If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Adult conditions
Pancreatic disease
- Diabetic ketoacidosis - A
- Diabetes and severe vomiting -A
- Acute severe hyperglycaemia
- Acute severe hypoglycaemia -A
- Hyperosmolar hyperglycaemic state (HHS) -A
- Newly diagnosed type 1 diabetes –B (call registrar or consultant on call)
- Foot ulcer with infection and systemically unwell or febrile -A
- Invasive infection or rapidly spreading cellulitis of the foot (defined by peripheral redness around the wound >2cm) -A
- Acute foot ischaemia -A
- Wet gangrene foot -A
Urgent cases – (refer to key below)
A – client to present to emergency department immediately
B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, present to an emergency department.
High Risk Foot
- Foot ulcer with infection and systemically unwell or febrile
- Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
- Acute ischaemia
- Wet gangrene
- Acute or suspected Charcot
Thyroid disorders
- Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
- Neutropenic sepsis in patient taking carbimazole or propylthiouracil
- Hyperthyroidism with hypokalaemia or paralysis
- Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
- Stridor associated with a thyroid mass
- Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement
Adrenal disease
- Addisonian crisis
- Suspected or confirmed acute adrenal insufficiency
- Phaeochromocytoma in crisis with uncontrolled hypertension
Pituitary disorders
- All patients with visual field loss (usually temporal and classically bitemporal superior quadrantinopia/hemianopia)
- Pituitary tumour with severe headache
- Pituitary tumour with evidence of symptomatic cortisol insufficiency
- Hyperprolactinaemia with visual impairment or other neurological signs
Oligo/amenorrhoea, hirsutism, acne, female infertility
- Signs in the central nervous system that could indicate a pituitary tumour (visual field defect headaches)
Calcium, electrolyte and metabolic bone disorders
- Acutely symptomatic hypocalcaemia (e.g. tetany) with serum calcium <2.0mmol/L
- Severe symptomatic hypercalcaemia (usually serum calcium > 3.0 mmol/l)
- Hypernatraemia or hyponatraemia with acute confusion/delirium
- Suspected or confirmed diabetes insipidus with hypernatraemia
Paediatric Conditions
Paediatric diabetes
- New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
- Ketoacidosis in a known diabetic with any of the following
- systemic symptoms (fever, lethargy) or
- vomiting or
- inability to eat (even if not vomiting) or
- abdominal pain or
- headache
Growth failure
- Suspected pituitary mass (visual field loss/CNS signs)
- Addisonian crisis (including unexplained hyponatraemia & hypoglycaemia)
- Myxoedema coma
- New onset diabetes insipidus (including unexplained hypernatraemia)
- Hypocalcaemia (including acute rickets) with seizures
