Ticking Time Bombs

Several of the conditions discussed here can easily be overlooked because they may present, at least initially, with non-concerning symptoms. However, they have the ability to cause serious harm. Remember,

  • Address abnormal vital signs or have a cohesive explanation as to why you are not addressing them.
  • Abnormal vital signs without a clear explanation, as well as vital signs that do not resolve with treatment, should prompt expanded consideration of the patient’s complaint, further investigation, and likely both.
  • Bad things happen and even healthy people get sick.

 

Adrenal Crisis

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Adrenal crisis is a life-threatening emergency due to an acute deficiency of adrenocortical hormones, namely cortisol and aldosterone, which can be fatal if not diagnosed early and treated aggressively. Classically it presents as severe hypotension refractory to IV fluids and vasopressors.

Diagnostic Criteria:

  • Hypoglycemia
  • Hyponatremia (<135mEq/L)
  • Hyperkalemia (>5mEq/L)
  • Non-anion gap metabolic acidosis
  • Low bicarbonate (15-20mEq/L)
  • Elevated BUN and creatinine