Acute Hypocalcemia

Acute Hypocalcemia Causes: 1-Hypoparathyroidism ➧ Destruction of parathyroids (most commonly surgical – parathyroid resection or accidental). ➧ Acute hypomagnesemia 2-Reduced 1,25 (OH) vit D 3-Chronic renal insufficiency ➧ Acute systemic illness ➧ Drugs: ketoconazole, doxorubicin, cytarabine ➧ Increased uptake of Ca in bone ➧ Osteoblastic metastases ➧ Hungry...

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Acute Hypercalcemia

Acute Hypercalcemia Most Common Causes: 1-Endocrine: ➧ Hyperparathyroidism ➧ MEN ➧ PTH-related peptide (PTHrP) by solid tumors 2-Neoplastic: ➧ Ca with bone metastases ➧ Myeloma 3-Granulomatous: ➧ Sarcoidosis  ➧ Tuberculosis Clinical picture: ➧ History of polyuria and polydipsia  ➧ Dehydration ➧ Bone pain ➧ Confusion ➧ Anorexia  ➧...

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Thyroid Storm

Thyroid Storm Definition: ➧ Acute life-threatening exacerbation of thyrotoxicosis Precipitating factors: ➧ Withdrawal of antithyroid drugs ➧ Severe infection ➧ Diabetic ketoacidosis (DKA) ➧ Cerebro-vascular accident (CVA) ➧ Cardiac failure ➧ Surgery ➧ Trauma  ➧ Radioiodine ➧ Drug reaction ➧ Iodinated contrast medium Clinical picture: ➧ Patient with Graves disease who has discontinued antithyroid medication OR is previously...

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Myxedema Coma

Myxedema Coma Definition: ➧ The end-stage of untreated or insufficiently treated hypothyroidism. Pathogenesis of Myxedema: (Figure 1) Figure 1: Pathogenesis of Myxedema Coma Precipitating factors: ➧ CVA ➧ Myocardial infarction ➧ Infection (UTI, Pneumonia) ➧ Gastrointestinal hemorrhage ➧ Acute trauma ➧ Administration of sedative, narcotic, or potent diuretics Typical...

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Acute Adrenal Insufficiency

Acute Adrenal Insufficiency Causes: ➧ Usually presents as an acute process in a patient with underlying chronic adrenal insufficiency ➧ Causes of Primary adrenal insufficiency:    - Auto-immune    - TB of adrenals    - Metastatic malignancy to adrenals ➧ Causes of Secondary or Tertiary adrenal insufficiency    - Pituitary or hypothalamic disease ➧ Acute destruction of the adrenals...

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Pituitary Apoplexy

Pituitary ApoplexyClinical Setting: ➧ Hemorrhagic infarction of a pituitary adenoma/tumor. ➧ Sudden crisis in a patient with a known or previously unknown pituitary tumor. ➧ It may occur in a normal gland during and after childbirth, with head trauma, or in a patient on anticoagulation therapy.  ➧ Sheehan’s Syndrome: -Refers to pituitary apoplexy of the...

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Pheochromocytoma Crisis

Pheochromocytoma Crisis Causes: ➧ The action of unopposed high circulating levels of catecholamines - α - receptors: Pressor response - β - receptors: positive ino- and chrono-topic Precipitating factors: ➧ Spontaneous ➧ Hemorrhage into pheochromocytoma ➧ Exercise ➧ Pressure on the abdomen ➧ Urination ➧ Drugs: glucagon, naloxone, metoclopramide,...

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Burn Fluid Resuscitation Formulas

Burn Fluid Resuscitation Formulas 1-Harkins formula (1942) Initial 24 hours: ➧ 1000 ml plasma/10% burn Used in patients with ≥ 10% burn. 2-Body weight burn budget (1947) Initial 24 hours: ➧ Ringer's lactate (RL) solution 1-4 L + 1200ml NS + 7.5% body weight colloid + 1.5-5 L D5W. Next 24 hours:  ➧ RL 1-4 L + 1200ml NS + 2.5%body weight colloid + 1.5-5 L D5W. 3-Evans formula (1952) Initial 24 hours: ➧ 0.9% saline at 1 ml/kg/%...

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