Endocrine and Metabolic Emergencies - NREMT: Paramedic Level
Card 1 of 25
What is the primary pathophysiology of type 2 diabetes mellitus in adults?
What is the primary pathophysiology of type 2 diabetes mellitus in adults?
Tap to reveal answer
Insulin resistance with relative insulin deficiency. Type 2 diabetes involves peripheral tissues resisting insulin effects, combined with inadequate compensatory insulin secretion.
Insulin resistance with relative insulin deficiency. Type 2 diabetes involves peripheral tissues resisting insulin effects, combined with inadequate compensatory insulin secretion.
← Didn't Know|Knew It →
What is the classic prehospital triad for diabetic ketoacidosis (DKA)?
What is the classic prehospital triad for diabetic ketoacidosis (DKA)?
Tap to reveal answer
Hyperglycemia, ketosis, and metabolic acidosis. DKA manifests from insulin lack causing glucose elevation, fat breakdown to ketones, and acid buildup from ketoacids.
Hyperglycemia, ketosis, and metabolic acidosis. DKA manifests from insulin lack causing glucose elevation, fat breakdown to ketones, and acid buildup from ketoacids.
← Didn't Know|Knew It →
What fruity odor on the breath most strongly suggests DKA?
What fruity odor on the breath most strongly suggests DKA?
Tap to reveal answer
Acetone (ketone) breath odor. Ketone production in DKA leads to acetone exhalation, producing a distinctive fruity scent.
Acetone (ketone) breath odor. Ketone production in DKA leads to acetone exhalation, producing a distinctive fruity scent.
← Didn't Know|Knew It →
What is the key distinguishing feature of hyperosmolar hyperglycemic state (HHS) versus DKA?
What is the key distinguishing feature of hyperosmolar hyperglycemic state (HHS) versus DKA?
Tap to reveal answer
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.
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.
← Didn't Know|Knew It →
Which patient group most commonly develops hyperosmolar hyperglycemic state (HHS)?
Which patient group most commonly develops hyperosmolar hyperglycemic state (HHS)?
Tap to reveal answer
Older patients with type 2 diabetes mellitus. Elderly type 2 diabetics are prone to HHS due to comorbidities, reduced thirst response, and gradual onset.
Older patients with type 2 diabetes mellitus. Elderly type 2 diabetics are prone to HHS due to comorbidities, reduced thirst response, and gradual onset.
← Didn't Know|Knew It →
What is the immediate prehospital priority treatment for suspected DKA or HHS?
What is the immediate prehospital priority treatment for suspected DKA or HHS?
Tap to reveal answer
Aggressive isotonic fluid resuscitation per protocol. Fluid replacement addresses profound dehydration and hypovolemia critical in both conditions to restore perfusion.
Aggressive isotonic fluid resuscitation per protocol. Fluid replacement addresses profound dehydration and hypovolemia critical in both conditions to restore perfusion.
← Didn't Know|Knew It →
What is the most common immediate cause of death in diabetic ketoacidosis (DKA)?
What is the most common immediate cause of death in diabetic ketoacidosis (DKA)?
Tap to reveal answer
Hypovolemic shock from severe dehydration. Osmotic diuresis from hyperglycemia causes massive fluid loss, leading to circulatory collapse if untreated.
Hypovolemic shock from severe dehydration. Osmotic diuresis from hyperglycemia causes massive fluid loss, leading to circulatory collapse if untreated.
← Didn't Know|Knew It →
Which bedside test should you obtain early for any patient with altered mental status?
Which bedside test should you obtain early for any patient with altered mental status?
Tap to reveal answer
Point-of-care blood glucose. Altered mental status often stems from metabolic issues like hypo- or hyperglycemia, making rapid glucose check essential.
Point-of-care blood glucose. Altered mental status often stems from metabolic issues like hypo- or hyperglycemia, making rapid glucose check essential.
← Didn't Know|Knew It →
What blood glucose threshold is commonly used to define hypoglycemia in adults?
