Hypopituitarism Stressful states such as infection, trauma, surgery: Severe metabolic disorders (hyponatremia, hypoglycemia), Psychiatric symptoms (psychosis, confusion, delirium), coma

Mostly caused by hypoglycemia and/or hyponatremia, Emphasis on rapid correction of hypoglycemia and water and electrolyte disorders, Quickly replenish related deficient hormones, At the same time, we actively control predisposing factors and deal with complications.

Graves' disease, thyrotoxic adenoma, or multinodular goiter: Sudden high fever (>39℃), profuse sweating, tachycardia (>160) Frequent vomiting and diarrhea, anxiety, facial tremors, delirium, and coma.

•Rapidly inhibit the synthesis and secretion of thyroxine (antithyroid drugs, iodine agents) •Rapidly reduce circulating thyroxine levels (plasma exchange, dialysis), •Decrease peripheral tissue response to thyroxine (β2-adrenergic blockers, reserpine or ethidium), protect important organs, •Prevent and treat functional failure (give antipyretics, glucocorticoids or artificial hibernation)

Hypothyroidism patients suddenly develop mental abnormalities (Disorientation, confusion, confusion, drowsiness and coma), Absolute hypothermia (<30~35℃), thyroid hormone levels are significantly reduced

Quickly replenish thyroid hormones and glucocorticoids to keep warm and resist infection.

Diagnostic points

rescue measures

Diagnostic points

rescue measures

Those with severe damage to the adrenal cortex or chronic adrenocortical hypofunction, Sudden extreme fatigue, high fever (>40℃), severe dehydration, oliguria and anuria, Tachycardia (>160 beats/min), arrhythmia, collapse shock, Vomiting and diarrhea, severe abdominal pain, irritability, and disturbance of consciousness.

Laboratory tests: Three hypos (hypoglycemia, hyponatremia, low cortisol), Two highs (hyperkalemia, high urea nitrogen) and Increased peripheral blood eosinophils (>0.3×109/L)

Immediate intravenous infusion of hydrocortisone, correction of glucose and Disturbances in water, electrolyte, and acid-base balance.

During the attack, blood pressure rises sharply (249~300/180~210 mm Hg), and hypertensive and hypotensive shocks alternate; metabolic disorders (increased blood sugar, impaired glucose tolerance, positive urine glucose); basal metabolic rate increases by more than 40% . Laboratory tests: 24-hour urine VMA, catecholamines, plasma free catecholamines increased, clonidine test, phentolamine block test were positive, and imaging examination revealed tumors.

Immediately inject phentolamine intravenously to control blood pressure, replenish blood volume, treat symptoms, and perform elective surgery to remove the tumor.

ketoacidosis

hyperosmolar coma

lactic acidosis

Replenish insulin quickly. Advocates low-dose insulin therapy, that is, the five "5" principles: 50U of regular insulin is added to 500 ml of normal saline, and is continuously infused at a rate of 50ml per hour, which is equivalent to 5U/h, so that blood sugar can steadily decrease, and the general decrease rate is 5mmol. /h; correct water, electrolyte and acid-base balance disorders. Lactic acidosis: Cause treatment, acid correction.

Patients with risk factors for hypoglycemia suddenly develop symptoms of sympathetic nervous system hyperexcitability (cold sweat, palpitations, hunger, pale complexion, hand tremors), brain dysfunction (blurred vision, restlessness, disturbance of consciousness, epilepsy, hemiplegia, aphasia) , coma), blood sugar < 2. 8 mmol /L.

Immediately infuse glucose intravenously, and apply mannitol and glucocorticoids if necessary.

Muscle weakness, decreased tendon reflexes, and serum potassium <3.5 mmol/L. The electrocardiogram showed low and flat T waves and increased U waves.

Rapid intravenous potassium replacement.

Severe and widespread skin flushing occurs suddenly, often lasting for hours to days; diarrhea can be significantly aggravated and accompanied by abdominal pain; central nervous system symptoms are common, ranging from mild dizziness and vertigo to drowsiness and deep coma; cardiovascular abnormalities are often present, Such as tachycardia, irregular heartbeat, high blood pressure or severe hypotension. Blood 5-hydroxytryptamine (5-HT) and urine 5-H IAA were significantly increased, and the provocation test was positive. Imaging and radionuclide imaging examinations can help detect tumors.

Those who find tumors should undergo active surgery; somatostatin and analogues, serotonin antagonists, etc. can be used for medical treatment.

Triad of intracranial hypertension (headache, vomiting and papilledema), abducens nerve palsy and diplopia, disturbance of consciousness, convulsions, decerebrate tonic seizures, changes in vital signs (increased blood pressure, slow pulse, deep and slow breathing, pupils not complete). CSF pressure >200 mm H2O.

Actively treat the cause and quickly lower intracranial pressure. Once cerebral herniation occurs, immediately intravenous infusion or injection of dehydrating agent, and surgical decompression if necessary.

myasthenic crisis

cholinergic crisis

Counterattack crisis

Keep the respiratory tract unobstructed, and perform positive-pressure breathing through tracheal intubation at appropriate times; desiccation therapy (i.e., immediately stop all anticholinesterase drugs under the conditions of positive-pressure oxygen supply and controlled breathing through tracheal intubation); high-dose hormone therapy; plasma exchange therapy ; Control infection and eliminate triggers.

A severe movement disorder that occurs in patients with Parkinson's disease, characterized by prolonged inability to move

The main treatment is to give adequate amounts of dopamine preparations.

During the treatment of patients with post-encephalitic shaking paralysis and antipsychotic drugs, it is an involuntary eye muscle spasm movement of the eyes upward or to one side.

