• The reason for admission
• Patient’s age
• Patient’s likely discharge date

Diabetes:

• Type of Diabetes (type 1 or type 2)
• Duration of Diabetes and macro/microvascular complications
• Current diabetes regimen include type of insulins and doses
• Usual/at home medication regimen – orals, insulin (and doses are important)
• HbA1c in the last 3 months?
• Specialist or GP care
• Pattern of BSaLs in hospital including any hypos
• Current feeding regimen – NBM, EN, Parenteral feeds, and whether any changes planned
• Steroids and what is likely regimen going forward
• Any planned procedures e.g. surgery, angiogram
• Renal or liver function impairment
• Cognition – is the patient currently coping with DM at home and would they cope with insulin or do they have a carer. Brief social History – i.e. lives alone or has supports
• Following up correspondence from relevant GP or specialist

Hyponatraemia:

• Symptoms – to suggest a cause (e.g. vomiting/diarrhoea) or symptoms to suggest there is neurological compromise
• Acute versus chronic – i.e. the trajectory of sodium; when was the cortisol last normal? (which may need getting bloods from LMO)
• Past medical history
• Medications

Cortisol deficiency:

• Previous history of adrenal or pituitary disorder
• History of recent infection, weight loss, postural dizziness, vomiting?
• Setting: is this patient acutely unwell?
• Any associated autoimmune conditions?

Thyroid disorder:

• Symptoms
• Past medical history
• Recent TFTs
• Medications – in particular thyroxine or carbimazole, amiodarone or IV contrast

Diabetes:

• QID if eating or q4-q6h if NBM readings. Fasting glucose levels and some pre plus 2 hour post-meal paired tests.
• HbA1c (if not done in past 2-3 months and if no blood loss to confound result) or obtain from LMO.
• BP and fasting lipids useful.
• LFT and UEC useful in choosing medication regime.
• Patient weight, height.
• Referral to diabetes educator and dietitian if appropriate.

Hyponatraemia:

• Fluid status – including postural BP
• Serum Na and osmolality
• Urine Na and osmolality (paired with serum)
• TSH
• Cortisol
• eGFR
• Weight trend

Cortisol deficiency:

• Morning cortisol and ACTH (paired) – but if haemodynamically unstable –  draw blood for cortisol and ACTH at any time, and start empirical GC without waiting for result, with discussion with senior colleagues – so this is related to setting.
• Blood pressure (including postural)
• Medications – any GC exposure: oral, inhalers, eye drops, IA
• Serum electrolytes

Thyroid disorders:

• Clinical assessment of thyroid activity – is the thyroid palpable? Tender? Is there clinical evidence of hyper/hypothyroidism? Obstructive symptoms?
• TSH, T4 and T3 level
• As appropriate TPO, TRab

• Information sourced from the GP/endocrinologist/pharmacist.
• If the JMO had formed a clinical impression and considered how they might manage the patient.
• Use ISBAR as initial structure; this is the situation (admission and current issue), and suggested management plan to discuss further guidance on that endocrine aspect of the case.

• Not taking history themselves and relying on power chart notes.
• For BGL control – lack of HbA1c, no blood glucose readings, no history from GP, wrong insulin eg humalog vs humalog mix.
• For hyponatraemia – need to order paired urine and serum tests, not examining fluid status, ordering both FT4 and TSH – to exclude secondary hypothyroidism, ordering cortisol/ACTH.
• For thyroid disorders – not examining the patient clinically, not knowing the recent TFT results.