Endocrine Emergencies

• Endocrine emergencies stem from hormone production or regulation dysfunctions.
• These dysfunctions can cause life-threatening metabolic disturbances.
• Requires quick identification and action in prehospital care.

Common Endocrine Emergencies:

• Diabetic emergencies are a key group.
• Thyroid disorders are another class of endocrine emergencies.
• Additionally, electrolyte imbalances related to endocrine dysfunction

Diabetic Emergencies

• Hypoglycemia is a condition of low blood sugar.
• Hyperglycemia is a condition of high blood sugar.
• Diabetic Ketoacidosis (DKA) is a complication.
• Hyperosmolar Hyperglycemic State (HHS) is another complication.

Adrenal Insufficiency

• Adrenal insufficiency, also known as Addisonian Crisis is a consideration.

Thyroid Disorders

• Thyroid Storm is a state of severe hyperthyroidism.
• Myxedema Coma is a state of severe hypothyroidism.

Electrolyte Imbalances

• Hyperkalemia in adrenal insufficiency is an electrolyte imbalance.
• Hyponatremia in SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) is another electrolyte imbalance.

Pathophysiology and Prehospital Considerations: Diabetic Emergencies

• Diabetes mellitus occurs due to impaired insulin production (Type 1) or insulin resistance (Type 2).

Hypoglycemia

• Blood glucose is less than 70 mg/dL when symptomatic.
• Causes include insulin overdose, skipped meals, excessive exercise, and alcohol.
• Symptoms include altered mental status (AMS), diaphoresis, tachycardia, tremors, and seizures.
• Conscious patients should receive 15-30g of oral glucose.
• Unconscious patients receive Dextrose 50% (D50) 25g IV push (or D10 in pediatric patients) or Glucagon 1mg IM

Hyperglycemia

• Blood glucose greater than 250 mg/dL when symptomatic.

Diabetic Ketoacidosis (DKA)

• More common in Type 1 Diabetes
• Fat metabolism leads to ketone production, causing metabolic acidosis.
• Symptoms include Kussmaul respirations, fruity breath, AMS, and dehydration.
• Treatment includes fluids (if allowed) and transport.

Hyperosmolar Hyperglycemic State (HHS)

• More common in Type 2 Diabetes
• Characterized by severe hyperglycemia without ketones
• Symptoms include profound dehydration, AMS, and blood glucose greater than 600 mg/dL.
• Management includes fluids (if permitted) and supportive care.

Adrenal Insufficiency (Addisonian Crisis)

• Caused by insufficient cortisol production
• Characterized by severe hypotension, nausea, vomiting, hyperkalemia, and hypoglycemia.
• Manage hypotension with IV fluids.
• Consider corticosteroid administration.

Thyroid Disorders: Thyroid Storm (Severe Hyperthyroidism)

• Causes include untreated hyperthyroidism, infection, and stress.
• Symptoms include hyperthermia, tachycardia, AMS, hypertension then hypotension.
• Provide supportive care, cooling measures, and transport.

Myxedema Coma (Severe Hypothyroidism)

• Occurs due to infection, cold exposure, or trauma in hypothyroid patients.
• Symptoms include hypothermia, bradycardia, hypotension, and respiratory depression.
• Provide passive rewarming, airway management, and IV fluids.

Pharmacology of Endocrine Emergency Medications:

• Dextrose 50% (D50) is indicated for hypoglycemia, administered 25g IV push, and increases blood glucose.
• Glucagon is indicated for hypoglycemia without IV access, administered 1 mg IM, and converts glycogen to glucose.
• Hydrocortisone (Solu-Cortef) is indicated for adrenal crisis, administered 100 mg IV, and replaces cortisol.
• Insulin is for hyperglycemia/DKA, varies in dosage, administered IV, and lowers blood glucose.
• Levothyroxine is for myxedema coma, administered 200-500 mcg IV, and replaces thyroid hormone.

Important Considerations

• Assess Altered Mental Status (AMS) and blood glucose early in endocrine emergencies.
• Recognize Kussmaul respirations in DKA as a compensatory mechanism for acidosis.
• If unsure whether a patient is hypoglycemic or hyperglycemic, administer glucose.
• Suspect adrenal crisis in refractory hypotension cases.
• Apply Passive rewarming for myxedema coma patients while avoiding aggressive rewarming.