Emergencies in children endocrinology

Diabetic ketoacidosis/ketoacidemia (DKA) is a potentially life-threatening metabolic disturbance caused by an absolute or relative insulin deficiency with resultant ketone body production and concomitant decrease in the measured total carbon dioxide concentration (TCO2) in serum. Initially, compensatory hyperventilation preserves a normal blood pH (ketoacidosis); without provision of sufficient insulin, ketonemia progresses, and a subnormal blood pH (ketoacidemia) ensues. The presence of even low concentrations of insulin in the portal circulation will usually inhibit the hepatic fatty acyl carnitine cycle, preventing DKA. In the absence of sufficient insulin this cycle is uninhibited, resulting in the production of ketone bodies.

Diabetic Ketoacidosis (DKA) Treatment Protocol

Thyroid Storm
Synonyms
Thyrotoxic crisis
Accelerated hyperthyroidism

Clinical Features of Thyroid Storm
Cardinal presenting features:
(1) Fever (almost invariably present; often severe and in excess of temperature elevation expected from the intercurrent illness)
(2) Tachycardia (out of proportion to the degree of fever)
(3) Acute metabolic encephalopathy (extreme restlessness, agitation, psychosis, delirium, confusion, stupor, or coma)
Other presenting features:
(1) Arrhythmias, palpitations
(2) Profuse sweating (warm moist skin)
(3) Heat intolerance
(4) High-output congestive heart failure
(5) Cardiogenic shock
(6) Goiter
(7) Proptosis, lid retraction
(8) Diarrhea
(9) Abdominal pain
(10) Jaundice
(11) Tremulousness
(12) Nausea and vomiting
(13) Stroke