الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Endocrinal emergencies are considered one of the most important challenges that may face the anesthiologist.
Diabetic ketoacidosis Manifested by nausea, vomiting, abdominal pain, Kussmaul’s respiration and there may be disturbance of consciousness up to coma. The treatment includes fluid replacement, insulin therapy with care to potassium monitoring, bicarbonate may be needed.
Hypoglycemic coma is a serious condition characterized by low blood glucose level, sympathetic nervous system stimulation and CNS dysfunction. Management by glucagons and glucose adminstration orally if the patient is conscious or intravenously if the patient is comatosed.
Nonketotic hyperosmolar syndrome occurs in type 2 D.M. and is manifested by altered consciousness varying from confusion or disorientation to coma, usually as a result of extreme dehydration, polyuria, tachycardia and hypotension. Management includes fluid replacement, insulin and electrolyte replacement especially potassium.
Thyroid storm is a life threatening condition, which occurs due to acute increase in the level of thyroid hormones in blood causing fever, tachycardia and some CNS and GIT symptoms. Management should be in an appropriate place as high dependency unit, it includes infusion of cold crystalloids, beta blockers, antithyroid drugs, corticosteroids and close monitoring of the patient.
Myxedema Coma occurs due to severe decrease in the level of thyroid hormones in blood causing bradycardia, hypotension, hypothermia, hypoglycemia, hypoventilation, decreased tolerance to cold and disturbed conscious level up to coma.
For patients with thyroid disease, it is fundamental to ensure that patients are clinically and chemically euthyroid prior to embarking on elective thyroid surgery.
Pheochromocytoma Occurs as a result of increased secretion of adrenaline, noradrenaline and dopamine from adrenal medulla tumours, causing severe hypertension and tachyarrhythmia, which may be fatal. Preoperative and intraoperative preparation with α blockers as phenoxybenzamine and β blockers as propranolol, with good intraoperative monitoring of blood pressure, pulse and ECG is a must.
Addissonian crisis Occurs due to decreased secretion of hormones of adrenal cortex. It is either primary, due to destruction of adrenal cortex, or secondary, due to sudden withdrawal of steroid therapy. Manifestations include severe abdominal and leg pain, muscle weakness, hypotension and hypoglycemia. Management usually includes gluco-corticoids hydrocortisone, IV fluid therapy and dopamine and noradrenaline drugs.
Carcinoid crisis is characterized by a sudden and profound DROP in blood pressure, tachycardia, hyperglycemia and bronchspasm and may cause death. Good preparation of the patient by α blockers, β blockers, IV fluid replacement, bronchodilators, antihistaminics in addition to octreotide drugs.
Parathyroid crisis is characterized by severe hypercalcemia, with associated signs and symptoms involving multiple organ systems, collapse and coma. Treatment includes Rehydration, Forced saline diuresis, Biphosphonates, Calcitonin, and Dialysis