Endocrine and Electrolyte Emergencies

Hyperthyroidism is caused by the excess of thyroid hormones T3 and T4. Graves’ disease is the most common cause of hyperthyroidism. Clinical features of hyperthyroidism are mostly due to the increased body’s metabolic rate. Hyperthyroidism is diagnosed by estimation of TSH and free T4 and T3. It is treated by pharmacological and surgical means.

Hypothyroidism is caused by the deficiency of T3 and T4. Hashimoto's disease (autoimmune thyroiditis) is the leading cause of hypothyroidism in non-iodine deficient regions. Clinical features of hypothyroidism are primarily due to the accumulation of matrix substances and a decreased metabolic rate. Hypothyroidism is diagnosed by the estimation of TSH and free T4. It is treated by administration of synthetic T4.

Hyperkalemia is defined by the serum potassium level when it is higher than 5.5mEq/L. It is usually an incidental finding in the general population but affects 10 % of the hospitalized patients. Severe hyperkalemia is rare but catastrophic as it causes respiratory paralysis, generalized muscle paralysis and cardiac arrest. 

Diabetic ketoacidosis is a common problem in type 1 diabetics and can be the presenting feature of newly-diagnosed diabetes. The typical patient with diabetic ketoacidosis is an adolescent or a child who is ill and who is presenting to the emergency department. In this article, you will gain a great overview of the diabetic management at the emergency department.

The hyperosmolar hyperglycemic state is characterized by severe hyperosmolality, hyperglycemia, and dehydration. Patients in a hyperosmolar hyperglycemic state do not have ketoacidosis. Diabetic ketoacidosis, on the other hand, is characterized by hyperglycemia, dehydration, and acidosis due to ketone bodies accumulation in the blood; thus, the condition was also known as hyperosmolar non-ketotic state (HONKS) or non ketotic hyperosmolar states (NKHS)

There are two common hyperglycemic emergencies encountered in diabetic patients; namely, diabetic ketoacidosis and hyperosmolar hyperglycemic state syndrome. Diabetic ketoacidosis is responsible for more than 110,000 hospital admissions per year in the United States. The estimated mortality of diabetic ketoacidosis is 2%. The hyperosmolar hyperglycemic state has a mortality rate of 20%. Because of the hyperglycemic crisis, every future doctor should have the essential information about these emergencies.