AMLS Endocrine Emergencies 2 — Questions and Answers
Question 1: Which blood glucose level generally defines symptomatic hypoglycemia requiring intervention in adults?
- Below 80 mg/dL
- Below 70 mg/dL (Correct answer)
- Below 60 mg/dL
- Below 50 mg/dL
Correct answer: Below 70 mg/dL
A blood glucose below 70 mg/dL is the standard threshold defining clinically significant hypoglycemia requiring treatment, though symptoms can vary widely between individuals.
Question 2: When managing DKA, insulin infusion is typically withheld until the serum potassium is at least what level?
- 2.5 mEq/L
- 3.0 mEq/L
- 3.5 mEq/L (Correct answer)
- 4.0 mEq/L
Correct answer: 3.5 mEq/L
Insulin drives potassium intracellularly, so insulin infusion should be withheld until serum potassium is at least 3.5 mEq/L to avoid life-threatening hypokalemia and cardiac dysrhythmias.
Question 3: A type 2 diabetic on metformin presents with Kussmaul respirations, abdominal pain, and an anion gap metabolic acidosis, but blood glucose is only 130 mg/dL. Which diagnosis should be considered?
- HHS
- Starvation ketosis
- Euglycemic diabetic ketoacidosis (Correct answer)
- Lactic acidosis from metformin
Correct answer: Euglycemic diabetic ketoacidosis
Euglycemic DKA occurs when patients (especially on SGLT-2 inhibitors) develop ketoacidosis with near-normal glucose, making it easy to miss; insulin deficiency and ketone production are present despite minimal hyperglycemia.
Question 4: In a patient with suspected adrenal crisis, which immediate treatment should be administered without waiting for confirmatory lab results?
- Oral hydrocortisone 20 mg
- IV dexamethasone or hydrocortisone plus fluid resuscitation (Correct answer)
- IM glucagon 1 mg
- IV thyroid hormone replacement
Correct answer: IV dexamethasone or hydrocortisone plus fluid resuscitation
Adrenal crisis is rapidly fatal if untreated; IV corticosteroid replacement (hydrocortisone or dexamethasone) with aggressive fluid resuscitation must be given empirically without waiting for lab confirmation.
Question 5: Which clinical sign best distinguishes pheochromocytoma from other hypertensive emergencies?
- Sustained hypertension unresponsive to beta-blockers
- Paroxysmal hypertension with diaphoresis, headache, and palpitations (Correct answer)
- Hypertension with bradycardia (Cushing's reflex)
- Progressive edema with severe hypertension
Correct answer: Paroxysmal hypertension with diaphoresis, headache, and palpitations
Pheochromocytoma classically causes paroxysmal episodes of severe hypertension accompanied by the triad of diaphoresis, severe headache, and palpitations due to catecholamine surges from the adrenal tumor.
Question 6: A conscious diabetic patient is found with a blood glucose of 52 mg/dL and mild confusion. Which is the most appropriate initial treatment?
- IV dextrose 50% (D50W) 25 g
- IM glucagon 1 mg
- 15-20 grams of fast-acting oral carbohydrates (Correct answer)
- IV normal saline 500 mL bolus
Correct answer: 15-20 grams of fast-acting oral carbohydrates
In a conscious patient able to protect their airway, the preferred initial treatment for mild hypoglycemia is 15-20 g of fast-acting oral carbohydrates (the '15-15 rule'), which is safe and effective.
Question 7: Which electrolyte abnormality is most commonly associated with DKA and requires careful monitoring during treatment?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
- Hypermagnesemia
Correct answer: Hypokalemia
Despite initially normal or elevated serum potassium in DKA (due to acidosis-driven extracellular shift), total body potassium is depleted, and treatment with insulin plus fluids causes rapid hypokalemia requiring aggressive potassium replacement.
AMLS Endocrine Emergencies 2
Which blood glucose level generally defines symptomatic hypoglycemia requiring intervention in adults?