Endocrine Abstracts

A series of 4 cases of delay in steroid treatment.

1. 35 year male, brought in by ambulance, with drowsiness and vomiting. He was known T1DM on insulin pump, Addison’s disease on hydrocortisone. He has multiple admissions secondary to DKA. Initial assessment showed drowsiness, tachycardia, tachypnea, low saturations, hyperglycemia, ketosis and borderline acidosis. He was started on DKA protocol. His blood glucose and ketones started to improve, but he remained drowsy even 12 hours after admission. The patient was still in ED, when one of the staff nurses, who herself has Addison’s disease, realized that our patient has not received any steroids since admission.At that time, first dose of IV hydrocortisone was prescribed and given. Within 45 minutes of steroid administration his GCS started to improve.

2. 17 year male attended ED at 17:20 with abdominal pain, nausea and vomiting, flu like symptoms for 2 days. Known T1DM and Addison’s disease – informed reception staff of need for hydrocortisone iv. Triage and clinician review at 18:15. Blood glucose 20.05 but no acidosis or ketosis. Pt received IV fluids and stat doses of insulin, initially no hydrocortisone. Seen by medical team after 5 hours and then prescribed and administered.

3. 21 year male. Admitted from nursing home to ITU, Background: Congenital toxoplasmosis, epilepsy, Diabetes insipidus, Pituitary insufficiency. Endocrine referral from ITU next morning for ’Complex Endocrine issues’. Fluctuating level of consciousness, sodium 128 mmol/l, serum glucose readings were in low normal range. Receiving usual dose of hydrocortisone down NG tube. Impression was hypoadrenalism. He was switched to IV hydrocortisone. Pt was reveiwed next day by endocrine team, his GCS, hyponatremia and hypoglycemia were improved.

4. 65 year gentleman presented to ED with 2 days history of day gastroenteritis. On day of admission, he got up to toilet at around 03.00 am– collapsed. Found to be hypotensive and hypoglycaemic by ambulance crew. Pt had pastl history of transphemoidal surgery for a pituitary tumor. Pt was given normal saline and dextrose in ED. Seen by medical team around 14:40. Need for IV hydrocortisone was highlighted and prescribed on EP. Pt asked for IV hydrocortisone in ED and then on ward but was not given by the staff, he was told he would have to wait until 10pm as that is when the dose was prescribed for. He received his first dose at 22:00.