What blood glucose threshold is commonly used to define hypoglycemia in adults?
Tap to reveal answer
Blood glucose less than $60\text{ mg/dL}$. Levels below this threshold impair brain function, as glucose is the primary neuronal energy source.
Blood glucose less than $60\text{ mg/dL}$. Levels below this threshold impair brain function, as glucose is the primary neuronal energy source.
← Didn't Know|Knew It →
What is the first-line treatment for a conscious patient with hypoglycemia who can swallow?
What is the first-line treatment for a conscious patient with hypoglycemia who can swallow?
Tap to reveal answer
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.
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.
← Didn't Know|Knew It →
What is the preferred treatment for severe hypoglycemia with IV access in an adult?
What is the preferred treatment for severe hypoglycemia with IV access in an adult?
Tap to reveal answer
IV dextrose per protocol (for example, $D10$ or $D50$ depending on system). Intravenous administration provides immediate glucose delivery to reverse severe symptoms efficiently.
IV dextrose per protocol (for example, $D10$ or $D50$ depending on system). Intravenous administration provides immediate glucose delivery to reverse severe symptoms efficiently.
← Didn't Know|Knew It →
What medication is indicated for severe hypoglycemia when IV access is not available?
What medication is indicated for severe hypoglycemia when IV access is not available?
Tap to reveal answer
Glucagon IM or IN per protocol. Glucagon stimulates hepatic glycogenolysis to increase blood glucose when IV routes are inaccessible.
Glucagon IM or IN per protocol. Glucagon stimulates hepatic glycogenolysis to increase blood glucose when IV routes are inaccessible.
← Didn't Know|Knew It →
Which antidiabetic drug class most commonly causes hypoglycemia in older adults?
Which antidiabetic drug class most commonly causes hypoglycemia in older adults?
Tap to reveal answer
Sulfonylureas. These agents stimulate insulin release, risking prolonged hypoglycemia in elderly with reduced clearance.
Sulfonylureas. These agents stimulate insulin release, risking prolonged hypoglycemia in elderly with reduced clearance.
← Didn't Know|Knew It →
Which vital sign pattern most strongly suggests hypoglycemic shock?
Which vital sign pattern most strongly suggests hypoglycemic shock?
Tap to reveal answer
Tachycardia with diaphoresis and possible hypotension. Adrenergic response to low glucose causes sympathetic activation, manifesting as these signs of compensatory shock.
Tachycardia with diaphoresis and possible hypotension. Adrenergic response to low glucose causes sympathetic activation, manifesting as these signs of compensatory shock.
← Didn't Know|Knew It →
Identify the most likely diagnosis: polyuria, polydipsia, weight loss, Kussmaul respirations.
Identify the most likely diagnosis: polyuria, polydipsia, weight loss, Kussmaul respirations.
Tap to reveal answer
Diabetic ketoacidosis (DKA). Symptoms reflect insulin deficiency causing hyperglycemia, dehydration, and acidosis with compensatory breathing.
Diabetic ketoacidosis (DKA). Symptoms reflect insulin deficiency causing hyperglycemia, dehydration, and acidosis with compensatory breathing.
← Didn't Know|Knew It →
Identify the most likely diagnosis: very high glucose, profound dehydration, focal deficits, no ketone odor.
Identify the most likely diagnosis: very high glucose, profound dehydration, focal deficits, no ketone odor.
Tap to reveal answer
Hyperosmolar hyperglycemic state (HHS). Presentation indicates severe hyperglycemia without acidosis, often with neurologic signs from hyperosmolarity.
Hyperosmolar hyperglycemic state (HHS). Presentation indicates severe hyperglycemia without acidosis, often with neurologic signs from hyperosmolarity.
← Didn't Know|Knew It →
Which endocrine emergency is caused by acute cortisol deficiency and can present with shock?
Which endocrine emergency is caused by acute cortisol deficiency and can present with shock?
