1. TREATMENT OF ENDOCRINE EMERGENCIES Sakharova Inna. Ye., M.D, Ph.D

2. 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. 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.

3. 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. 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. 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. Both medications can be administered orally, through nasogastric sonde or rectally if necessary.

4. Peripheral thyroid hormone action as well as tachycardia and hypertension can be minimized by beta-blockers: typically propranolol administered intravenously initially in 1- mg 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. beta-blockers: typically propranolol administered intravenously initially in 1- mg 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.

5. Glucocorticoids: prednisone 2-6 mg/kg hydrocortisone 20 mg/kg intravenously every 8 hours with normal saline or 5 % glucose 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 Should not be given salicylates for treatment of hypertermia

6. 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) 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)

7. When glucose decreased to 14 mmol/L (250 mg/dL) – insulin can be injected subcutaneously (dose 1 U/kg/day). 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 15- 20 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. If the patient is hemodynamically stable, isotonic saline can be given at a rate of 15- 20 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.

8. Hypoglycemic coma Glucagon (before 5 years 0,5 mg IM or SC< after 5 years – 1 mg IM or SC) 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) 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)

9. Treatment of acute adrenal (addisonian) crisis Hydrocortison (Cortef) IV 100 mg as a bolus Hydrocortison (Cortef) IV 100 mg as a bolus Intravenous saline and glucose 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 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