👤 By the CinnaEMS Content Team🕐 Updated 2026-09-27🏷️ Medical, Obstetrics & Gynecology🔖 Free to read, print, and share
Also known as: DKA · diabetic ketoacidosis · HHS · hyperosmolar hyperglycemic state · adrenal crisis · thyroid storm · myxedema coma
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Use this quick-reference guide to recognise, treat and hand over Endocrine Crises on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Dka
Young · fast onset
Kussmaul · fruity breath
📌 Hhs
Older · slow onset
Extreme sugar · severe dehydration
📌 Adrenal
Steroid user in shock
Fluid fails → their steroid
📌 Thyroid
Storm: fever · fast · agitated
Myxedema: cold · slow · stuporous
📚 Endocrine Crises — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Endocrine emergencies look like other illness: a stroke, a drunk, sepsis or panic. The exam checks the distinguishing features of diabetic ketoacidosis, hyperosmolar state, adrenal crisis and thyroid storm, and the supportive care EMS delivers.
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Key points
Understand these first
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.
Fluid resuscitation for DKA and HHS with reassessment of lung sounds.
Monitor the ECG — potassium shifts cause dysrhythmias.
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Red flags — report now
Escalate immediately
Kussmaul breathing with altered mental status
Shock that does not respond to fluid in a steroid user
Fever with heart rate far above expected
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Patient teaching
What patients must know
Kussmaul breathing is compensation for acidosis — do not try to slow it.
❓ Endocrine Crises: NREMT 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.
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Quick Tip
Check glucose in every altered patient; hypoglycemia can mimic stroke or intoxication.