If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) 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
- Malignant 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
