530 Emergency Medicine
of the preformed hormone but can be given only after PTU has taken effect
otherwise it will promote further hormone production.
Dantrolene (a)is used in the management of malignant hyperthermia
and neuroleptic malignant syndrome. Administering acetaminophen and
broad coverage antibiotics (b)or diazepam (d)will not address the under-
lying etiology of the patient’s illness. Iodine (c)should not be administered
prior to PTU.
483.The answer is e. (Tintinalli, pp 169, 171, 1284, 1287, 1307.)
Hypokalemiapresents with muscle weaknessand characteristic ECG
changes,such as flat T waves and U waves, and is not associated with
seizures or altered mental status.
Glucose level can be rapidly obtained from a fingerstick glucose check.
Hypoglycemia(a)is a known reversibly cause of seizures and is corrected
with administration of dextrose. Significant hyperglycemia (b)occurs in
DKA (glucose usually is 200-800 mg/dL) or nonketotic hyperosmolar crisis
(glucose usually is more than 800 mg/dL) and is treated with IV fluids and
insulin. Hyper and hyponatremia (c and d)are known causes of seizures.
484.The answer is d.(Rosen, pp 1779-1782.)Adrenal cortical insuf-
ficiencyis an uncommon, potentially life-threatening condition that if
recognized early, is readily treatable. The most common cause of adrenal
insufficiency is hypothalamic-pituitary-adrenal axis suppression from long-
term exogenous glucocorticoid administration.This patient abruptly
stopped her high-dose steroids. The clinical presentation of adrenal insuffi-
ciency is vague but typically includes weakness, fatigue, nausea, vomiting,
hypotension,andhypoglycemia.Electrolyte abnormalities are common.
Hyponatremiaandhyperkalemiaare present in more than two-thirds of
cases. Management includes supportive care with administration of gluco-
corticoids and electrolyte correction.
(a and b)Myxedema coma is a syndrome of extreme hypothyroidism,
whereas thyroid storm is extreme hyperthyroidism. (c)Hyperaldosteronism
is characterized by hypertension and hypokalemia. (e)DKA typically pre-
sents with elevated glucose, an anion-gap metabolic acidosis, and ketone
production.
485.The answer is d.(Tintinalli, p 1312.)This patient presents with a
rare but life-threatening hypermetabolic state of thyroid storm.It occurs
in patients with known or undiagnosed hyperthyroidism and is usually