Endocrine
Diabetes
- A1c ≥6.5% supports diabetes diagnosis.
- Metformin is common first-line if renal function adequate and no contraindication.
- Insulin for catabolic symptoms, severe hyperglycemia, DKA/HHS, or very high A1c with symptoms.
DKA vs HHS
| Feature | DKA | HHS |
|---|
| Glucose | Usually >250 | Often >600 |
| Ketones | Prominent | Minimal/absent |
| pH | Low | Usually >7.30 |
| Osmolality | Elevated | Very elevated |
| Treatment | Fluids, K, insulin | Fluids first, K, insulin |
Thyroid Storm
- Beta blocker, thionamide, iodine after thionamide, steroids, supportive care.
Adrenal Crisis
- IV hydrocortisone and fluids; do not delay treatment for confirmatory labs if unstable.