
Contents
67 Stress hyperglycaemia and endocrine emergencies
Get access-
Published:February 2021
Cite
Abstract
Although endocrine pathology is usually treated in an outpatient clinic, intensive care may be required when endocrinopathies are associated with other medical illnesses or reach a state of decompensation. Although endocrine emergencies are quite rare, they are potentially life-threatening if not recognised promptly and managed effectively. Therefore, every clinician should always be attentive to a possible diagnosis of these complex disorders. The three major diabetic emergencies comprise diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and prolonged hypoglycaemia. Hyperglycaemic crises are characterised by hypovolaemia and electrolyte disturbances, and may be triggered by potentially life-threatening conditions. Hence, airway-breathing-circulation securement, early fluid resuscitation, and adequate diagnosis and treatment of the underlying condition are the cornerstones of acute management. Subsequently, monitoring and correction of electrolyte disturbances and insulin treatment are initiated. Profound hypoglycaemia should be suspected in every patient with coma of unclear etiology, especially if the patient has an indistinct history or was treated with insulin or sulfonylurea/meglitinide. This condition warrants an immediate administration of glucose, followed by regular blood glucose monitoring. Alternatively, glucagon may be injected subcutaneously, or preferably intramuscularly. Hyperglycaemia in critically ill patients is associated with adverse outcome. The optimal blood glucose target for critically ill patients remains unclear, however. In any case, clinicians should prevent severe hyperglycaemia, hypoglycaemia and large glucose fluctuations. The classical non-diabetic endocrine emergencies comprise thyroid storm, myxoedema coma, acute adrenal crisis, and phaeochromocytoma. They all pose diagnostic and therapeutic challenges and require specific treatment such as endocrine replacement or blockage therapy, apart from supportive care and treatment of the inciting event. It is important to note that such conditions are occasionally the first manifestation of an endocrine disorder. This chapter also briefly discusses amiodarone-induced thyroid dysfunction.
Sign in
Personal account
- Sign in with email/username & password
- Get email alerts
- Save searches
- Purchase content
- Activate your purchase/trial code
- Add your ORCID iD
Purchase
Our books are available by subscription or purchase to libraries and institutions.
Purchasing informationMonth: | Total Views: |
---|---|
October 2022 | 9 |
November 2022 | 2 |
December 2022 | 3 |
January 2023 | 10 |
February 2023 | 13 |
March 2023 | 18 |
April 2023 | 14 |
May 2023 | 11 |
June 2023 | 10 |
July 2023 | 9 |
August 2023 | 8 |
September 2023 | 14 |
October 2023 | 18 |
November 2023 | 10 |
December 2023 | 10 |
January 2024 | 16 |
February 2024 | 6 |
March 2024 | 15 |
April 2024 | 9 |
May 2024 | 12 |
June 2024 | 12 |
July 2024 | 9 |
August 2024 | 5 |
September 2024 | 9 |
October 2024 | 4 |
November 2024 | 4 |
December 2024 | 8 |
January 2025 | 8 |
February 2025 | 8 |
March 2025 | 11 |
April 2025 | 4 |
Get help with access
Institutional access
Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:
IP based access
Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account.
Sign in through your institution
Choose this option to get remote access when outside your institution. Shibboleth/Open Athens technology is used to provide single sign-on between your institution’s website and Oxford Academic.
If your institution is not listed or you cannot sign in to your institution’s website, please contact your librarian or administrator.
Sign in with a library card
Enter your library card number to sign in. If you cannot sign in, please contact your librarian.
Society Members
Society member access to a journal is achieved in one of the following ways:
Sign in through society site
Many societies offer single sign-on between the society website and Oxford Academic. If you see ‘Sign in through society site’ in the sign in pane within a journal:
If you do not have a society account or have forgotten your username or password, please contact your society.
Sign in using a personal account
Some societies use Oxford Academic personal accounts to provide access to their members. See below.
Personal account
A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions.
Some societies use Oxford Academic personal accounts to provide access to their members.
Viewing your signed in accounts
Click the account icon in the top right to:
Signed in but can't access content
Oxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian.
Institutional account management
For librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more.