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HWN Suggests

Endocrine And Metabolic Emergencies In Emergency Medicine

A junior member of our faculty once approached me for some career advice, inquiring as to what clinical area of emergency medicine in which he should develop an academic niche. I advised him to focus on endocrine and metabolic emergencies. He immediately grimaced as if he had just bitten into a lemon. My reasons for the recommendation were simple: the endocrine system has a direct influence on every other organ system in the body; dysfunction of most organ systems produces metabolic derangements that can be life-threatening; endocrine and metabolic emergencies are very common in clinical practice and a not insignificant portion of the emergency medicine core curriculum; and finally, people…

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  Metabolic Crisis - The ED Doc’s Approach

When I think of inborn errors of metabolism, I immediately begin to hyperventilate and feel as though I am back in the library in medical school frantically trying to study for Step 1. But then I remember: “I’m an emergency medicine doctor, and it’s less important that I remember that the enzyme branched-chain alpha blah blah blah is deficient in the autosomal something maple syrup urine disease, and more important that I remember how to recognize and subsequently stabilize these patients when they come into my department in metabolic crisis.” And even luckier for me, it’s actually pretty straightforward so long as you know what labs to order and how to respond to them.

Articles of Interest

Emergency management of critically ill adult patients with inherited metabolic disorders

Patients with certain inherited disorders of intermediary metabolism may present to the emergency department with acute metabolic decompensation, following physiological stress such as fever, intercurrent illness, prolonged fasting, excessive protein intake or poor compliance with medication. This metabolic crisis is either due to the accumulation of toxic substrates such as ammonia, lactate, organic acids or deficiency of energy production.

Endocrine and metabolic emergencies

Many patients presenting to the ED may have disordered metabolism due to an underlying endocrine disease. These patients are often critically ill and require rapid assessment and intervention to prevent further complications, coma, and death.

Metabolic Emergencies

Acid–base disorders are commonly encountered in the emergency department (ED) and their recognition is important for the diagnosis, assessment of severity and monitoring of many disease processes. Although these disorders are usually classified according to the major metabolic abnormality present (acidosis or alkalosis) and its origin (metabolic or respiratory), it is important to realize that acid–base disorders of a mixed type commonly occur and that the recognition and assessment of these are more complex.

Renal, Metabolic and Endocrine Emergencies

Hyperkalemia, metabolic acidosis...