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ER Cases

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Elevated lipase
indicates what?

Pancreatitis

High T-waves on EKG


indicates what?

High potassium levels

High TSH points to


(primary/secondary)
hypothyroidism

PRIMARY hypothyroidism

Numbess, tingling
around the mouth,
Chvostek's sign and
Trousseau's sign point
to what endocrine
disorder?

HYPOcalcemia

13.

Most likely cause: Accidental


removal of parathyroid!

What is the most likely


cause if these
symptoms come on
after thyroid surgery?
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15.

On physical exam,
what would you look
for in a patient with
adrenal insufficiency?

Hyperpigmentation of the skin


(too much ACTH)

The respiration rate of


a patient with DKA is
(high/low). Why?

HIGH, because a patient with


DKA has excess H+ (acidic), so
hyperventilation excretes more
CO2 which H+ will naturally
follow, thus compensating for the
acidosis

16.

TEST: If you suspect


the patient has
primary adrenal
insufficiency, what test
would you run to
confirm it?

Cosyntropin stimulation test

TEST: Never let


someone with a low
______ _____ get by
you

BLOOD SUGAR

TRUE or FALSE:
Steroids usually does
not cause adrenal
insufficiency

FALSE!!!! Steroids suppresses


adrenal function!

TRUE or FALSE: You


don't get an ACTH
increase with
secondary adrenal
insufficiency

TRUE!!

What are some DDx


for loss of
consciousness?

Diabetes --> Diabetic ketoacidosis


Urinary tract infection
Adrenal Insufficiency

17.

What are some


treatment options
for treating the
elderly patient
who is
unconscious?

IV fluids (Normal saline)


Steroids (takes a while to work)
Labs

What are the 3 Ps


of diabetes?

Polyuria
Polydipsia
Polyphagia

What are we going


to find that is
positive for a
patient suspected
with diabetic
ketoacidosis?

High blood and urinary glucose


High urinary ketones
Tinting of skin (dehydration)
Dry tongue (dehydration)
Collapsed veins (dehydration)
High specific gravity

What class of
drugs would you
use to control
blood pressure in
a patient with
hyperthyroidism?

Beta blockers!

What is the class


of drugs used to
treat
hyperthyroidism?

Thioamines! (PTU and Methimazole)

What is the
mechanism of
DKA?

Low insulin --> high blood glucose -->


high urinary glucose (producing
symptoms of dehydration)
Low insulin --> lipolysis (remember,
insulin wants to form fat, so a lack of
insulin breaks down fat) --> elevated
free fatty acids --> conversion to
ketones --> ketones have low pKa -->
metabolic acidosis
DKA results when glucose cannot be
used for energy so the body turns to
using fatty acids for energy, and
ketones is a byproduct of elevated fatty
acids

18.

What is the
treatment for
DKA?

IV fluids for rehydration


Insulin to suppress ketone production