Diabetes and Endocrinology

Adult conditions

Pancreatic disease

• Diabetic ketoacidosis - A
• Diabetes and severe vomiting -A
• Acute severe hyperglycaemia
• Acute severe hypoglycaemia -A
• Hyperosmolar hyperglycaemic state (HHS) -A
• Newly diagnosed type 1 diabetes –B (call registrar or consultant on call)
• Foot ulcer with infection and systemically unwell or febrile -A
• Invasive infection or rapidly spreading cellulitis of the foot (defined by peripheral redness around the wound >2cm) -A
• Acute foot ischaemia -A
• Wet gangrene foot -A

Urgent cases – (refer to key below)
A – client to present to emergency department immediately
B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, present to an emergency department.

High Risk Foot

• Foot ulcer with infection and systemically unwell or febrile
• Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
• Acute ischaemia
• Wet gangrene
• Acute or suspected Charcot

Thyroid disorders

• Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
• Neutropenic sepsis in patient taking carbimazole or propylthiouracil
• Hyperthyroidism with hypokalaemia or paralysis
• Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
• Stridor associated with a thyroid mass
• Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement

Adrenal disease

• Addisonian crisis
• Suspected or confirmed acute adrenal insufficiency
• Phaeochromocytoma in crisis with uncontrolled hypertension

Pituitary disorders

• All patients with visual field loss (usually temporal and classically bitemporal superior quadrantinopia/hemianopia)
• Pituitary tumour with severe headache
• Pituitary tumour with evidence of symptomatic cortisol insufficiency
• Hyperprolactinaemia with visual impairment or other neurological signs

Oligo/amenorrhoea, hirsutism, acne, female infertility

• Signs in the central nervous system that could indicate a pituitary tumour (visual field defect headaches)

Calcium, electrolyte and metabolic bone disorders

• Acutely symptomatic hypocalcaemia (e.g. tetany) with serum calcium <2.0mmol/L
• Severe symptomatic hypercalcaemia (usually serum calcium > 3.0 mmol/l)
• Hypernatraemia or hyponatraemia with acute confusion/delirium
• Suspected or confirmed diabetes insipidus with hypernatraemia

Paediatric Conditions

Paediatric diabetes

• New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
• Ketoacidosis in a known diabetic with any of the following
  
  • systemic symptoms (fever, lethargy) or
  • vomiting or
  • inability to eat (even if not vomiting) or
  • abdominal pain or
  • headache

Growth failure

• Suspected pituitary mass (visual field loss/CNS signs)
• Addisonian crisis (including unexplained hyponatraemia & hypoglycaemia)
• Myxoedema coma
• New onset diabetes insipidus (including unexplained hypernatraemia)
• Hypocalcaemia (including acute rickets) with seizures