Endocrine Emergencies in the ICU

8/9/2019 Endocrine Emergencies in the ICU

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2/47

OBJECTIVES AKA WHY READ THIS

• Recognize !e c"inic#" $%e&en#ion& o' en(oc%inee)e%gencie& in*o"*ing !e $#nc%e#&+ !,%oi(+#(%en#"+ #n( $i-i#%, g"#n(&

• Le#%n !e #$$%o#c! o "#/o%#o%, e&ingnece&%, 'o% !e (i#gno&i& #n( )#n#ge)en o'!e&e con(iion& in !e ICU

• Un(e%&#n( !e %e#)en 'o% )o& en(oc%inee)e%gencie&


3/47

DIABETIC KETOACIDOSIS

• DKA i& c!#%#ce%ize( /, # &,n(%o)e o'!,$e%g",ce)i#+ 0eone)i#+ #n( #n #nion g#$)e#/o"ic #ci(o&i&+ -&-#"", 1 23.

•

T!e (eg%ee o' #ci(o&i& #n( )#gni-(e o' !einc%e#&e in #nion g#$ #%e (e$en(en on !e %#eo' 0eo#ci( $%o(-cion #n( -%in#%, e4c%eion.

• H,$e%g",ce)i# g",co&-%i# #n( #n o&)oic

(i-%e&i&+ %e&-"ing in e4%#ce""-"#% 5-i( *o"-)e(e$"eion+ 6!ic! c#n /e $%o'o-n( #n( %e&-" in!,$oen&ion


4/47

DKA7 PRESENTATION

• O!e% c#-&e& o' 0eo#ci(o&i&7• A"co!o"

• S#%*#ion

•

DKA i& -&-#"", (i#gno&e( in 0no6n (i#/eic& 6!o$%e&en o !e e)e%genc, %oo) 6i! ei!e%nonco)$"i#nce o% 6i! # conco)i#n &%e&&'-"i""ne&&+ e&$eci#"", in'ecion+ 6!ic! !#& %e&-"e( in$%og%e&&i*e", 6o%&ene( g",ce)ic con%o" #n( !eon&e o' 0eogene&i&.


5/47

DKA PRESENTATION

• M#n, o' !e &,)$o)& o' DKA %e&-" in "#%ge)e#&-%e '%o) #ci(o&i&7 $o",-%i#+ $o",(i$&i#+#c!,c#%(i#+ #n( "e!#%g,.

•

T!e (eg%ee o' #ci(o&i& i& !e $%i)#%, (ee%)in#no' (e$%e&&e( &en&o%i-).

• S,)$o)& &-c! #& n#-&e#+ *o)iing+ #/(o)in#"$#in+ #n( K-&&)#-" %e&$i%#ion& 86i! #

c!#%#ce%i&ic '%-i, /%e#!9 )#, /e $%e&en.


6/47

LAB :INDINGS

• E"e*#ion& in &e%-) g"-co&e #n( !e $%e&ence o'0eone& in &e%-) in -%ine

• L#/o%#o%, #/no%)#"iie& &een # $%e&en#ion in

DKA inc"-(e7 # "o6 &e%-) /ic#%/on#e+ e"e*#e(#nion g#$+ "e-0oc,o&i&+ !,$e%0#"e)i#+ e"e*#e(BUN #n( c%e#inine 8&-gge&ing $%e%en#"#zoe)i#9+ #n( e"e*#e( #),"#&e #n( "i$#&e.

•

Le-0oc,o&i& i& $%o$o%ion#e o !e (eg%ee o'#ci(e)i# #n( c#n con'-&e !e c"inic#" $ic-%e #&%eg#%(& !e $%e&ence o' in'ecion.


7/47

LAB :INDINGS

• H,$e%0#"e)i#+ (-e o e4%#ce""-"#% o&)oic &!i'ing #n(in&-"in (e;cienc,+ i& co))on (e&$ie # (e;ci in o#" /o(,$o#&&i-)+ "#%ge", '%o) -%in#%, "o&&e&.

