Check glucose in every altered patient; hypoglycemia can mimic stroke or intoxication.
Before you read
Test yourself first: 1 question
Question 1 of 1
A patient with sickle cell disease has severe bone and joint pain after dehydration and cold exposure. The underlying problem is:
Answer: A. Dehydration, cold and hypoxia make red cells sickle and lodge in the microcirculation, so the tissue downstream becomes ischemic and the pain is genuine and severe — oxygen, warmth, fluid and analgesia all target that mechanism. It is not a clotting or muscular problem, and these patients are routinely under-treated for pain because they present often and look well between crises.
Keep the streak going with more questions like these, each with a full rationale.
What is endocrine crises?
The exam checks the distinguishing features of diabetic ketoacidosis, hyperosmolar state, adrenal crisis and thyroid storm, and the supportive care EMS delivers.
Key points to remember
- Check glucose in every altered patient; hypoglycemia can mimic stroke or intoxication.
- DKA: younger, hours to a day, Kussmaul respirations, fruity breath, dehydration.
- HHS: older, days to weeks, extreme glucose and dehydration, little ketosis, often altered.
- Adrenal crisis: steroid-dependent patient in shock unresponsive to fluid — support their emergency steroid.
- Thyroid storm: fever, severe tachycardia, agitation; myxedema coma: hypothermia, bradycardia, stupor.
Field priorities
- Airway and glucose first in any altered patient.
- Fluid resuscitation for DKA and HHS with reassessment of lung sounds.
- Monitor the ECG — potassium shifts cause dysrhythmias.
Coaching the patient
- Kussmaul breathing is compensation for acidosis — do not try to slow it.
Red flags: act now
- Kussmaul breathing with altered mental status
- Shock that does not respond to fluid in a steroid user
- Fever with heart rate far above expected
Endocrine Crises: FAQs
What are the priority actions for Endocrine Crises in the field?
Airway and glucose first in any altered patient. Fluid resuscitation for DKA and HHS with reassessment of lung sounds. Monitor the ECG — potassium shifts cause dysrhythmias.
What findings in Endocrine Crises change your plan or your transport decision?
Kussmaul breathing with altered mental status. Shock that does not respond to fluid in a steroid user. Fever with heart rate far above expected.
What do I need to know about Endocrine Crises for the NREMT?
Check glucose in every altered patient; hypoglycemia can mimic stroke or intoxication. DKA: younger, hours to a day, Kussmaul respirations, fruity breath, dehydration. HHS: older, days to weeks, extreme glucose and dehydration, little ketosis, often altered. Adrenal crisis: steroid-dependent patient in shock unresponsive to fluid — support their emergency steroid.
What should the crew communicate or document for Endocrine Crises?
Kussmaul breathing is compensation for acidosis — do not try to slow it.
