Endocrine / Metabolic Archives - The Emergency Medical Minute

Episode 972: Hepatic Encephalopathy

September 2, 2025

Contributor: Alec Coston, MD Educational Pearls: Hepatic encephalopathy (HE) is defined as a disruption in brain function that results from impaired liver function or portosystemic shunting. Manifests as various neurologic and psychiatric symptoms such as confusion, inattention, and cognitive dysfunction Although ammonia levels have historically been recognized as important criteria for HE, the diagnosis is…

Episode 968: Heavy Metals

August 4, 2025

Contributor: Megan Hurley MD Educational Pearls: Acute toxicity of heavy metals: Gastrointestinal upset is the most common presentation Chronic toxicity of heavy metals: Symptoms depend on the metal ingested Increased risk of cancer Altered mentation Developmental delays (in children) Kidney failure Four heavy metals that are tested for in a general panel and their sources:…

Episode 921: Pediatric Hypoglycemia

September 16, 2024

Contributor: Taylor Lynch, MD Educational Pearls: When it comes to hypoglycemia, the age dictates possible causes Neonate: Hormonal deficiency Congenital Adrenal Hyperplasia (21-hydroxylase deficiency, 11β-hydroxylase deficiency) Primary or Secondary Adrenal Insufficiency leading to cortisol deficiency Hypopituitarism Inborn errors of metabolism Systemic infection (Under 30 days old should trigger a full infectious workup) Toddler Accidental ingestions…

Episode 906: Case Study of Hypernatremia

June 3, 2024

Contributor: Aaron Lessen MD Educational Pearls: The case: A gentleman came in from a nursing home with symptoms concerning for sepsis. He was hypotensive, hypoxic, febrile, and mentally altered. His past medical history included previous strokes which had left him with deficits for which he required a feeding tube. Initial workup included some point of…

Episode 897: Adrenal Crisis

April 1, 2024

Contributor: Ricky Dhaliwal MD Educational Pearls: Primary adrenal insufficiency (most common risk factor for adrenal crises) An autoimmune condition commonly known as Addison’s Disease Defects in the cells of the adrenal glomerulosa and fasciculata result in deficient glucocorticoids and mineralocorticoids Mineralocorticoid deficiency leads to hyponatremia and hypovolemia Lack of aldosterone downregulates Endothelial Sodium Channels (ENaCs)…

Podcast 896: Cancer-Related Emergencies

March 25, 2024

Contributor: Travis Barlock, MD Educational Pearls: Cancer-related emergencies can be sorted into a few buckets: Infection Cancer itself and the treatments (chemotherapy/radiation) can be immunosuppressive. Look out for conditions such as sepsis and neutropenic fever. Obstruction Cancer causes a hypercoagulable state. Look out for blood clots which can cause emergencies such as a pulmonary embolism,…

Episode 894: DKA and HHS

March 11, 2024

Contributor: Ricky Dhaliwal, MD Educational Pearls: What are DKA and HHS? DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both acute hyperglycemic states. DKA More common in type 1 diabetes. Triggered by decreased circulating insulin. The body needs energy but cannot use glucose because it can’t get it into the cells. This leads to…

Podcast 860: Thyrotoxicosis

July 20, 2023

Contributor: Travis Barlock MD Educational Pearls: Clinical picture: A patient comes in with altered mental status, tachycardia, fever, elevated T4, and low TSH. What’s the diagnosis?… Thyrotoxicosis secondary to Graves’ Disease. How do you treat thyrotoxicosis? First, give a beta-blocker such as propranolol. This suppresses the elevated adrenergic activity. Second, give a thionamide such as…

Podcast 791: Hyperglycemic Hyperosmolar State

June 20, 2022

Contributor: Aaron Lessen, MD Educational Pearls: Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality Unlike in DKA,…

The Slow Roller

March 1, 2022

the slow roller Chief Complaint: Lethargy HPI: 56-year-old male who uses a wheelchair at baseline arrives via EMS from home with complaints of lethargy. EMS was originally contacted because occupants of the patient’s home thought his blood glucose level was low. The patient had slowed respirations and was bradycardic upon EMS arrival. His blood glucose…

Endocrine / Metabolic