Administer adequate amounts of anticholinergics and dopamine supplements in a timely manner.

Patients with a history of chronic hemolysis experience sudden chills and high fever, low back pain, oliguria and anuria, bleeding tendency, aggravation of anemia, deepening of jaundice, drop in blood pressure, and obvious enlargement of the liver and spleen. Laboratory tests suggest: increased red blood cell destruction (increased hemoglobin metabolites, increased plasma hemoglobin content, shortened red blood cell life, and compensatory proliferation of the red blood cell system).

Immediate use of glucocorticoids, blood transfusion, prevention and treatment of renal failure (early use of mannitol, furosemide), and elimination of causes and incentives.

Patients with original hemorrhage and coagulation dysfunction suddenly develop persistent bleeding (continuous bleeding from skin, mucous membranes, joints, internal organs, or minor trauma surgery). Laboratory tests: Abnormal routine items (platelet count and release, coagulation time and clot shrinkage time, capillary fragility test), abnormal coagulation factor preliminary screening test.

For bleeding caused by vascular factors, local bleeding should be stopped immediately and drugs to reduce capillary fragility should be administered; for bleeding caused by platelet factors, glucocorticoids and platelet transfusion should be administered; for bleeding caused by coagulation factor deficiency, the missing coagulation factors should be supplemented.

Patients with original abnormal platelet quantity and/or quality may unexpectedly and spontaneously experience subcutaneous and mucosal bleeding, and may have persistent bleeding from the gastrointestinal tract, respiratory tract, genitourinary tract or trauma surgery. In severe cases, the adrenal cortex and intracranial bleeding may also occur. Laboratory tests: significant decrease in platelets, positive capillary fragility test, prolonged bleeding time, abnormal platelet adhesion test and platelet aggregation test, and poor blood clot retraction.

On the basis of active treatment of the primary disease, fresh blood and/or platelet suspension should be immediately transfused, glucocorticoids, immunosuppressants, and hemostatic agents should be applied, and splenectomy should be performed if necessary.

The sudden onset of anemia and fatigue worsens, with fever, nausea and vomiting, pale complexion, weakness, rapid pulse, and decreased blood pressure. Laboratory examination showed anemia, pancytopenia, and bone marrow-like erythroid cell maturation disorder.

Actively control the infection and stop suspected drugs immediately; appropriate blood transfusion, folic acid and compound vitamin B supplementation; in severe cases, hematopoietic cell growth factors can be given.

HS patients rapidly develop macrocytic anemia, a significant increase in bone marrow red blood cells, and a decrease in serum folate.

On the premise of actively treating HS, supplement enough folic acid.

The condition of patients with chronic myelogenous leukemia changes drastically, and a large number of blasts appear in the bone marrow and blood, with blasts and promyelocytes ≥90%.

Treated as acute leukemia.

This crisis should be considered when vascular infarction, splenic infarction, aplastic crisis, megaloblastic crisis, or hemolytic crisis occurs.

Different treatment methods are adopted according to the type of crisis.

The patient's blood pressure suddenly and significantly increased to 250/130 mm Hg (1 mm Hg= 0.133 kPa), accompanied by severe headache, dizziness and nausea, chest tightness and palpitations, blurred vision, dry mouth and sweating, and trembling hands and feet; target organ damage and acute myocardial infarction may be present. Ischemia, acute left heart failure, acute renal failure, hypertensive encephalopathy, acute stroke.

Antihypertensive drugs are administered intravenously to rapidly reduce blood pressure, with a blood pressure control target of 160/100 mm Hg, to protect target organs and deal with organ dysfunction.

Body temperature >40.6℃, convulsions, coma, shock, bleeding, respiratory and renal failure.

Cooling (physical cooling: ice water bath, application of ice caps, ice packs, and ice blankets; drug cooling: indomethacin, glucocorticoids; artificial hibernation; acupuncture at acupoints); sedation of convulsions (diazepam, barbiturates); correction of water and electrolyte acid-base Disturbances in balance.

Patients with systemic lupus erythematosus develop rapidly progressive lupus nephritis, severe central nervous system damage, severe heart damage, severe lupus hepatitis, severe lupus pneumonia, severe vasculitis, hemolytic anemia, thrombocytopenic purpura, and agranulocytosis. etc., all should consider that a lupus crisis has occurred.

Methylprednisolone pulse therapy, intravenous infusion of high-dose human immune globulin, and symptomatic treatment.

The color of the transplanted skin flap becomes darker, cyanosis, temperature drops, skin striae disappear, skin flap swells, texture becomes hard, capillary refill test and acupuncture test are abnormal.

Surgical exploration and re-anastomosis of blood vessels.

Patients with late-stage neurosyphilis suddenly develop upper abdominal pain, nausea, and vomiting, which may stop suddenly or last for hours or even days, and often occur repeatedly.

Treat symptomatically.

Patients with scleroderma present with proteinuria, hematuria, hypertension, azotemia, and decreased creatinine clearance; severe cases show rapid progression of malignant hypertension, that is, severe headache, nausea and vomiting, decreased vision, convulsions, and/or Acute renal failure.

To treat underlying diseases, apply ACEI early, and if necessary, add acetaminophen or prazosin, and perform dialysis treatment for renal failure.

In addition to manifestations of Meniere's disease (episodes of vertigo, fluctuating In addition to progressive deafness, tinnitus, and ear fullness), The patient may collapse suddenly but remains conscious.

It is often used to regulate autonomic nervous function, improve inner ear microcirculation, Comprehensive drug treatment focusing on relieving labyrinth hydrops.