• Se%-) &o(i-) i& *#%i#/"e in DKA #n( %e5ec& # /#"#nce

/e6een o&)oic (i"-ion in !e &e%-) '%o) !,$e%g",ce)i##n( -%in#%, "o&&e& (-e o o&)oic (i-%e&i&.

• P&e-(o!,$on#%e)i# )#, /e &een in $#ien& 6i!conco)i#n !,$e%"i$i(e)i#

• A%e%i#" /"oo( g#& &!o6& #ci(o&i& 6i! # co)$eno%,

%e&$i%#o%, #"0#"o< &i& #n( !,$oc#$ni#. Aci(e)i# i& -&-#"",$%e&en.

•


8/47

TREATMENT O: DKA

• E4$#n(ing in%#*#&c-"#% *o"-)e #n( i& /e&$e%'o%)e( -i"izing no%)#" "ine &o"-ion.

• Reg-"#% in&-"in i& #()ini&e%e( #& #n IV /o"-& o'

3.=3 o 3.=> U?0g?!+ 'o""o6e( /, # conin-o-& IVin'-&ion # 3.=3 U?0g?!.

• B"oo( g"-co&e &!o-"( /e "o6e%e( /, #/o- >3)g?(L?! #n( #&&e&&e( !o-%",+ 6i! (o6n6#%(

#(@-&)en& )#(e in !e in&-"in (%i$ #& /"oo(g"-co&e "o6e%&.

• Se%-) e"ec%o",e& &!o-"( /e #&&e&&e( 2


9/47

DKA TREATMENT

• Once in%#*#&c-"#% *o"-)e !#& /een %e&o%e( #n(!e $#ien& g"-co&e !#& "o6e%e( o !e 233%#nge+ g"-co&e #n( !,$oonic "ine &o"-ion+ in

!e 'o%) o' (e4%o&e > in 3.> N#C"+ &!o-"( /e#()ini&e%e( -ni" !e DKA !#& %e&o"*e(.

• T!i& &e%*e& o #*oi( !,$og",ce)i# in !e cone4o' no #& ,e %e&o"*e( DKA #n( $e%)i& !econin-e( #(< )ini&%#ion o' IV in&-"in.

• IV in&-"in &!o-"( /e conin-e( -ni" 0eogene&i&!#& %e&o"*e(+ #& %e5ece( in no%)#"iz#ion o' !e#nion g#$.


10/47

WHAT ABOUT BIRCARB

• T!e %o-ine %e#)en o' )e#/o"ic #ci(o&i& 6i!IV &o(i-) /ic#%/on#e !#& /een "#%ge",#/#n(one(+ in %ecogniion !# *igo%o-& *o"-)e

e4$#n&ion #"one i& gene%#"", &-cien.• P#ien& $%e&ening 6i! # $H F.33 c#n /e

con&i(e%e( 'o% !i& i' i&&-e $e%'-&ion i&co)$%o)i&e( o% "i'e


11/47

TREATMENT

• U&-#"", 23 o 3 )E?L i& #((e( o 3.> "ine&o"-ion+ #& !e #((iion o' $o#&&i-) o no%)#""ine &o"-ion 6o-"( %e&-" in !e #()ini&%#ion

o' !,$e%onic 5-i(&.• H,$o$!o&$!#e)i# o'en (e*e"o$& (-%ing

%e#)en o' DKA. I %#%e", %e-i%e&&-$$"e)en#ion+ 6!ic! &!o-"( /e #()ini&e%e(on", i' c"inic#"", &igni;c#n o% &e*e%e 8=.3 )g? (L9.

• C"inic#" %e&o"-ion o' DKA c#n /e )onio%e( *i#*eno-& $H #n( &e%-) #nion g#$. Re$e# #%e%i#"/"oo( g#&e& #%e no %e-i%e(.


12/47

TREATMENT

• A'e% !e no%)#"iz#ion o' !e #nion g#$ !#&occ-%%e(+ !e $#ien &!o-"( %ecei*e&-/c-#neo-& %eg-"#% in&-"in.

