ADULT GERONTOLOGY ACUTE CARE 621 KEY
CONCEPTS AND REVIEW NOTES 2026
◉ HYPERthyroidism/Grave's. Answer: TSH LOW, T3 High, Grave's
Disease, bulgy eyes, weight loss, fine thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
◉ Thyroid crisis. Answer: PTU or Methimazole with adjunct within 1
hour Lugol's propranolol, hydrocortisone
No ASA
◉ Hypothyroidism. Answer: (TSH assay most sensitive test) TSH
ELEVATED, T4 LOW
hasimototo's most common, LOW AND SLOW, cold intolerance,
weight fain, brittle nails, brady, hypoactive BS, Levothyroxine 50-
100mcg
◉ Myxedema Coma. Answer: AIRWAY, fluid replacement PRN,
levothyroxine 400mcgIVx1
◉ Subacute thyroiditis. Answer: Treated symptomatically with
propanonlol
,◉ Pheocromocytoma. Answer: Labile hypertension, TSH normal,
postural hypotension, plama-free metanephrines to rule out, CT to
confirm, surgical removal, postop: hypotension, adrenal
insufficiency, hemorrhage
urine catecholamines, alpha blockers phentolamine
◉ DKA. Answer: -intracellular dehydration, kussmaul,
hyperglycemia >250, ketonemia, hyperkalemia
Management: 1L first hour>500ml/hr, 0.1/kg/hr, glucose <250
change to D51/2
when switching to subq insulin, inititate subQ insulin 2-3 hours
prior to stopping insulin drip
◉ HHNK (Hyperosmolar Hyperglycemic NON KETOSIS). Answer:
Type 2 DM, super elevated glucose >600, hyperosmolar >310,
normal anion gap, elevated hgbA1c, normal pH
Management: massive fluid replacement, overall deficit usually 6-
10L, 15U regular insulin IV followed by 10-15U subq
,◉ Dawn Phenomenon. Answer: "Dawn Rising", elevated glucose at
night and high in AM, increase the bedtime dose of insulin
◉ Somogyi Effect. Answer: Nocturnal hypoglycemia, elevated
glucose at 0700 due to rebound, reduce or omit bedtime dose (need
to know the glucose in the middle of the night)
◉ Serum Cr. Answer: .5-1.5, most sensitive renal marker
◉ BUN. Answer: 10-20, can fluctuate independent of creatinine and
due to specific causes (i.e. GI bleed/dehydration)
◉ Normal fasting glucose level. Answer: 60-99
◉ Type I DM. Answer: HLA-DR3/DR4 association, ketone
development, islet cell antibodies
Polyuria, polydipsia, polyphagia, random plasma glucose >200,
impaired glucose tolerance 100-125, bring back in to repeat test
Consult dietary, if ketones present need insulin 0.5u/kg/day 2/3 AM
1/3 PM
, ◉ Type II DM. Answer: Obesity and syndrome X, skin infections,
recurrent vaginitis, no ketones present in blood/urine, start with
weight control and diet
Sulfonylureas most widely prescribed stimulate pancreas to make
more insulin
Biguanides- adjust for sulfonyurleas but cannot be used alone-
Metformin-standard of care with diagnosis of Type 2 lactic acidosis
is a side effect
◉ Syndrome X. Answer: Obesity, hypertension, abnormal lipid
profile
◉ WHO ladder of pain management. Answer: 1. Start with non
opioid
2. maintain initial + opioid,
3. don't lose the initial non-opioid and add stronger pain medication
(morphine, hydromorphone, fentanyl, etc)
breakthrough pain= fentanyl patch
◉ Non-infectious Post operative fever. Answer: Ask what do his
lungs sound like?
CONCEPTS AND REVIEW NOTES 2026
◉ HYPERthyroidism/Grave's. Answer: TSH LOW, T3 High, Grave's
Disease, bulgy eyes, weight loss, fine thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
◉ Thyroid crisis. Answer: PTU or Methimazole with adjunct within 1
hour Lugol's propranolol, hydrocortisone
No ASA
◉ Hypothyroidism. Answer: (TSH assay most sensitive test) TSH
ELEVATED, T4 LOW
hasimototo's most common, LOW AND SLOW, cold intolerance,
weight fain, brittle nails, brady, hypoactive BS, Levothyroxine 50-
100mcg
◉ Myxedema Coma. Answer: AIRWAY, fluid replacement PRN,
levothyroxine 400mcgIVx1
◉ Subacute thyroiditis. Answer: Treated symptomatically with
propanonlol
,◉ Pheocromocytoma. Answer: Labile hypertension, TSH normal,
postural hypotension, plama-free metanephrines to rule out, CT to
confirm, surgical removal, postop: hypotension, adrenal
insufficiency, hemorrhage
urine catecholamines, alpha blockers phentolamine
◉ DKA. Answer: -intracellular dehydration, kussmaul,
hyperglycemia >250, ketonemia, hyperkalemia
Management: 1L first hour>500ml/hr, 0.1/kg/hr, glucose <250
change to D51/2
when switching to subq insulin, inititate subQ insulin 2-3 hours
prior to stopping insulin drip
◉ HHNK (Hyperosmolar Hyperglycemic NON KETOSIS). Answer:
Type 2 DM, super elevated glucose >600, hyperosmolar >310,
normal anion gap, elevated hgbA1c, normal pH
Management: massive fluid replacement, overall deficit usually 6-
10L, 15U regular insulin IV followed by 10-15U subq
,◉ Dawn Phenomenon. Answer: "Dawn Rising", elevated glucose at
night and high in AM, increase the bedtime dose of insulin
◉ Somogyi Effect. Answer: Nocturnal hypoglycemia, elevated
glucose at 0700 due to rebound, reduce or omit bedtime dose (need
to know the glucose in the middle of the night)
◉ Serum Cr. Answer: .5-1.5, most sensitive renal marker
◉ BUN. Answer: 10-20, can fluctuate independent of creatinine and
due to specific causes (i.e. GI bleed/dehydration)
◉ Normal fasting glucose level. Answer: 60-99
◉ Type I DM. Answer: HLA-DR3/DR4 association, ketone
development, islet cell antibodies
Polyuria, polydipsia, polyphagia, random plasma glucose >200,
impaired glucose tolerance 100-125, bring back in to repeat test
Consult dietary, if ketones present need insulin 0.5u/kg/day 2/3 AM
1/3 PM
, ◉ Type II DM. Answer: Obesity and syndrome X, skin infections,
recurrent vaginitis, no ketones present in blood/urine, start with
weight control and diet
Sulfonylureas most widely prescribed stimulate pancreas to make
more insulin
Biguanides- adjust for sulfonyurleas but cannot be used alone-
Metformin-standard of care with diagnosis of Type 2 lactic acidosis
is a side effect
◉ Syndrome X. Answer: Obesity, hypertension, abnormal lipid
profile
◉ WHO ladder of pain management. Answer: 1. Start with non
opioid
2. maintain initial + opioid,
3. don't lose the initial non-opioid and add stronger pain medication
(morphine, hydromorphone, fentanyl, etc)
breakthrough pain= fentanyl patch
◉ Non-infectious Post operative fever. Answer: Ask what do his
lungs sound like?
