Endocrine Abstracts

Aim: To compare the use of glitazones against NICE guidelines. (Glitazone recommended as second line therapy in combination with metformin or sulfonyl urea in patients with intolerance or contra-indications to any of the two, not as monotherpay or triple therapy or in combination with insulin).Methods: Patients on glitazone therapy (n=60) were randomly identified from a pharmacy data base from August to December 2006. Retrospective case note revie...

We report the case of a 42-year-old transsexual with Di-George syndrome (DGS) presenting in adulthood with profound hypocalcaemia and personality disorder. The patient had multiple hospital admissions with episodes of deliberate self-harm and recurrent seizures. Routine investigations revealed hypocalcaemia secondary to hypoparathyroidism. The diagnosis of DGS was delayed until six years later. The clue to the underlying condition was the finding of DGS in the patient’s d...

Introduction: The global migration of healthcare professionals has enabled those trained in low-and-middle income countries (LMICs) to move and work in high-income countries (HICs) and vice-versa. While medical licensing exams in HICs are designed to assess competency of the immigrating HCPs, there is limited literature on the differences in approach to manage clinical cases between those from LMIC and HIC. Simulation via Instant Messaging – Birmingham Advance (SIMBA) is ...

65-year-old lady presents to GP with 3-month history of fatigue, weight loss and nausea with background of stable Chronic Lymphocytic Leukaemia (CLL). GP started Levothyroxine 25 mg OD due to low T4 of 5.9 pmol/l (12-22) and low TSH of 0.25 mU/l (0.27-4.2). As she continued to feel tired, random cortisol was requested which was low at 25nmol/l leading to admission. Admission cortisol was 55nmol/l with an inappropriately normal ACTH of 11.6 ng/l (7.2-63.3). Pituitary profile sh...

Introduction: Simulation via Instant Messaging – Birmingham Advance (SIMBA) is a simulation-based training model shown to have increased clinicians’ confidence in managing cases in diabetes and endocrinology, as well as sustained clinical knowledge.1 Traditional simulation models have typically focussed on a specific group of healthcare professionals. We evaluated if there is a difference in performance between different training groups during SIMBA.<p...

Prompt, effective and safe management of Diabetic Ketoacidosis (DKA) is key to reducing mortality rate and length of stay. An Integrated care pathway (ICP) Pro-forma for DKA management during the first 24 hrs, based on a modified JBDS guideline was introduced in the trust. DKA management based on the pro-forma between Nov 17 to Feb 18 was audited; focussing on fluid management in terms of timing and electrolyte replacement, CBG monitoring, faster senior reviews, HDU admissions...

Introduction: Inpatient hypoglycaemia management remains a significant challenge. An audit in 2009 revealed poor understanding (“recognition” by frontline staff) of the need to treat and manage hypoglycaemia. Consequently a management protocol, documentation sheet and hypoboxes with standardized quantities (15 g) of dextrose in various forms were introduced throughout the hospital.Aims: We re-audited inpatient hypoglycaemia management and the i...

Introduction: Inappropriate meal to insulin timing, poor appetite, tight glycaemic control, cardiac, renal or hepatic impairment and sepsis are seen in association with hypoglycaemia. Poor understanding of these risks and management of hypoglycaemia(hypo) remain challenging. Hypo management guidelines and hypoboxes with standardized 15 g of dextrose in various forms were introduced throughout the hospital in November 2010 after an audit in 2009 revealed poor understanding of t...

Hypoglycaemia is defined as capillary blood glucose (CBG) of ≤4 mmol/l irrespective of symptoms. We audited the recognition and management of inpatient hypoglycaemia with a view to identify potential areas for improvement.Methods: A total of 120 inpatients with diabetes were identified in the hospital on a single day, of whom n=32 had ≥1 episode(s) of hypoglycaemia, as evidenced by their CBG. Data relating to recognition and management...

A 48 years old male presented with an acute episode of dizziness, weakness, diaphoresis, palpitations, and shakiness. Hypoglycaemia was confirmed with a CBG of 1.6 mmol/L. His symptoms resolved on treatment with Hypostop gel and 10% dextrose. He had an otherwise unremarkable physical examination. In view of his history of consumption of a bottle of vodka daily a diagnosis of alcohol induced hypoglycaemia was made on discharge. A year later he was found being agitated and aggre...