•

So$ IV (e4%o&e #n( IV in&-"in i& (i&conin-e( 3)in "#e% #'e% !e $#ien c#n e#

• Ce%e/%#" e(e)# c#n occ-% #& # co)$"ic#ion o'DKA %e#)en in $#ien& -n(e% 23 ,e#%& o' #ge+

•

Ri&0 i& )iig#e( i' %#$i( co%%ecion o' &o(i-) #n(6#e% (e;ci& #%e #*oi(e( #n( g"-co&e i& #((e(o IV 5-i(& once &e%-) g"-co&e "e*e" !#& (%o$$e(o !e "o6 233 %#nge


13/47

HYPEROSMOLAR NONKETOTICDEHYDRATION SYNDROME

• HHS+ #"&o o'en %e'e%%e( o #& !e !,$e%o&)o"#%non0eoic &,n(%o)e+ occ-%& 6!en !,$e%<g",ce)i# occ-%& 6i! "i"e o% no 0eo#ci(o&i&.

•

HHS occ-%& in $#ien& 6!o #%e on", $#%i#"",in&-"in (e;cien+ #n( !ence HHS i& )o%e co))on#)ong o"(e%+ ,$e 2 (i#/eic&.

• T!e &e*e%i, o' !,$e%g",ce)i# i& o'en -ie

&igni;c#n 8=+333 )g? (L9• T!e %e&-"#n !,$e%o&)o"#"i, $%o(-ce&

(e$%e&&ion o' !e CNS+ 6!ic!+ 6!en &e*e%e+ c#nc#-&e co)#.


14/47

HHS TREATMENT

• Se%-) &o(i-) i& o'en "o6 in HHS (-e o o&)oic&!i'ing o' 6#e% '%o) !e in%#ce""-"#% co)$#%)en.

• T!e &e%-) &o(i-) "e*e" i& ;ciio-&", #"e%e( /,

!,$e%g",ce)i#.

• A co))on co%%ecion '#co% o (ee%)ine !e #c-#"&e%-) &o(i-) i&7

• N# co%%ece( = N# )e#&-%e( 3.3=4 8G"-co&e in

)g?(L 9 <

8N#?=3 < =9


15/47

HHS TREATMENT

• T!e %e#)en o' HHS in*o"*e& !e )e )#n<#ge)en $%inci$"e& #& DKA7 *igo%o-& *o"-)e%e$"#ce)en #n( #n IV in&-"in (%i$.

•

T!e #)o-n o' no%)#" "ine &o"-ion %e-i%e( o%e&o%e e4%#ce""-"#% 5-i( en(& o /e g%e#e% inHHS !#n in DKA.

• H#"' no%)#" "ine &o"-ion i& #()ini&e%e( once

!i& !#& /een #c!ie*e(.


16/47

GLUCOSE CONTROL IN THE ICU

• T!e "#%ge No%)og",ce)i# in Inen &i*e C#%e E*#"-#ion #n( S-%*i*#"U&ing G"-co&e A"go%i!) Reg-"#ion 8NICE


17/47

HYPOGLYCEMIA

• H,$og",ce)i# 8/"oo( g"-co&e "e*e" Q3 )g? (L

C#-&e&7

• T!e inge&ion o' o%#" !,$og",ce)ic #gen& o% #n

o*e%(o&e o' "ong


18/47

HYPOGLYCEMIA TREATMENT

• H,$og",ce)i# &!o-"( /e $%o)$", %e#e( 6i! #n#)$-"e o' (e4%o&e+ con#ining >3 )L o' >3 (e4%o&e8#0# = #)$9 &o"-ion+ IV $-&!.

• B"oo( g"-co&e &!o-"( /e )onio%e( !o-%", *i# ;nge%&ic0

)e#&-%e)en&+ en#/"ing # i)e", !e%#$e-ic %e&$on&e.• A &econ( #)$ )#, /e %e-i%e( 6i!in #n !o-% o'

%e#)en. P#ien& &!o-"( #"&o %ecei*e # (e4%o&e (%i$ o'ei!e% > o% =3 &o"-ion+ # # %#e #$$%o$%i#e o !ec"inic#" ci%c-)&#nce& enco-n< e%e(.

• G"-c#gon+ !,(%oco%i&one+ o% oc%eoi(e c#n /e#()ini&e%e( i' !,$og",ce)i# i& $%o'o-n( #n( %e'%#co%,o !e #/o*e )e#&-%e&+ /- i i& &e"(o) %e-i%e(.


