- Addison’s Disease
- Diabetic Ketoacidosis
- Thyroid Storm
- Addison disease is an insidious, usually progressive hypofunctioning of the adrenal cortex causing a deficiency in cortisol and aldosterone.
- Abdominal pain, N/V, fever, confusion. May present with hyperpigmentation of skin/mucous membranes and hypotension.
- Clinical diagnosis; BMP will show hyponatremia, hypoglycemia, and hyperkalemia. Plasma cortisol and aldosterone levels will be low. ACTH (cosyntropin) stimulation test helps confirm diagnosis.
- Hydrocortisone, supportive care.
*Deep Dive: Adrenal Crisis in the ED (emDOCs)
- 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.
- Abdominal pain, nausea/vomiting, fatigue, altered mental status.
- May be dehydrated, tachycardic, and have a fruity-smelling breath.
- 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
- IV fluids, insulin infusion, and electrolyte repletion (especially potassium)
*Deep Dive: DKA recognition and management (EM Cases)
- Hyperthyroidism refers to an increase in the production and release of the thyroid hormone thyroxine. Most commonly caused by Grave’s disease
- Palpitations, sweating, heat intolerance, and high blood pressure.
- Goiter, exophthalmos, pretibial edema
- Low TSH, Elevated T4 and T3
- 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)
*Deep Dive: Hyperthyroidism ED presentations (emDOCs)
- 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)
- Confusion, tachycardia, sweating, and high blood pressure.
- Goiter, tremors, lid lag
- Decreased TSH, Elevated T3/T4
- Treat with “ABCWI” (antithyroid drug, beta-blocker, corticosteroids, wait 1 hour, iodine)
*Deep Dive: Thyroid Storm Management (emDOCs)