Download TREATMENT OF ENDOCRINE EMERGENCIES

TREATMENT OF ENDOCRINE
EMERGENCIES
Sakharova Inna. Ye., M.D, Ph.D
• Endocrine emergencies represent a group
of potentially life-threatening conditions
that are frequently overlooked, resulting
in delays in both diagnosis and treatment,
factors that further contribute to their
already high associated mortality rates.
The treatment of thyroid storm
• Propylthiouracil (PTU) blocks peripheral
•
•
conversion of T4 to T3 and can be given as
a 600- to 1000-mg loading dose, followed
by 1200 mg/day divided into doses given
every 4 to 6 hours.
Methimazole can be used as an alternate
agent but does not block peripheral T4
conversion.
Both medications can be administered
orally, through nasogastric sonde or
rectally if necessary.
Peripheral thyroid hormone action as
well as tachycardia and hypertension
can be minimized by
• beta-blockers: typically propranolol
administered intravenously initially in 1mg dose every 10 to 15 minutes until
symptoms are controlled or esmolol
administered as a loading dose of 250-500
mcg/kg followed by an infusion of 50-100
mcg/kg/minute.
• Glucocorticoids: prednisone 2-6
mg/kg hydrocortisone 20 mg/kg
intravenously every 8 hours with
normal saline or 5 % glucose
• Should not be given salicylates for
treatment of hypertermia
Diabetic coma (DKA III stage)
• An initial intravenous bolus of regular
insulin at 0.1 U/kg body weight, followed
by a continuous infusion of regular insulin
at a dose of 0.1 U/kg/hour is the standard
therapy (before 50 U of insulin should be
diluted in 50 ml of normal saline – than 1
ml will have 1 U of insulin)
• When glucose decreased to 14 mmol/L
•
(250 mg/dL) – insulin can be injected
subcutaneously (dose 1 U/kg/day).
If the patient is hemodynamically stable,
isotonic saline can be given at a rate of 1520 mL/kg/hour for the first several hours.
Once the serum glucose level is below
200-250 mg/dL, the fluids should be
changed to one-half normal saline with
dextrose (D5 1/2NS) given at a rate
sufficient to replace the free water loss
induced by the osmotic diuresis.
Hypoglycemic coma
• Glucagon (before 5 years 0,5 mg IM or
•
SC< after 5 years – 1 mg IM or SC)
20 % dextrose (D20) 1 ml/kg or 10 %
dextrose (D10) 2 ml/kg – during first 3
minutes, than 10 % glucose 2-4 ml/kg up
to glucose level 7-11 mmol/L (glucose
level should be checked every 30 minutes)
Treatment of acute adrenal
(addisonian) crisis
• Hydrocortison (Cortef) IV 100 mg as a
•
•
bolus
Intravenous saline and glucose
Hydrocortison 10-15 mg/kg as a
continuous infusion for 24 hours Decrease
one third of the hydrocortison daily dose
every day until a maintenance dosage is
reached within 5 days