19/47

MYEDEMA COMA

• M,4e(e)# co)# i& # &e*e%e 'o%) o' !,$o!,<%oi(i&) c!#%#ce%ize( /, CNS (e$%e&&ion #n(!,$o!e%)i# '%o) # "o6 /#" )e#/o"ic %#e

•

Wo)en #%e )o%e co))on", #ece( !#n )en.• S,)$o)&7 "e!#%g,+ co"( ino"e%#nce+ (e"#,e(

(ee$ en(on %e5e4e&+ !,$o!e%)i#+ /%#(,c#%(i#+#"o$eci#+ (%,+ (o-g!, &0in+ !o#%&ene&&+ #n(!,$e%< g"o&&i#.

• A $e%ic#%(i#" e-&ion )#, /e $%e&en

• L#/o%#o%, #/no%)#"iie& !# #%e (i#g< no&icinc"-(e #n e"e*#e( TSH #n( # "o6 '%ee T


20/47

MYEDEMA COMA SYMPTOMS

• Se*e%#" o!e% "#/o%#o%, #/no%)#"iie& c#n occ-%. T!e&e inc"-(e !,$on#%e)i#+ !,$e%c#$< ni#+ #no%)oc,ic no%)oc!%o)ic #ne)i#+ !,$e%<

"i$i(e)i#+ !,$og",ce)i#+ #n( #n e"e*#ion inc%e#ine $!o&$!o0in#&e.

• H,$on#%e)i# i& (-e o #n i)$#i%)en in '%ee6#e% e4c%eion #n( c#n %e&-" in &eiz-%e #ci*i,.

•

H,$og",ce)i# c#n occ-% '%o) !,$o!,%oi(i&)#"one o% )#, /e (-e o conco)i#n #(%en#"in&-cienc,.


21/47

MYEDEMA COMA

• M,4e(e)# co)# i& o'en !e %e&-" o' $%o"onge(nonco)$"i#nce 6i! !,%oi( &-$$"e< )en#ion in !e '#ce o'#/&en !,%oi( '-ncion+ &-c! #& 'o""o6ing I== #/"#ion.

• D%-g& !# c#n c#-&e -n(e%",ing !,$o!,%oi(i&) inc"-(e

#)io(#%one+ $%o$,"!io-%#ci"+ "i!i-)+ #n( &-"'on#)i(e&.• M,4e(e)# co)# c#n /e $%eci$i#e( /, co"( e4$o&-%e+ !e

conco)i#n #()ini&%#ion o' &e(#i*e (%-g&+ e&$eci#"",o$ioi(&+ o% &%e&& &-c! #& in'ecion #n( ),oc#%(i#" in'#%cion.

• In'ecion )#, /e )#&0e( /, #n in#/i"i, o )o-n #

e)$e%#-%e &$i0e. M,4e(e)# !#& # &igni;c#n #%i/-#/"e)o%#"i, o' #")o& 3+ $#%ic-"#%", #)ong e"(e%", #n(&e$ic $#ien& o% $#ien& 6i! $%o"onge( !,$o!e%)i#+c#%(i#c co)$%o< )i&e+ o% co)#.


22/47

MYEDEMA COMA TREATMENT

• Once c"inic#"", &-&$ece(+ # &e%-) TSH+ '%ee T+ #n(co%i&o" &!o-"( /e (%#6n.

• A co&,n%o$in &i)-"#ion e& &!o-"( #"&o /e$e%'o%)e( 6!en


23/47

EUTHYROID SICK SYNDROME

• P#ien& 6!o #%e c%iic#"", i"" '%e-en", !#*e#/no%)#"iie& in !,%oi( '-ncion e&&+ &-gge&ing !e$o&&i/i"i, o' !,$o!,%oi(i&).

• Bec#-&e o' #n inc%e#&e( con*e%&ion o' T o %e*e%&e T+ !e&e $#ien& (e)on&%#e # "o6 &e%-) T "e*e"+# con(iion c#""e( e-!,%oi( &ic0 &,n(%o)e.

