Endocrine / Metabolic Archives - Page 3 of 5 - The Emergency Medical Minute

Podcast # 456 Hypoglycemia: Not feeling so sweet

April 12, 2019

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…

Podcast # 428: Severe Hypothyroidism

January 27, 2019

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…

Podcast # 421: Sweet DKA Pearls

January 9, 2019

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…

Podcast # 417: Water Balance

December 15, 2018

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,…

Podcast # 371: EKG changes of Hyperkalemia

August 28, 2018

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.

Podcast # 346: Pediatric DKA

June 27, 2018

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…

Podcast #310: Bicarb in DKA

March 26, 2018

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;…

Podcast #292: Hypercalcemia

January 17, 2018

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…

Podcast #290: The Biochemistry of DKA

January 12, 2018

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…

Podcast #186: IV Contrast

March 21, 2017

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…

Endocrine / Metabolic