Sepsis and Septic Shock (Clinical)
Overview Definitions Epidemiology[2,5] Risk factors[2,5,14] Etiology and Pathophysiology Etiology[2,5] Pathophysiology[2,5] Pathogen load and virulence + host genetic composition and comorbidities result in a complex, exaggerated, and prolonged host response to infection that evolves over time. Clinical Presentation Diagnosis General approach[2,3,6,9,13,14,16] Diagnostic criteria Criteria for sepsis:[9] Criteria for septic shock:[9] SOFA score:[6,9] Table: SOFA score[1,6,9] Organ/system […]
Neutropenic Fever (Clinical)
Overview Definition[1,6] Neutropenic fever is defined as a single oral temperature > 38.3 ℃ (101 ℉) or a temperature > 38.0℃ (100.4℉) for at least 1 hour with an absolute neutrophil count (ANC) of < 1,500 cells/µL or an ANC that is expected to decrease to < 500 cells/µL during the next 48 hours. Epidemiology[1,2,6] […]
Hyperglycemic Crises (Clinical)
Overview Definition Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are serious, acute complications of diabetes mellitus. Epidemiology[3–5] Etiology[1–4,6] Pathophysiology Normal physiology[3–5] The normal response to increased serum glucose involves the release of insulin by pancreatic beta cells. This leads to: Pathophysiology of DKA[4,5,8] Pathophysiology of HHS[4,5,8] Clinical Presentation Clinical presentation of DKA[2,4,6,9] Clinical presentation […]
Acetaminophen Overdose (Clinical)
Epidemiology Pathophysiology Pharmacokinetics[1,12] Normal metabolism[1,2,4,12] Pathogenesis[1,2,4,12] Clinical Presentation The clinical course of APAP poisoning is often divided into 4 stages, which are classified according to duration since time of ingestion.[12] Diagnosis Evaluation[1,2,3,9,12] Rumack-Matthew nomogram[1,2,12] Management Treatment approach Entails supportive care, limiting drug absorption, and treatment of toxic effects: N-acetylcysteine (NAC) Acute overdose Rule of 150[6] […]
Frostbite (Clinical)
Overview Definition Frostbite is injury to tissue resulting from cold exposure at temperatures below 0°C (32°F). Frostbite exists on the severe end of a spectrum, with frostnip and pernio at the milder end. Epidemiology[1,2,4] Pathophysiology[1,2,4] Frostbite injury results from: 4 phases: Clinical Presentation and Diagnosis The diagnosis of frostbite is clinical and should be distinguished […]
Rhabdomyolysis (Clinical)
Overview Definition[2‒4] Rhabdomyolysis is a syndrome marked by muscle necrosis, resulting in the release of toxic intracellular muscle constituents into the circulation (especially myoglobin). Etiology[1‒4] Pathophysiology Muscle injury[2‒4] Renal injury[2,4] Renal injury is the most common systemic complication of rhabdomyolysis. Factors contributing to renal failure include: Clinical Presentation Signs and symptoms[2,4] Additional clues[2,4] Diagnosis Laboratory […]
Acute Limb Ischemia (Clinical)
Overview Definition[1, 4–7] Acute limb ischemia (ALI) is a vascular emergency caused by a rapid decrease in limb perfusion. Symptom duration is < 2 weeks following the acute event. Epidemiology[5] Etiology[4] Pathophysiology Clinical Presentation Features[1,4–7,14] Diagnosis Acute limb ischemia is diagnosed on the basis of medical history, clinical presentation, physical examination, and vascular imaging.[1,5] History […]
Hypoglycemia (Clinical)
Overview Definition[1‒3,5,6] Hypoglycemia is an emergency condition defined as a serum glucose level ≤ 70 mg/dL (≤ 3.9 mmol/L). Classification[3,4] Etiology[1,3] Pathophysiology Glucose homeostasis[6‒8] Serum glucose levels are maintained within the normal range of 71–99 mg/dL owing to a coordinated balance between insulin, glucagon, and the sympathetic nervous system. As the serum glucose level falls, […]
Accidential Hypothermia (Clinical)
Overview Definition[3,12] Hypothermia is a decrease in core body temperature to below 35°C (95°F). The focus of this concept page is primarily on accidental hypothermia. Epidemiology[4,6,7] Etiology[1‒3] Pathophysiology Mechanisms of heat loss[2,5,12] Pathogenesis[1‒5] Clinical Presentation General manifestations[3,5,6,12] The following features may be present, depending on the severity of hypothermia: Stages of hypothermia (by core temperature)[3‒6,12] […]
Neuroleptic Malignant Syndrome (Clinical)
Overview Definition[1-3] Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic disorder associated with the use of antipsychotics that presents as a classic tetrad: Epidemiology[3,5,7,11] Etiology[2,3] NMS is an idiosyncratic reaction to neuroleptic (antipsychotic) drugs. Risk factors[5-7] Pathophysiology and Clinical Presentation Pathophysiology[1-3] Clinical presentation[2-5] Cardinal features of the neuroleptic malignant syndrome include: Other signs and symptoms […]