• T "e*e"& )#, #"&o /e "o6+ $#%ic-"#%", in !e &eingo' $%o%#ce( c%iic#" i""ne&&+ #n( !e TSH "e*e" c#n

#"&o *#%,+ /eing ei!e% &"ig!", e"e*#e( o% (ec%e#&e(.• :%ee T "e*e"& #%e no%)#"+ in(ic#ing !e #/&ence o'

c"inic#" !,$o!,%oi(i&). Hence+ no !,%oi(&-$$"e)en#ion i& %e-i%e(.


24/47

THYROID STORM

• T!,%oi( &o%) i& !,$e%!,%oi(i&) in !e $%e&ence o'&igni;c#n c#%(i#c o% CNS )#ni'e&#ion&.

• T!e&e inc"-(e c#%(i#c (,&%!,!)i#&+ &-c! #& ne6on&e #%i#" ;/%i""#ion+ #%i#" 5-e%+ #n(&-$%#*en%ic-"#% #c!,c#%(i#+ o% CNS )#n< i'e&#ion&+&-c! #& %e)o%+ (e"i%i-)+ &-$o%+ o% e*en co)#.

• T!e $#ien )#, /e !,$e%en&i*e #n( #c!,c#%(ic.

• O!e% )#ni'e&#ion& o' !,$e%!,%oi(i&) )#, /e

$%e&en+ &-c! #& e4o$!!#")o&+ !,$e%%e5e4i#+ !e#ino"e%#nce+ #n4ie,+ n#-&e#+ *o)iing+ (i#%%!e#+#/(o)in#" $#in+ #n( !e $%e&ence o' ;ne !#i% o%$%ei/i#" e(e)#.


25/47

CAUSES O: THYROID STORM

• G%#*e& (i&e#&e+ #n #-oi))-ne con(iion+ i& !e)o& co))on c#-&e o' !,$e%!,%oi(i&).

• !,%oi( &o%) c#n /e %igge%e( /, $!,&io"ogic

&%e&& in !e &eing o' -n(e%",ing!,$e%!,%oi(i&)+ 6!ic! )#, !#*e /een -n&-&<$ece( -ni" !# i)e. T!e&e c#n inc"-(e &-%ge%,+$%egn#nc,+ %#-)#+ o% &igni;c#n #c-e i""ne&& o'#n, 0in(.


26/47

WORK UP THYROID STORM

• L#/o%#o%, ;n(ing& in !,$e%!,%oi(i&) #n(!,%oi( &o%) inc"-(e7• e"e*#ion& in T #n( T+ 6i! # "o6 TSH.

•

In #n -nco))on *#%i#n o' !,%oi( &o%) c#""e( T !,%oo4ico&i&• T "e*e"& #%e e"e*#e( /- T "e*e"& %e)#in no%)#"

•

In cen%#" !,$e%!,%oi(i&)+ TSH+ T+ #n( T #%e#"" e"e*#e(.


27/47

TREATMENT THYROID STORM

• T%e#)en o' !,%oi( &o%) i& )-"i'#cee(

• T!,%oi( !o%)one &,n!e&i& i& in!i/ie( /,

#()ini&e%ing ei!e% $%o$,"!io-%#ci"+ 233 )g!+ o% )e!i)#zo"e+ 23 )g


28/47

TREATMENT THYROID STORM

• I)$o%#n",+ io(ine )-& on", /e #()ini&e%e( #'e%!,%oi( !o%)one &,n!e&i& !#& /een /"oc0e(+ ino%(e% o #*oi( e4#ce%/#ing !e $%o/"e) /,en!#nce( !,%oi( !o%)one $%o(-cion.

• A()ini&%#ion o' $%o$,"!io-%#ci" 8(ec%e#&ingcon*e%&ion o' T ino T9+ !,(%oco%i&one+ =33 )g!+ #n( $%o$%#no"o".

• P%o$%#no"o"+ 3 o 3 )g


29/47

OTHER MODALITIES

• P#&&i*e coo"ing i' !,$e%< $,%e4i# i& $%e&en.

