13 results
Adrenal Insufficiency Differential Diagnosis Algorithm
Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Differential Diagnosis Algorithm ... , hypotension, hyponatremia ... , hypoglycemia Testing ... ACTH) stimulation test ... • Low or normal
Modified Hyponatremia Algorithm
Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants
Hypotonic Hyponatremia: 
 • ADH ON (UOsm > 100):
Algorithm Hypertonic ... Hypothyroidism, Adrenal insufficiency ... Cerebral salt wasting ... Primary polydipsia, Low ... #sodium #nephrology
Hyponatremia Diagnosis Algorithm
UOsm ≥ POsm - Vasopressin-Dependent
 • UNa < 20 mEq/L - Appropriate (↓ EABV)
Hyponatremia Diagnosis ... Algorithm UOsm ... Primary polydipsia, Low ... intake, Renal insufficiency ... #causes #nephrology
Hyponatremia Differential Diagnosis Algorithm - Utilizing Uric Acid 
ADH promotes Urea/uric acid excretion along with water
Hyponatremia Differential ... Diagnosis Algorithm ... Acid → renal salt wasting ... #nephrology #sodium ... #low #uricacid
Hyponatremia - Differential Diagnosis Algorithm
ADH Independent:
 • Tea and Toast Syndrome, Beer Potomania - Low solute
Hyponatremia - Differential ... Diagnosis Algorithm ... Beer Potomania - Low ... Hypothyroidism, adrenal insufficiency ... #causes #nephrology
Primary Adrenal Insufficiency:
 • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
between 8 and 9 AM - Low ... aldosterone - Low ... cases in which injury ... Plasma ACTH - Low ... laboratory #diagnosis #testing
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH

Early am cortisol < 3
Adrenal Insufficiency ... Diagnosis Algorithm ... then go to stim testing ... Standard Stim test ... primary AI - Low
Volume Based Approach to Hyponatremia
Hypovolemic, Serum uric acid >4
 • Urine Na <20: Extra-renal losses
 •
Based Approach to Hyponatremia ... Cerebral salt wasting ... Hypothyroidism, Low ... #algorithm #diagnosis ... #sodium #low #nephrology
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... can be high or low ... Hypothyroidism, Adrenal Insufficiency ... Cerebral Salt Wasting ... table #sodium #nephrology
Diagnosis Adrenal Insufficiency - Algorithm

Step 1) Screening Test: 6-8AM Cortisol Level
 - Early morning cortisol levels
Diagnosis Adrenal Insufficiency ... - Algorithm ... specificity for AI (but low ... require Cosyntropin testing ... - Low ACTH is