A 60-year-old female with diabetes and hypertension from skilled nursing facility presents with worsening mental status, shortness of breath, and muscle weakness. Vital signs include BP 175/100, HR 105, RR 22, SpO2 95% on room air, T 100.7F, and blood glucose of 275. Physical exam is remarkable for A&Ox2, obesity, striae, bilateral upper/lower extremity muscle weakness, and 2+ bilateral lower extremity edema. CMP/CBC is unremarkable, BNP is 250, and EKG shows low voltage. Outpatient random serum cortisol is 2700 nmol/L. What is the diagnosis, and urgent interventions will reduce the patient’s morbidity/mortality?

The 52 in 52 series returns with the SALSA trial.

Today on the emDOCs cast with Brit Long, MD and Skyler Lentz, MD, we cover a challenging condition: adrenal insufficiency.

A 23-year-old male presents with recurrent episodes of global headache, flushing, sweating, and palpitations. These episodes first started 1 month ago. They occur several times per day and last less than one hour. He has also noted a 10-pound weight loss since these episodes started. Exam reveals blood pressure 183/108 mm Hg, HR 1114 beats per minute, RR 18, temperature 98.4 C, saturation 98% on room air. His skin is flushed. Your cardiovascular, pulmonary, abdominal, and motor and sensory exams are otherwise normal. What is the likely diagnosis?

What do we need to consider when evaluating and treating suspected decompensated hypothyroidism?

Anyone who works in the Emergency Department has seen patients brought in by EMS or sent from the clinic with a chief complaint of “high blood sugar.” Now, we are not talking about patients with diabetic ketoacidosis, but just simple hyperglycemia. This is a common complaint with no real consensus on optimal blood glucose levels before safe discharge.

Adrenal insufficiency is a life-threatening emergency - learn to recognize it early and treat aggressively! Check out this amazing post via CORE EM!

The first post in the new EM Primer Series...What are the pearls you need to know for myxedema?