• Ace#)ino$!en i& $%e'e%%e(+ #& #ce,""ic,"#e inc%e#&e&'%ee !,%oi( !o%)one in !e &e%-) !%o-g! (i&$"#ce)enon $"#&)# $%oein&.

• T!,%oi(eco), )#, /e %e-i%e( i' # $#ien (e*e"o$& "i'e<!%e#ening #g%#n-"oc,o&i& '%o) $%o$,"!io-%#ci" o%)e!i)#zo"e.

• Io(ine !e%#$, i& (i&conin-e( #n( co%ico&e%oi(& )#, /e#$e%e( once !,$e%$,%e4i#+ CNS+ #n( c#%(i#c

)#ni'e&#ion& !#*e %e&o"*e(.• P#ien& 6i! G%#*e& (i&e#&e &!o-"( -"i)#e", -n(e%go

!,%oi( #/"#ion.• C#n /e #cco)$"i&!e( ei!e% &-%gic#"", o% 6i! I==.


30/47

ADRENAL CRISIS

• P%i)#%, < (-e o in&-cien $%o(-cion o' #(%enoco%ico%o$ic!o%)one+ o% &econ(#%,+ -&-#"", %e&-"#n '%o)-n(e%$%o(-cion o' g"-coco%icoi(& #n( )ine%#"oco%icoi(&.

• C#-&e& o' $%i)#%, #(%en#" in&-cienc, inc"-(e7•

A-oi))-ne• A((i&on& (i&e#&e

• /i"#e%#" #(%en#" !e)o%%!#ge

• #/%-$ 6i!(%#6#" o' e4ogeno-&", #()ini&e%e( co%ico&e%oi(&+

• TB

• &e$ic &!oc0

• )eningococce)i#

• )e#&#ic )#"ign#nc,

• #),"oi(o&i&

• #n( (%-g& &-c! #& eo)i(#e #n( 0eocon#zo"e.


31/47

ADRENAL CRISIS

• C#-&e& o' &econ(#%, #(%en#" in&-cienc, inc"-(e$i-i#%, -)o%& c%#nio$!#%,ngio)# #& #$o&o$e%#i*e co)$"ic#ion $o&$#%-) !,$o$i<-i#%i&) 8S!ee!#n& &,n(%o)e9 in;"%#i*e (i&e#&<

e& &-c! #& !e)oc!%o)#o&i&+ %coi(o&i&+!i&ioc,o&i&+ o% !i&o$"#&)o&i& TB o% 6i!(%#6#" o'e4ogeno-&", #()ini&e%e( co%ico&e%oi(&.

• P#ien& 6i! &econ(#%, #(%en#" in&-cienc, "#c0

!,$e%$ig)en#ion+ (e!,(%#ion+ #n( !,$e%0#"e)i#• H,$oen&ion i& "e&& $%o)inen+ 6!e%e#&

!,$og",ce)i# i& )o%e co))on !#n in $%i)#%,#(%en#" in&-cienc,.


32/47

ADRENAL CRISIS

• A(%en#" c%i&i& occ-%& in $#ien& 6i! #(%en#"in&-cienc, 6!o !#*e !,$oen&ion #n( *o"-)e(e$"eion '%o) !e #/&ence o' )ine%#"oco%icoi(&.

• C"inic#"",+ $#ien& )#, )#ni'e& !,$oen&ion+ n#-&e#+

*o)iing+ '#ig-e+ #no%e4i#+ (e$%e&&ion+ #n( #)eno%%!e##n( )#, "#c0 !,$e%$ig)en#ion #n(?o% *ii"igo.

• A/(o)in#"+ 5#n0+ "o6e% /#c0+ o% c!e& $#in #%e co))onin $#ien& 6i! /i"#e%#" #(%en#" !e)o%%!#ge o%

in'#%cion+ !e )#in %i&0 '#co%& 'o% 6!ic! #%e#nico#g-"#ion #n( $o&< o$e%#i*e &#e.

• L#/o%#o%, #/no%)#"iie& c#n inc"-(e !,$og",ce)i#+

!,$on#%e)i#+ !,$e%0#< "e)i#+ #n( eo&ino$!i"i#.


