Endocrine emergencies
SAQ THYROID STORM - JB
A 42-year-old man is brought to your ED by ambulance with acute confusion. His wife states that he is previously well & on no medications, but his health has been deteriorating for three months, with tiredness & 10kg weight loss despite an enormous appetite. On the bright side, he has become completely impervious to the cold & the extra money they’ve spent on groceries has been saved on heating bills. Observations are:
A intact
B RR 40, sats 100%, chest clear
C HR 140, BP 180/100, CR 2 sec
D E4(staring & bulging), V4 (agitated & aggressive), M5 (localising to pain), no focal neurology
E Temp 38.5, BSL 10, vomiting, no rash or other signs
a. What is your provisional and differential diagnosis for this man’s clinical picture? (3 marks)
Provisional diagnosis:
______________________________________________________________
Differential diagnosis:
____________________________________________________________________________________________________________________________
JB answer: I’d say they need at least:
• Most likely thyroid storm
• But also other causes of confusion & high temperature e.g.
o Infection (meningoencephalitis, sepsis of any source)
o Too much drug: e.g. salicylates, TCAs, anticholinergics, amphetamine/cocaine,
o Too little drug: e.g. withdrawal of etoh/benzos, heat stroke, phaeochromocytoma)
b. What conditions may precipitate this clinical picture? (2 marks)
____________________________________________________________________________________________________________________________
JB answer: I’d say they need to recognise that nasties need to be ruled out, and at least 1 of the other preciptants:
• Nasty precipitants eg acute MI, sepsis, trauma, IV contrast
• UnderDx/Rx TTX esp Graves
• Also XS thyroxine or too little antithyorid Rx
c. How will you treat him in the ED? (5 marks)
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
JB answer: I’d suggest they cover everything in bold (not exact doses or details)
• Address ABC/ good supportive care, esp:
o O2 & IV fluids, because high risk of dehydration & cardiovascular collapse
o Sedation eg benzodiazepine
• Get help: from clever endocrinologists, and needs ICU
• Investigations:
o Endocrine blood tests esp TFT
o Seek and treat nasty DDx and nasty precipitants e.g. sepsis, ingestion, MI
d. Specific ED Rx of thyroid storm:
a. IV B-blocker
b. Hydrocortisone 100mg IV
c. Carbimazole load PO/NGT (exact dose I’d look up) then after 4h add Lugols iodine drops)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- endocrine ed
- norepinephrine function in endocrine system
- icd 10 endocrine screening
- unc endocrine surgery
- endocrine society osteoporosis guideline
- capitulo 8 emergencies medical
- endocrine society osteoporosis in men
- medical emergencies with low rbc count
- icd 10 screening endocrine disorder
- connection between endocrine and osteoporosis
- transgender guidelines endocrine society
- american endocrine society