Endocrine and Metabolic Emergencies - NREMT Paramedic Level

Which endocrine emergency is caused by acute cortisol deficiency and can present with shock?

Adrenal crisis (acute adrenal insufficiency). Sudden cortisol lack disrupts metabolism and vascular tone, precipitating refractory shock.
What is the prehospital treatment priority for suspected adrenal crisis with hypotension?

Isotonic fluids; consider dextrose and steroids per protocol. Fluids restore volume; dextrose and steroids address hypoglycemia and cortisol deficiency per guidelines.
What is the key distinguishing feature of hyperosmolar hyperglycemic state (HHS) versus DKA?

Severe hyperglycemia and dehydration with minimal or no ketosis. HHS occurs in type 2 diabetes with enough insulin to prevent ketosis but not hyperglycemia, causing osmotic diuresis and dehydration.
Which breathing pattern is most associated with DKA and metabolic acidosis?

Kussmaul respirations. Deep, rapid breathing compensates for metabolic acidosis by expelling CO2 to raise blood pH.
Identify the most likely cause: confusion improves rapidly after oral glucose administration.

Hypoglycemia. Rapid reversal of confusion with glucose confirms low blood sugar as the etiology of neurologic symptoms.
What is the immediate management priority for symptomatic hyperkalemia causing dysrhythmias?

Stabilize myocardium with calcium per protocol; treat underlying cause. Calcium antagonizes potassium's membrane effects, stabilizing cardiac rhythm while addressing root cause.
What is the classic presentation of thyroid storm in the field?

Hyperthermia, tachycardia, agitation, and altered mental status. Thyrotoxicosis causes hypermetabolic state with sympathetic overdrive, leading to these systemic effects.
What is the primary hormone deficiency that causes type 1 diabetes mellitus?

Absolute insulin deficiency due to pancreatic beta-cell failure. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, leading to no insulin production.
What is the classic presentation of myxedema coma in the field?

Hypothermia, bradycardia, hypotension, and altered mental status. Severe hypothyroidism slows metabolism, resulting in decreased heat production and cardiovascular depression.
Which bedside test should you obtain early for any patient with altered mental status?

Point-of-care blood glucose. Altered mental status often stems from metabolic issues like hypo- or hyperglycemia, making rapid glucose check essential.
Which vital sign pattern most strongly suggests hypoglycemic shock?

Tachycardia with diaphoresis and possible hypotension. Adrenergic response to low glucose causes sympathetic activation, manifesting as these signs of compensatory shock.
What medication is indicated for severe hypoglycemia when IV access is not available?

Glucagon IM or IN per protocol. Glucagon stimulates hepatic glycogenolysis to increase blood glucose when IV routes are inaccessible.
What blood glucose threshold is commonly used to define hypoglycemia in adults?

Blood glucose less than $60\text{ mg/dL}$ . Levels below this threshold impair brain function, as glucose is the primary neuronal energy source.
Which patient group most commonly develops hyperosmolar hyperglycemic state (HHS)?

Older patients with type 2 diabetes mellitus. Elderly type 2 diabetics are prone to HHS due to comorbidities, reduced thirst response, and gradual onset.
What is the immediate prehospital priority treatment for suspected DKA or HHS?

Aggressive isotonic fluid resuscitation per protocol. Fluid replacement addresses profound dehydration and hypovolemia critical in both conditions to restore perfusion.
Which antidiabetic drug class most commonly causes hypoglycemia in older adults?

Sulfonylureas. These agents stimulate insulin release, risking prolonged hypoglycemia in elderly with reduced clearance.
Identify the most likely diagnosis: very high glucose, profound dehydration, focal deficits, no ketone odor.

Hyperosmolar hyperglycemic state (HHS). Presentation indicates severe hyperglycemia without acidosis, often with neurologic signs from hyperosmolarity.
Which temperature management is most appropriate for suspected myxedema coma?

Passive rewarming and gentle handling. Avoid active rewarming to prevent vasodilation and shock; gentle methods support gradual recovery.
What is the most common immediate cause of death in diabetic ketoacidosis (DKA)?

Hypovolemic shock from severe dehydration. Osmotic diuresis from hyperglycemia causes massive fluid loss, leading to circulatory collapse if untreated.
What is the classic prehospital triad for diabetic ketoacidosis (DKA)?

Hyperglycemia, ketosis, and metabolic acidosis. DKA manifests from insulin lack causing glucose elevation, fat breakdown to ketones, and acid buildup from ketoacids.
What is the first-line treatment for a conscious patient with hypoglycemia who can swallow?

Oral glucose (or other oral carbohydrates) if able to protect airway. Oral intake rapidly raises blood glucose without IV risks, provided airway protection ensures safety.
What is the preferred treatment for severe hypoglycemia with IV access in an adult?

IV dextrose per protocol (for example, $D10$ or $D50$ depending on system). Intravenous administration provides immediate glucose delivery to reverse severe symptoms efficiently.
What is the primary pathophysiology of type 2 diabetes mellitus in adults?

Insulin resistance with relative insulin deficiency. Type 2 diabetes involves peripheral tissues resisting insulin effects, combined with inadequate compensatory insulin secretion.
Identify the most likely diagnosis: polyuria, polydipsia, weight loss, Kussmaul respirations.

Diabetic ketoacidosis (DKA). Symptoms reflect insulin deficiency causing hyperglycemia, dehydration, and acidosis with compensatory breathing.
What fruity odor on the breath most strongly suggests DKA?

Acetone (ketone) breath odor. Ketone production in DKA leads to acetone exhalation, producing a distinctive fruity scent.

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