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ADRENAL CRISIS

• In in(i*i(-#"& 6!o #%e no &%e&&e(+ # o#" co%i&o""e*e" o' 1=> "g?(L i& &-cien o %-"e o- #(%en#"in&-cienc,. A "e*e" Q> "g?(L con&i< -e&#/&o"-e #(%en#" in&-cienc, 6i! =33&$eci;ci, /- "o6 &en&ii*i, 89. A c-


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ADRENAL CRISIS DIAGNOSIS

• T!i%, o% 3 )in #'e% !e #()ini&%#ion o' 2>3 "go' co&,n%o$in+ # 'o%) o' &,n!eic#(%enoco%ico%o$ic !o%)one+ # %i&e in o#"co%i&o" "e*e" Q "g?(L o% #n #/&o"-e "e*e" Q23"g?(L )#, /e in(ic#i*e o' %e"#i*e #(%en#"in&-cienc,.

• De4#)e!#&one+ =3 )g )#, /e #()ini&e%e( #&# &ing"e (o&e 6!i"e # co&,n%o$in &i)-"#ion e&

i& /eing $e%'o%)e( #& !e%#$, 'o% #(%en#"in&-cienc, &o !# !e "#/o%#o%, #n#",&i& i& no#"e%e(+ #& i& !e c#&e 6i! !,(%oco%i&one.


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ADRENAL CRISIS LITERATURE

• In # %ecen %#n(o)ize(+ $"#ce/o


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PHEOCHROMOCYTOMA

• A $!eoc!%o)oc,o)# i& # c#ec!o"#)ine<&ec%eing -)o% o' c!%o)#n ce""& )o&co))on in !e #(%en#" g"#n(&+ i )#, occ-%e"&e6!e%e in !e /o(,.

• S,)$o)&+ 6!ic! #%e (-e o !e %e"e#&e o'c#ec!o"#)ine& &-c! #& e$ine$!%ine+no%e$ine$!%ine+ #n(?o% (o$#)ine+ inc"-(e #c!,<c#%(i#+ $#"$i#ion&+ (i#$!o%e&i&+ !e#(#c!e+ c!e&

$#in+ %e)o%+ #n( 5-&!ing. T!e c"#&&ic %i#( o'e$i&o(ic !e#(#c!e+ &6e#ing+ #n( #c!,c#%(i# i&&e"(o) in e*i(ence.


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PHEOCHROMOCYTOMA

• T!e (i#gno&i&+ once &-&$ece(+ i& /e& con<;%)e( /, o/#ining $"#&)# "e*e"& o' )e#ne$!<%ine #n( no%)e#ne$!%ine o% 2

• S-/&e-en o # c!e)ic#" (i#gno&i&+ i)#ging

&-(ie& &-c! #& CT &c#n o% I=2<)e#io(o/enz,"g-#ni(ine &c#n #%e $e%< 'o%)e( o"oc#"ize !e -)o% #n( (ee%)ine %e&ec#/i"i,.


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PHEOCHROMOCYTOMA

• P#ien& 6i! 0no6n $!eoc!%o)oc,o)# 6!o #%e &c!e(-"e( o-n(e%go &-%ge%, &!o-"( %ecei*e $%eo$e%#i*e )#n#ge)en 6e"" in#(*#nce o' &-%ge%, 6i! #n #


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DIABETES INSIPIDUS 8DI9

• DI i& # con(iion in 6!ic! 6#e% #(&o%$ion /, !eco""ecing -/-"e& o' !e 0i(ne, i& i)$#i%e(+ ei!e%'%o) # "#c0 o' !e #ni(i-%eic !o%)one 8ADH9#%ginine *#&o$%e&&in 8AVP9+ #& in cen%#" DI+ o%(-e o !e "#c0 o' %e&$on&i*ene&& o' !e co""ecing-/-"e&+ #& i& !e c#&e in ne$!%ogenic DI.

• S,)$o)& #%e (%i*en /, !e "o&& o' '%ee 6#e%#n( inc"-(e $o",-%i#+ $o",(i$< &i#+ !,$e%n#%e)i#+

*o"-)e con%#cion+ #n( !,$e%o&)o"#"i,.


