysis to raise blood glucose rapidly. Oral glucose gel is contraindicated in an unresponsive child due to aspiration risk. IO dextrose is a valid alternative but requires more setup time than glucagon IM/IN.

A 14-year-old with known Addison's disease presents with severe weakness, hypotension unresponsive to IV fluid boluses, vomiting, and sodium of 126 mEq/L. She reports running out of her medications one week ago. What is the priority treatment?

Answer: Administer IV hydrocortisone immediately

Acute adrenal crisis (Addisonian crisis) is life-threatening adrenocortical failure presenting with fluid-refractory hypotension, hyponatremia, and hyperkalemia. IV hydrocortisone (stress-dose steroids) is the definitive treatment and must not be delayed. Vasopressors are adjunctive but will not reverse the crisis without steroid replacement. This patient's missed medications precipitated the crisis.

A 7-year-old with a history of craniopharyngioma resection presents with urine output of 9 mL/kg/hr, extreme thirst, urine specific gravity of 1.001, and serum sodium of 160 mEq/L. What is the most likely diagnosis?

Answer: Diabetes insipidus

Diabetes insipidus (DI) results from deficiency of antidiuretic hormone (ADH), commonly occurring after cranial surgery or trauma. It presents with massive polyuria of very dilute urine (specific gravity ≤1.005), polydipsia, and hypernatremia. It differs from DM in that blood glucose is normal and there is no glycosuria. Treatment is desmopressin (DDAVP).

A 10-year-old presents with palpitations, heat intolerance, weight loss despite increased appetite, exophthalmos, and a visible neck mass. For which acute complication should the emergency nurse be alert?

Answer: Thyroid storm (thyrotoxic crisis)

This presentation is classic for Graves' disease (hyperthyroidism). Thyroid storm is a life-threatening decompensation characterized by hyperthermia (>40°C), severe tachycardia, hypertension, vomiting, and altered mental status — often triggered by illness or missed doses. Treatment requires beta-blockers, thionamides (PTU/methimazole), iodine solution, and corticosteroids given in sequence.