Tap to reveal answer
Adrenal crisis (acute adrenal insufficiency). Sudden cortisol lack disrupts metabolism and vascular tone, precipitating refractory shock.
Adrenal crisis (acute adrenal insufficiency). Sudden cortisol lack disrupts metabolism and vascular tone, precipitating refractory shock.
← Didn't Know|Knew It →
What is the prehospital treatment priority for suspected adrenal crisis with hypotension?
What is the prehospital treatment priority for suspected adrenal crisis with hypotension?
Tap to reveal answer
Isotonic fluids; consider dextrose and steroids per protocol. Fluids restore volume; dextrose and steroids address hypoglycemia and cortisol deficiency per guidelines.
Isotonic fluids; consider dextrose and steroids per protocol. Fluids restore volume; dextrose and steroids address hypoglycemia and cortisol deficiency per guidelines.
← Didn't Know|Knew It →
What is the classic presentation of thyroid storm in the field?
What is the classic presentation of thyroid storm in the field?
Tap to reveal answer
Hyperthermia, tachycardia, agitation, and altered mental status. Thyrotoxicosis causes hypermetabolic state with sympathetic overdrive, leading to these systemic effects.
Hyperthermia, tachycardia, agitation, and altered mental status. Thyrotoxicosis causes hypermetabolic state with sympathetic overdrive, leading to these systemic effects.
← Didn't Know|Knew It →
What is the classic presentation of myxedema coma in the field?
What is the classic presentation of myxedema coma in the field?
Tap to reveal answer
Hypothermia, bradycardia, hypotension, and altered mental status. Severe hypothyroidism slows metabolism, resulting in decreased heat production and cardiovascular depression.
Hypothermia, bradycardia, hypotension, and altered mental status. Severe hypothyroidism slows metabolism, resulting in decreased heat production and cardiovascular depression.
← Didn't Know|Knew It →
Which temperature management is most appropriate for suspected myxedema coma?
Which temperature management is most appropriate for suspected myxedema coma?
Tap to reveal answer
Passive rewarming and gentle handling. Avoid active rewarming to prevent vasodilation and shock; gentle methods support gradual recovery.
Passive rewarming and gentle handling. Avoid active rewarming to prevent vasodilation and shock; gentle methods support gradual recovery.
← Didn't Know|Knew It →
What is the immediate management priority for symptomatic hyperkalemia causing dysrhythmias?
What is the immediate management priority for symptomatic hyperkalemia causing dysrhythmias?
Tap to reveal answer
Stabilize myocardium with calcium per protocol; treat underlying cause. Calcium antagonizes potassium's membrane effects, stabilizing cardiac rhythm while addressing root cause.
Stabilize myocardium with calcium per protocol; treat underlying cause. Calcium antagonizes potassium's membrane effects, stabilizing cardiac rhythm while addressing root cause.
← Didn't Know|Knew It →
Identify the most likely cause: confusion improves rapidly after oral glucose administration.
Identify the most likely cause: confusion improves rapidly after oral glucose administration.
Tap to reveal answer
Hypoglycemia. Rapid reversal of confusion with glucose confirms low blood sugar as the etiology of neurologic symptoms.
Hypoglycemia. Rapid reversal of confusion with glucose confirms low blood sugar as the etiology of neurologic symptoms.
← Didn't Know|Knew It →
What is the primary hormone deficiency that causes type 1 diabetes mellitus?
What is the primary hormone deficiency that causes type 1 diabetes mellitus?
Tap to reveal answer
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.
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.
← Didn't Know|Knew It →
Which breathing pattern is most associated with DKA and metabolic acidosis?
Which breathing pattern is most associated with DKA and metabolic acidosis?
Tap to reveal answer
Kussmaul respirations. Deep, rapid breathing compensates for metabolic acidosis by expelling CO2 to raise blood pH.
Kussmaul respirations. Deep, rapid breathing compensates for metabolic acidosis by expelling CO2 to raise blood pH.
← Didn't Know|Knew It →