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adrenal differential endocrinology insufficiency hypokalemia potassium acth causes evaluation laboratory clinicopathology cushing hyperfunction hyponatremia lazy nephrology perioperative preop preoperative risk
Adrenal Insufficiency Differential Diagnosis Algorithm Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Algorithm Clinical ... , hypoglycemia Testing ... hormone (ACTH) stimulation ... test AND • Baseline ... plasma ACTH Low
Diagnosis Adrenal Insufficiency - Algorithm Step 1) Screening Test: 6-8AM Cortisol Level - Early morning cortisol levels
Insufficiency - Algorithm ... specificity for AI (but low ... require Cosyntropin testing ... : Cosyntropin Stimulation ... - Low ACTH is
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH Early am cortisol < 3
Algorithm - Evaluation ... then go to stim testing ... Standard Stim test ... primary AI - Low ... #Stimulation #Test
Primary Adrenal Insufficiency: • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
between 8 and 9 AM - Low ... aldosterone - Low ... Plasma ACTH - Low ... Evaluation #laboratory #diagnosis ... #testing #endocrinology
Hypokalemia - Differential Diagnosis Algorithm Transcellular Shift: • Alkalosis • ↑ beta-2 adrenergic simulation • Erythropoiesis
- Differential Diagnosis ... Algorithm Transcellular ... beta-2 adrenergic simulation ... • GI losses (NG ... vomiting) • Low
Cushing Syndrome Testing Algorithm INDICATIONS FOR TESTING: • Suspected Cushing syndrome (central obesity, muscle weakness, refractory hypertension) Testing:
Algorithm INDICATIONS ... Cortisol, Saliva • Low ... dexamethasone suppression test ... Cushing #Syndrome #diagnosis ... #algorithm #endocrinology
Hypokalemia - Differential Diagnosis Poor Intake - Starvation - Anorexia GI Losses - Vomiting / NG
- Differential Diagnosis ... - Vomiting / NG ... type 4) - Salt wasting ... #Low #Potassium ... #Table #Classification
A lazy man's classification of hyponatremia There are two possible approaches to the diagnosis of hyponatremia: .
A lazy man's classification ... approaches to the diagnosis ... essentially the same tests ... cerebral salt wasting ... #Algorithm #Differential
Preoperative Risk Evaluation Major Pre-Op Questions: 1. Does the patient have any modifiable risk factors that could be
event, follow ACC algorithm ... determine if stress test ... Orthopedic • Low ... surgery Stress Testing ... stratification #diagnosis
Causes of Hypokalemia I. Decreased intake A. Starvation B. Clay ingestion II. Redistribution into
Downstream stimulation ... diuresis, salt-wasting ... #Differential #Diagnosis ... #Low #Potassium ... #Classification
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