The document discusses various endocrine emergencies including diabetic ketoacidosis (DKA), hypoglycemia, and thyroid storm. It provides details on the causes, symptoms, diagnostic criteria and treatment approaches for each condition. DKA results from lack of insulin and needs urgent treatment including rehydration, insulin administration, and electrolyte correction. Hypoglycemia can be caused by too much insulin or too little food intake and requires glucose administration. Thyroid storm is a life-threatening exacerbation of hyperthyroidism that requires treatments to correct the hyperthyroidism and address any precipitating factors.

1. Endocrine Emergencies Professor Ikram S Ismail PhD (Wales) FRCP (Edin) FAMM FACE

7. DKA: Pathophysiology

8. DKA: Pathophysiology

10. DKA - Signs Dehydration Osmotic Diuresis, vomiting Tachycardia Dehydration Hypotension Dehydration, acidosis Warm skin Acidosis (peripheral vasodilatation) Hyperventilation Ketosis, acidosis Coma, drowsiness Hyperosmolality

13. Established DKA >3.0 If concurrent stress and poor compliance - admit >1.5 Retest glucose and ketones in 2-4hrs 0.6 – 1.5 Check clinical status <0.6

14. DKA – Investigations Hyperglycaemia, hyperketonaemia Insulin deficiency Decreased pH, PCO2, bicarbonate Increased ketogenesis Hyponatraemia Hyperglycaemia Variable K Insulin deficiency, acidosis, urine loss Raised WCC Hyperketonaemia Raised haematocrit Dehydration

15. DKA - Deficits Water 5 to 8 liters Sodium 400-700 mmol Chloride 300-500 mmol Potassium 300-1000 mmol Calcium 100 mmol Magnesium 50 mmol Phosphate 50 mmol Bicarbonate 350 to 400 mmol

28. Hypoglycaemia : Symptoms and Signs