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DI DIAGNOSIS

• Di#gno&i& i& )#(e /, )e#&-%ing -%ine &$eci;cg%#*i,+ 6!ic! %e*e#"& (i"-e -%ine.

• P%i)#%, $o",(i$&i# # "o6 $"#&)# &o(i-)

concen%#ion 8Q=F )E?L9 i& &een 6i! # "o6-%ine o&)o"#"i, 8one

• In DI # !ig!


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DI

• ADH i& $%o(-ce( in !e !,$o!#"#)-& #n(%e"e#&e( /, !e #ne%io% $i-i#%, g"#n(. C#-&e& o'cen%#" DI inc"-(e c#-&e& o' $#n!,$o$i-i#%i&)+&-c! #& S!ee!#n& &,n(%o)e+ #no4i#+ %#-)#+#n( -)o%&.

• In #((iion+ in;"%#i*e con(iion& inc"-(ing%coi(o&i& #n( ",)$!o)# #& 6e"" #& in'ecio-&(i&e#&e& &-c! #& ne-%o&,$!i"i& o% -/e%c-"o&i& c#n

%e&-" in cen%#" DI.


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NEPHROGENIC DI

• Ne$!%ogenic DI occ-%& in !e &eing o' #(e-#eAVP #n( i& c#-&e( /, (i&o%(e%& o' !e 0i(ne, !#in*o"*e (#)#ge o !e co""ecing -/-"e&+ 6!e%eAVP 6o-"( o%(in#%i", #c o $%o)oe 6#e%#(&o%$ion.

• Ne$!%ogenic DI c#n /e c#-&e( /, &e*e%#" (%-g&+inc"-(ing "i!i-)+ (e)ec"oc,< c"ine+ #)$!oe%icinB+ #n( #ni%e%o*i%#" (%-g& &-c! #& eno'o*i% #n(

in(in#*i%.

• ADH "e*e"& #%e e"e*#e( in ne$!%ogenic DI /- #%e(i)ini&!e( o% #/&en in cen%#" DI.


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CENTRAL DI

• Cen%#" DI c#n /e c"inic#"", (i&ing-i&!e( '%o) ne$!%ogenic DI/, #()ini&e%ing !e ADH #n#"og (e&)o$%e&&in in con@-ncion6i! 6#e% %e&%icion7 #()ini&%#ion o' = "g (e&)o$%e&&in

&-/c-#neo-&", 6i"" c#-&e !e -%ine o&)o"#"i, o inc%e#&e /,# "e#& >3 i' !e%e i& co)$"ee DI on # cen%#" /#&i&.

• In $#%i#" cen%#" DI+ !e -%ine o&)o"#"i, 6i"" inc%e#&e /, =3o >3. In ne$!%ogenic DI+ !e -%ine o&)o"#"i, 6i"" gene%< #"",no inc%e#&e #'e% AVP #()ini&%#ion. W#e% %e&%icion i&-&e'-" o (ee%)ine i' $%i)#%, $o",(i$&i# i& $%e&en.

• Wi! 6#e% %e&%icion+ $#ien& 6i! $%i)#%, $o",(i$&i# 6i""e4!i/i # %i&e in -%ine o&)o"#"i,+ -&-#"", o #/o*e >33)O&)?0g+ /- 6i"" no %e&$on( o (e&)o$%e&&in &inceen(ogeno-& %e"e#&e i& in#c.


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CENTRAL DI

• T%e#)en o' cen%#" DI en#i"& co%%ecing !e '%ee6#e% (e;ci #& 6e"" #& $%e*enion o' ongoing$o",-%i# !%o-g! !e #()ini&%#ion o'(e&)o$%e&&in = o% 2 "g &-/c-#neo-&", =2!. :%ee6#e% (e;ci i& c#"c-"#e( in !e 'o""o6ing)#nne%7

• 3. 4 $#ien& 6eig! in 0g 4 88$#ien&&o(i-)?=39


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RE:ERENCES

• ACCP C%iic#" C#%e Bo#%( %e*ie6 2=& e(iion

Endocrine Emergencies in the ICU

Documents

Transcript of Endocrine Emergencies in the ICU