Endocrine Emergencies Answers 527is administered to block hormone release from the thyroid but should be
given 1 hour after PTU to prevent organification of the iodine.
(a)Tricyclic antidepressant overdose can present with altered mental
status and tachycardia. Bicarbonate is administered for a widened QRS on
ECG.(b)Chlordiazepoxide is given to patients to prevent alcohol with-
drawal, which can also present with confusion and tachycardia. (c)Ceftriax-
one is commonly used to treat meningitis, which can present with confusion,
tachycardia, and fever. (e)The patient’s diarrhea is not caused by an infec-
tious etiology and therefore ciprofloxacin is not required. She may require
fluid resuscitation, but for now her BP is stable.
477.The answer is b.(Rosen, pp 1774-1778.)Myxedema comais a syn-
drome that represents extreme hypothyroidism.It is a life-threatening condi-
tion that has a mortality of up to 50%. Signs and symptoms of hypothyroidism
are usually present including dry skin, delayed deep tendon reflexes, coarse
hair, and generalized nonpitting edema. Myxedema coma, however, is better
characterized by profound lethargy or comaandhypothermia.Hypothermia
is present in approximately 80% of patients. In addition, patients may present
with respiratory depression and sinus bradycardia.
(a)Apathetic thyrotoxicosis is an atypical presentation of hyperthy-
roidism seen commonly in the elderly but noted in all ages. Signs and symp-
toms are few and subtle. Patients usually have multinodular goiter. The
diagnosis should be considered in elderly patients with chronic weight loss,
proximal muscle weakness, depressed affect, new-onset atrial fibrillation, or
congestive heart failure. (c)Graves disease is secondary to autoimmune
stimulation of thyrotropin (TSH) receptors leading to elevated levels of thy-
roid hormones. (d)An acute stroke should not cause periorbital edema and
hypothermia.(e)Schizophrenia may be mistakenly diagnosed in patients
with thyroid abnormalities. It is not a correct diagnosis in this scenario when
the patient is unconscious and hypothermic.
478.The answer is a.(Rosen, pp 1755-1757.)Hyperglycemic hyperos-
molar nonketotic coma (HHNC)is a syndrome representing marked
hyperglycemia(serum glucose > 600 mg/dL), hyperosmolarity(plasma
osmolarity > 350 mOsm/L), considerable dehydration(9 L in 70-kg patient),
anddecreased mental functioningthat may progress to coma. HHNC may
be the initial presentation of previously unrecognized diabetes in an adult
withtype 2 diabetes mellitus.Elderly diabetics are at greaterriskfor this