Martucci Gennaro, Bonicolini Eleonora, Parekh Dhruv, Thein Onn Shaun, Scherkl Mario, Amrein Karin
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy.
Critical Care, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.
Semin Respir Crit Care Med. 2021 Feb;42(1):78-97. doi: 10.1055/s-0040-1713084. Epub 2020 Sep 3.
This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.
本综述旨在概述重症医学领域中的代谢和内分泌挑战。这些是一组具有高度重叠性的异质性临床病症，伴有非特异性体征和症状。几种疾病累及多个器官系统，可能导致灾难性功能障碍和死亡。在大多数情况下，内分泌挑战伴随其他器官衰竭出现，或表现为长期入住重症监护病房及营养不良的并发症。然而，当内分泌紊乱表现为孤立综合征时，它们是罕见且极端的表现形式。由于它们不常见，通常在诊断和管理方面都会带来挑战。急性加重可能由感染、创伤、手术和出血等诱因引发。在这种复杂情况下，早期诊断和及时治疗需要了解特定的内分泌综合征。在此，我们回顾糖尿病昏迷、低钠血症、高钙血症、甲状腺急症、垂体功能不全、肾上腺危象和维生素D缺乏，通过明确常见临床表现来突出诊断工具和技巧以及管理途径。
