Endocrine / Metabolic Archives - Page 2 of 3 - The Emergency Medical Minute

Endocrine / Metabolic

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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Podcast # 421: Sweet DKA Pearls

Author: Gretchen Hinson, MD Educational Pearls: Diabetic ketoacidosis patients are subject to electrolyte derangements Potassium should be monitored closely: K < 3.3 = Do not give insulin and replete K first 3.3 < K < 5.3 = give 20-30mEq K for each L of IVF K > 5.3 = delay potassium replacement Adult patients are…

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Podcast # 417: Water Balance

Author: Katie Sprinkle, MD Educational Pearls: Hyponatremia results when patients over hydrate and dilute their sodium with too much free water Symptoms of hyponatremia can mimic symptoms of dehydration (dizziness,  lightheadedness, general malaise) With severe hyponatremia patients can progress to seizure, coma, and death Hypernatremia results from dehydration and is more common References: Bennett BL,…

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Podcast # 371: EKG changes of Hyperkalemia

Author:  Jared Scott, MD Educational Pearls: EKG changes do not necessarily correlate to degree of hyperkalemia Traditional progression through peaked T-waves, flattened p-waves, QRS widening, and then sine-waves before asystole References Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18:721–729.

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Podcast # 346: Pediatric DKA

Author: Chris Holmes, MD Educational Pearls: There is a risk of cerebral edema in pediatrics with DKA if over resuscitated. Recent study comparing normal saline vs. ½ normal saline showed no difference in rates of cerebral edema regardless of rate of infusion. Recommend sticking with a fluid resuscitation protocol you are familiar with (i.e., 2…

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Podcast #310: Bicarb in DKA

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology – acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete, but will have a falsely normal/elevated serum potassium. 3 risk of giving bicarb in DKA – alkalosis will drive potassium intracellularly but can overshoot (hypokalemia) and  increase risk of arrhythmias;…

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Podcast #292: Hypercalcemia

Author: John Winkler, M.D.  Educational Pearls Normally, the parathyroid is the master regulator of serum Ca levels. It secretes PTH, which stimulates calcium uptake from the bone and gut. Causes of hypercalcemia include: parathyroid tumor, lytic bone lesions (multiple myeloma), breast cancer, renal injury, and some lung cancers. Hypercalcemia can lead to poor bone quality…

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Podcast #290: The Biochemistry of DKA

Author: Dave Rosenberg, M.D. Educational Pearls DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time. In DKA, glucose cannot be taken into the cells. This signals the body to create and use acidic ketones for energy. This leads to acidosis. To compensate for increased acid, H…

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Podcast #186: IV Contrast

Run Time: 2 minutes Author: Aaron Lessen M.D. Educational Pearls: Regularly a patient’s creatinine level is an important factor in determining whether a patient will receive IV contrast with a CT because it is thought that contrast can harm the kidneys and could worsen underlying kidney disease. A recent retrospective study compared the rates of…

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Podcast #181: Electrolyte Emergency

Run Time: 5 minutes Author: Peter Bakes, MD Educational Pearls: Calcium is ubiquitous ion in the body necessary for bone, muscle, and nerve function Hypocalcemia is associated with tetany (elicit Chvostek’s sign and Trousseau’s sign) and irritability Hypocalcemia can progress to seizures and prolonged QT which can cause cardiac arrest Hypocalcemia can be caused by…

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