Synopsis
Recognise endocrine physiology causing acute deterioration, start syndrome-directed stabilisation promptly, and avoid correction strategies that create secondary neurological or cardiovascular harm.
- Bedside glucose is the fastest reversible endocrine assessment in any patient with altered behaviour, seizure, focal neurology or reduced consciousness.
- DKA is defined by the combination of hyperglycaemia or known diabetes, ketonaemia and acidosis; glucose alone neither confirms nor grades it.
- HHS produces profound hyperosmolality and dehydration with little significant ketonaemia, so fluid replacement and osmolality trajectory require particular care.
Investigation priorities
Identify hypoglycaemia immediately and establish whether ketonaemia is driving an acute diabetic presentation.
Management branches
An acutely unwell patient may have endocrine or metabolic decompensation.
- Run ABCDE with monitors and intravenous access, check bedside glucose and ketones, and treat hypoglycaemia immediately while confirming response.
- Send blood gas, electrolytes, renal function, calcium and syndrome-specific samples, recording all treatment given before sampling.
Key medicines
HydrocortisoneFor suspected adrenal crisis, give 100 mg intravenously or intramuscularly immediately, followed by the current Society for Endocrinology or local emergency replacement regimen with specialist review.
Intravenous insulin for DKAUse the current JBDS-aligned fixed-rate intravenous insulin infusion based on measured body weight, with fluids, potassium and background basal-insulin decisions specified by the local pathway.