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Endocrinal emergencies

Endocrinal emergencies. Dr. Miada Mahmoud Rady. Hyperosmolar Non ketotic coma. Also known as hyperglycemic , hyperosmolar ,Non ketotic coma ( HHNC). Occurs in neglected , uncontrolled diabetes esp. in elderly. Occurs primarily in type 2 diabetes .

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Endocrinal emergencies

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  1. Endocrinal emergencies Dr. Miada Mahmoud Rady

  2. Hyperosmolar Non ketotic coma • Also known as hyperglycemic , hyperosmolar ,Non ketotic coma ( HHNC). • Occurs in neglected , uncontrolled diabetes esp. in elderly. • Occurs primarily in type 2 diabetes . • Predisposing factor : stressful condition which impairs fluid intake e.g. infection , operation , stroke , MI .

  3. Pathogenesis : • Stressful conditions → secretion of hormones that counteract effect the of insulin→ hyperglycemia. • Impaired ability to drink along with hyperglycemia causes hyperosmolarity. • Characterized by : hyperglycemia , hyperosmolarity and no significant ketosis.

  4. Clinical presentation : • Symptoms of uncontrolled D.M • Sever dehydration. • Neurologic changes may be found, including: i. Drowsiness. ii. Delirium and coma iii. Focal or generalized seizures iv. Visual and sensory disturbances v. Hemiparesis Neurological symptoms occurs more with HONK

  5. Stroke and MI can cause and result from HONK • Laboratory : • Hyperglycemia > 600 mg /dl. • Hyperosmolarity ( ↑Na conc.). • No ketosis. • Complication : • Increased blood viscosity which increase liability to cerebrovascular accident and myocardial infarction.

  6. Management : • Airway management is the top priority. • Endotracheal intubation may be indicated for comatose patients. • Cervical spine immobilization should be used for all unresponsive patients found lying down. • Large-bore IV access should be gained as soon as possible.

  7. Obtain a blood glucose level as soon as possible. • A bolus of 500 mL 0.9% NS is appropriate for nearly all adults who are clinically dehydrated. • In patients with a history of congestive heart failure and/or renal insufficiency, a 250-mL bolus may be more appropriate. • Administer 12.5 to 25 g of D50 if the glucose level is less than 60 to 80 mg/dL (depending on local protocols).

  8. 4 s Adrenal gland • located above kidney ( suprarenal gland ) . • Consists of two parts : • Hormones secreted and their function : • cortisol → sugar→ increase BMR using fat and protein for energy . • Aldestorone → salt → Na and water reabsorption (↑ Na ) , K excretion ( ↓ K ).

  9. Androgens→ sex → sex hormones . • Adrenaline and noradrenaline → stress→ stimulates sympathetic nervous system . • Cortisol primary role is to assist with the response to stress, but it also: a. Helps to maintain blood pressure and cardiovascular function b. Regulates the metabolism of carbohydrates, proteins, and fats c. Modulates glucose levels d. Slows the inflammatory response

  10. Addison disease • Primary suprarenal failure • Etiology :decreased function of the adrenal cortex with decreased production of cortisol and aldestorone . • Pathophysiology : occurs when 90% of both glands are destroyed or atrophied . • Clinical presentation : • develops over several months • usually well tolerated • May present with Addison crises ( uncommon)

  11. clinical picture of Addison disease

  12. Management : • Address ABCS . • Aggressive fluid therapy. • Hydrocortisone is indicated in the acute management of a crisis.

  13. Secondary adrenal insufficiency • Pathophysiology : • lack of ACTH secretion from the pituitary gland • sudden withdrawal of corticosteroids in patient on chronic steroid therapy. • Presentation : • May appear suddenly (addisonian crisis) • Chief manifestation is shock • Symptoms may also include: • Confusion • Low blood pressure • Severe pain and/or vomiting

  14. Management : • Address ABCS . • Aggressive fluid therapy. • Hydrocortisone is indicated in the acute management of a crisis.

  15. Cushing syndrome • Pathophysiology : Caused by: • Excess cortisol production by the adrenal glands : • Example: Tumors of the pituitary or adrenal cortex. • Excessive and prolonged use of cortisol or other corticosteroid hormones : • Example: treatment of asthma .

  16. characteristic changes: • Metabolismof carbohydrate, protein, and fat is disturbed. (a) Blood glucose level rises. • Protein synthesis is impaired. (a) Body proteins are broken down. • Leads to loss of muscle fibers and muscle weakness. • Bones become weaker and more susceptible to fracture

  17. signs and symptoms • Weakness and fatigue • Depression and mood swings • Increased thirst and urination • High blood glucose level • Weight gain (a) Abdomen (b) Face (“moon face”) (c) Neck (d) Upper back (“buffalo hump”)

  18. Thinning of the skin (a) Easy bruising (b) Pink or purple stretch marks (striae) • Increased acne, facial hair growth, and scalp hair loss in women, and cessation of menstrual periods • Darkening of skin of the neck • Obesity and poor growth in height in children

  19. Management • Assess and manage ABCs. • Prehospital treatment is generally supportive. • Obtain blood glucose level, and administer D50 if indicated.

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