Endocrine Emergencies 525484.A 53-year-old woman is brought to the ED by her husband, who states
that she is feeling very weak over the last 2 days, is nauseated, and vomiting
at least three times. The husband states that his wife was taking a high dose
medication for her joint pain but ran out of her pills last week. Her vital signs
are BP of 90/50 mm Hg, HR 87 beats per minute, RR 16 breaths per minute,
and temperature 98.1°F. You place her on the monitor, begin IV fluids, and
send her blood to the laboratory. Thirty minutes later the metabolic panel
results are back and reveal the following:
Na+ 126 mEq/L
K+ 5 mEq/L
Cl− 99 mEq/L
HCO 3 21 mEq/L
BUN 24 mg/dL
Creatinine 1.6 mg/dL
Glucose 69 mg/dL
Ca+ 11 mEq/LWhat is the most likely diagnosis?
a. Myxedema coma
b. Thyroid storm
c. Hyperaldosteronism
d. Adrenal insufficiency
e. Diabetic ketoacidosis (DKA)
485.A 44-year-old agitated woman is brought to the ED by her husband.
He states that she has had fevers to 101°F and a productive cough at home
for the last 3 days. Today she became labile, agitated, and complained of
abdominal pain. She was recently diagnosed with Graves disease and started
on PTU. Her BP is 156/87 mm Hg, HR is 145 beats per minute, temperature
is 102.4°F, and RR is 20 breaths per minute. On examination, the patient is
agitated, confused, and has rales on auscultation bilaterally. Which of the
following is the most likely diagnosis?
a. Pheochromocytoma
b. Cocaine ingestion
c. Heat stroke
d. Thyroid storm
e. Neuroleptic malignant syndrome