Endocrine / Metabolic Archives - The Emergency Medical Minute

Endocrine / Metabolic

Podcast 667: Lactated Ringers for DKA

Contributor:  Aaron Lessen, MD Educational Pearls: Recent study looked at whether lactated ringers might be a better choice for fluid resuscitation in patients with DKA compared to normal saline Normal saline can cause a hyperchloremic metabolic acidosis Time to resolution of acidosis was 4 hours less with lactated ringers compared to normal saline Time on…

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Podcast 559: Metabolic Acidosis

Contributor: Dylan Luyten, MD Educational Pearls Acidosis can be caused by a respiratory, metabolic, or mixed source A respiratory acidosis will have a low serum pH and elevated bicarbonate if it’s chronic, but most importantly end tidal CO2 or arterial CO2 will be high.   With a metabolic acidosis we expect to see a low serum…

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Podcast 548:  Adrenal Crisis

Contributor: Nick Tsipis, MD Educational Pearls: Congenital adrenal hyperplasia (CAH) is a group of enzyme deficiencies in the adrenals leading to a deficiency of hormones normally synthesized by the adrenals (mineralocorticoids, glucocorticoids, androgens) 21-hydroxylase is most commonly the deficient enzyme. 21-hydroxylase is needed to produce aldosterone and cortisol, and those with chronic cortisol deficiencies need…

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Podcast 533:  Hypoglycemia

Contributor: Dylan Luyten, MD Educational Pearls: Insulin related hypoglycemia can vary from a brief transient effect from short-acting forms (i.e. insulin lispro) to prolonged from long acting (i.e. insulin glargine), and will require different treatment and/or observation Of oral glycemic agents, sulfonylureas are a common culprit while metformin is rarely a cause Sulfonylureas also deserve…

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Podcast 530: Anion Gap Acidosis + Metformin Toxicity

Contributor: Don Stader, MD Educational Pearls: The common causes of anion gap metabolic acidosis include (MUDPILES) Metformin, Methanol  Uremia  DKA Paraldehyde  INH/Iron  Lactate Ethylene Glycol  Salicylate  Metformin is a very common drug used to treat type 2 diabetes, however in the right setting, it can cause a profound lactic acidosis. There is a very high…

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Podcast 503: Magical Magnesium 

Contributor: Dylan Luyten, MD Educational Pearls: Those that are hypokalemic are often hypomagnesemic, and should receive magnesium (Mg) supplementation if repleting potassium Mg levels are typically not necessary – if someone is suspect to have hypomagnesemia, just given them Mg Mg increases the AV node refractory period and therefore may be helpful as an adjunct…

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Podcast # 469: Go PO

Author: Dave Rosenberg, MD Educational Pearls: Nothing by mouth (NPO) status routinely used before surgery to reduce the theoretical risk of aspiration However, surgery poses a large physiological stress. Calories and fluid are needed to overcome stresses like these Patients who drank 1/2 strength Gatorade up to 2 hours before surgery did better than those…

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Podcast # 465: As easy and 1, 2, 10 – Capillary Refill and Sepsis

Author: Ryan Circh, MD Educational Pearls: The 2019 ANDROMEDA-SHOCK trial compared using serum lactates to capillary refill assessment in septic shock patients to guide resuscitation Capillary refill time was standardized (this is not straightforward): A glass microscope slide was pressed on the ventral side of the right index finger Pressure was increased until the skin…

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Podcast # 456 Hypoglycemia: Not feeling so sweet

Author: Jared Scott, MD Educational Pearls:   Beta-blockers can mask the effects of hypoglycemia Prolonged/refractory hypoglycemia should raise a suspicion for sulfonylurea (or other oral hypoglycemic) overdose Interventions to reverse hypoglycemia include feeding the patient, IV dextrose, glucagon Octreotide can be used as an antidote with sulfonylurea ingestion References Alsahli M, Gerich JE. Hypoglycemia. Endocrinol…

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Podcast # 428: Severe Hypothyroidism

Author: Gretchen Hinson, MD Educational Pearls: Clinical manifestations of severe hypothyroidism may include: Pale, cool, diaphoretic skin Myxedema is the non-pitting edema seen in hypothyroidism Hypothermia, heart failure, hypotension and shock Shortness of breath Cholestasis, constipation Encephalopathy and coma   Mortality is 30-50% Specific treatment includes thyroid hormone (T3, T4, or both) and glucocorticoids (for…

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