When to Escalate
Begin with Safety, Baseline, and Scope
Endocrine disorders can change a patient’s level of consciousness, circulation, hydration, and glucose supply to the brain before a specific diagnosis is known.
Endocrine disorders can change a patient’s level of consciousness, circulation, hydration, and glucose supply to the brain before a specific diagnosis is known. Start with appearance and stability: mental status, airway protection, respiratory effort, heart rate, blood pressure, temperature, oxygen saturation, pain, and ability to swallow. A patient who suddenly becomes diaphoretic, tremulous, confused, or unusually irritable needs a prompt bedside glucose check while help is obtained. Hypoglycemia can progress from adrenergic symptoms—sweating, palpitations, anxiety, and tremor—to neuroglycopenic symptoms such as confusion, behavior change, seizure, or coma. If the patient is unconscious, having a seizure, or cannot swallow safely, do not give food or fluid by mouth. Activate the emergency or hypoglycemia protocol and obtain urgent assistance. Weight, intake and output, and vital-sign trends add context that one isolated measurement cannot provide. Unexpected weight loss may reflect inadequate insulin effect, hyperthyroidism, or adrenal insufficiency. Rapid weight gain, edema, or falling urine output may reflect fluid retention or another systemic process. When orthostatic vital signs are ordered or indicated by symptoms, use fall precautions because dizziness and volume depletion raise the...