critical endo

DKA (Diabetic Ketoacidosis) and HHS (Hyperglycemic Hyperosmolar State)

  • Pathophysiology:

    • DKA: Insulin deficiency → increased counter-regulatory hormones → metabolic acidosis → hyperglycemia.

    • HHS: Insulin resistance → osmotic diuresis → dehydration.

  • Risk Factors:

    • Stress (injury, illness, surgery), new-onset diabetes, noncompliance with insulin.

  • Health Impact:

    • DKA: acidosis, dehydration, arrhythmias, renal perfusion issues.

    • HHS: profound dehydration, neurological manifestations, clot risks.

  • Clinical Presentation:

    • Fatigue, nausea, abdominal pain, fruity breath (DKA), hyperventilation, hypotension.

  • Diagnostic Studies:

    • DKA: Blood glucose > 250 mg/dL, metabolic acidosis (pH < 7.3).

    • HHS: Blood glucose > 600 mg/dL, serum osmolality > 320 mOsm/kg.

  • Treatment Goals:

    • Restore circulatory volume, monitor electrolytes, manage hyperglycemia, and correct imbalances.

Diabetes Insipidus

  • Pathophysiology:

    • Decreased ADH → increased urine output and extreme thirst.

    • Two types: Central DI (ADH deficiency) and Nephrogenic DI (resistance to ADH).

  • Risk Factors:

    • Central DI: neurosurgery, head trauma, autoimmune conditions.

    • Nephrogenic DI: renal disease, gene mutations.

  • Health Impact:

    • Severe dehydration, electrolyte imbalance, higher mortality in complex cases.

  • Clinical Presentation:

    • Polyuria, polydipsia, nocturia, hypernatremia.

  • Diagnostic Studies:

    • MRI, water deprivation test, serum and urine osmolality.

  • Treatment Goals:

    • Restore fluid balance, normalize ADH levels with desmopressin, manage underlying conditions.

SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)

  • Pathophysiology:

    • Excess ADH → impaired water excretion → hyponatremia.

  • Risk Factors:

    • Malignancies (e.g., small cell lung cancer), CNS disorders, medications (e.g., carbamazepine).

  • Health Impact:

    • Risk of seizures, confusion, and other neurological complications.

  • Clinical Presentation:

    • Nausea, fatigue, mental status changes, decreased urine output.

  • Diagnostic Studies:

    • Serum and urine osmolality, renal function tests, ADH levels.

  • Treatment Goals:

    • Treat underlying cause, manage fluid restrictions, administer hypertonic fluids if necessary.

Addisonian Crisis

  • Pathophysiology:

    • Acute cortisol and aldosterone deficiency → vascular collapse and sodium/water retention issues.

  • Risk Factors:

    • Addison’s disease, abrupt steroid withdrawal, acute adrenal injury.

  • Health Impact:

    • Severe hypotension, altered mental status, acute renal injury risks.

  • Lab Testing:

    • Serum electrolytes (hyponatremia, hyperkalemia), low serum cortisol.

  • Treatment Goals:

    • IV steroid replacement, fluid resuscitation, manage electrolytes.

Myxedema Crisis

  • Pathophysiology:

    • Decompensated hypothyroidism → reduced metabolic function, tissue edema.

  • Risk Factors:

    • Poorly managed hypothyroidism, infection, prolonged cold exposure.

  • Clinical Presentation:

    • Altered mental status, hypothermia, non-pitting edema.

  • Lab Testing:

    • High TSH, low T3/T4, hyponatremia.

  • Treatment Goals:

    • IV thyroxine administration, glucocorticoids, manage fluids cautiously.