Metabolic Illness and Endocrinopathies

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the metabolic illness and endocrinopathies. In 2009, the NICE SUGAR trial suggested that trauma patients were found to be in a subgroup of critically ill patients that benefited from tight glucose control with a range of 81 to 108 mg/dL. Patients undergoing subtotal parathyroidectomy may only require oral calcium and vitamin D supplementation, while those patients undergoing total parathyroidectomy with/without reimplantation usually require more aggressive calcium replacement therapy. An Addisonian crisis, or hypocortisolism, consists of hypotension, vomiting and diarrhea, hyperkalemia, hypercalcemia, hypoglycemia, fever, syncope, lethargy, and possible abdominal pain. The cardiovascular effects of thyrotoxicosis can be severe and are treated with a beta-blocker. While the level of ketonemia is not known, there is lack of significant metabolic acidosis. Urine creatinine, desmopressin challenge, or a corticotropin stimulation test will not aid in making the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH).