Overview
Start with Instability and Glycaemic Emergencies
Endocrine disorders often declare themselves through a change in consciousness, circulation, temperature regulation, or fluid balance before the underlying hormone disorder is k...
Endocrine disorders often declare themselves through a change in consciousness, circulation, temperature regulation, or fluid balance before the underlying hormone disorder is known. Begin with airway, breathing, circulation, level of consciousness, vital signs, current medications, and a bedside capillary glucose measurement when altered mental status, diaphoresis, weakness, tremor, seizure activity, or unexplained confusion is present. A low glucose reading can explain sudden neuroglycopenic findings such as confusion, dysarthria, behaviour change, seizure, or reduced consciousness. Adrenergic symptoms—sweating, tremor, palpitations, hunger, and anxiety—may appear earlier, but they can be blunted in people taking beta-blockers or those with recurrent hypoglycaemia. Treat suspected hypoglycaemia promptly according to the patient’s ability to swallow and local protocol; do not wait for laboratory confirmation when the bedside reading and clinical picture agree. Hyperglycaemia becomes an emergency when it is accompanied by dehydration, vomiting, abdominal pain, deep or rapid breathing, ketone odour, hypotension, confusion, or declining urine output. These findings suggest diabetic ketoacidosis or hyperosmolar hyperglycaemic state rather than uncomplicated high glucose. Obtain urgent assessment, establish access as authorized, monitor cardiac rhythm and fluid status, collect ordered blood...