Endocrine Crises

Endocrine crises can look alike at first: weakness, vomiting, altered mentation, hypotension, or a dangerous change in heart rate. The accompanying pattern separates them. DKA produces ketones and metabolic acidosis; HHS produces extreme hyperglycemia, hyperosmolality, and prominent neurologic change with little ketosis. Thyroid storm accelerates metabolism, while myxedema coma slows temperature regulation, ventilation, and circulation. Adrenal crisis removes cortisol support for vascular tone and glucose regulation. At the bedside, do not begin by trying to name the syndrome from one laboratory value. First assess airway, breathing, circulation, mental status, temperature, capillary glucose, perfusion, and cardiac rhythm. Then use the pattern and targeted tests to guide treatment. A patient with shock, respiratory distress, severe electrolyte disturbance, or declining consciousness needs emergency escalation while diagnostic work continues.