E: ENDO

cells

After your ABCDs, you should consider E: endocrine-metabolic, using the mnemonic ENDO–Electrolyes, Normothermia, Determine acid-base, consider hOrmones. This starts at the bedside with vital signs (glucose, temp), moves on to full electrolytes and acid/base considerations, and finally considers hormones (which might require treatment even though lab results might not be available).

ELECTROLYTES

Glucose

-hypoglycemia: if you have low sugar, think SALT to remember the differential:

  • Sepsis
  • Adrenal insufficient
  • Liver failure
  • Toxic (alcohol, aspirin, insulin, oral hypoglyemics)

-hyperglycemia: think DIABETIC to help you manage DKA

  • DDx (septic/Cushings)
  • Inciting (infection, ischemic, intoxication, lack insulin)
  • ABCs (IV, monitor)
  • Bolus NS
  • Electrolyte monitor (K will drop)
  • Treat with insulin
  • IV change to D5 when glucose normalizes
  • Complication prevention (underlying infection, hypokalemia, cerebral edema)

 

Potassium

-hyperkalemia –> stabilize with calcium (if not dig toxic), shift with ventolin/bicarb/insulin, remove with dialysis

-hypokalemia –> correct K and Mg

 

Sodium

-hypernatremia–> fluid

-hyponatremia–> volume status: fluid if hypovolemic, diurese if hypervolemic, fluid restrict if euvolemic

 

Calcium

-hypercalcemia–> fluid, diuresis, pamidronate

-hypocalcemia–> replace Calcium

 

Magnesium

-hypermagnesemia–>Ca, fluid, lasix

-hypomagnesemia–> replace Mg

 

NORMOTHERMIA

Hyperthermia: consider the differential of FEVERS:

  • Free T4/pheo
  • Environmental
  • Vascular (stroke, PE)
  • Etoh withdrawl/cocaine
  • Rx (NMS from antipsychotic, serotonin syndrome from SSRI, MH from six, transfusion reaction, salicylates)
  • Septic

Hypothermia: r/o sepsis, environmental, hypothyroid

 

DETERMINE ACID-BASE

Acidosis

-respiratory–> ventilate

-metabolic–> treat underlying: keto-acidosis, lactic acidosis,

  • Low oxygen
  • Aspirin
  • Consuming metformin
  • Theophiline/thiamine
  • Iron/INH
  • Cyanide/carbon monoxide
  • All turnover
  • Chronic renal failure
  • Infection
  • Diabetes

-alkalosis-respiratory–> oxygenate, treat sepsis, r/o aspirin overdose

-metabolic–> r/o respiratory acidosis

 

HORMONES:

-thyroid: hyperthyroid–> treat

-hypothyroid–> synthroid

-cortisol-Cushings–> treat

-Addisons, adrenal crisis –> cortisol

-catecholamines: pheochromocytoma–>adrenergic blockade

 

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