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Symptoms and Signs – Differential Diagnosis of Postural Hypotension
• Adrenal insufficiency
• Antihypertensive medications (especially α-blockers, diuretics, angiotensin-converting enzyme [ACE] inhibitors)
• Central autonomic dysfunction (Shy-Drager syndrome)
• Idiopathic orthostatic hypotension
• Impaired cardiac output (constrictive pericarditis, aortic stenosis)
• Peripheral autonomic dysfunction (diabetes mellitus [DM], Guillain-Barré)
• Peripheral venous disease
• Volume depletion (hemorrhage, dehydration)
• Adrenal insufficiency
• Antihypertensive medications (especially α-blockers, diuretics, angiotensin-converting enzyme [ACE] inhibitors)
• Central autonomic dysfunction (Shy-Drager syndrome)
• Idiopathic orthostatic hypotension
• Impaired cardiac output (constrictive pericarditis, aortic stenosis)
• Peripheral autonomic dysfunction (diabetes mellitus [DM], Guillain-Barré)
• Peripheral venous disease
• Volume depletion (hemorrhage, dehydration)
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Symptoms and Signs – Differential Diagnosis of Hypothermia
• Cerebrovascular accident (CVA)
• Drug intoxication
• Hypoglycemia
• Myxedema coma
• Cerebrovascular accident (CVA)
• Drug intoxication
• Hypoglycemia
• Myxedema coma
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Symptoms and Signs – Differential Diagnosis of Hypothyroidism
• Chronic fatigue syndrome
• Dementia from other causes
• Depression
• Systemic disorders (e.g., nephrotic syndrome, congestive heart
failure [CHF], amyloidosis)
• Chronic fatigue syndrome
• Dementia from other causes
• Depression
• Systemic disorders (e.g., nephrotic syndrome, congestive heart
failure [CHF], amyloidosis)
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Symptoms and Signs – Differential Diagnosis of Hyperkinetic Movement Disorders
• Thyrotoxicosis
• Tardive dyskinesia (e.g., phenothiazines)
• Systemic lupus erythematosus (SLE), polycythemia
• Liver failure
• Hemiballismus (lacunar cerebrovascular accident [CVA] near subthalamic nuclei in basal ganglia, metastatic lesions, toxoplasmosis [in AIDS])
• Dystonia (idiopathic, familial, drug induced [prochlorperazine, metoclopramide]), Wilson’s disease
• Chorea, choreoathetosis: drug induced, Huntington’s chorea, Sydenham’s chorea
• Thyrotoxicosis
• Tardive dyskinesia (e.g., phenothiazines)
• Systemic lupus erythematosus (SLE), polycythemia
• Liver failure
• Hemiballismus (lacunar cerebrovascular accident [CVA] near subthalamic nuclei in basal ganglia, metastatic lesions, toxoplasmosis [in AIDS])
• Dystonia (idiopathic, familial, drug induced [prochlorperazine, metoclopramide]), Wilson’s disease
• Chorea, choreoathetosis: drug induced, Huntington’s chorea, Sydenham’s chorea
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Symptoms and Signs – Differential Diagnosis of Hyperkalemia
PSEUDOHYPERKALEMIA
• Hemolyzed specimen
• Severe thrombocytosis (platelet count >106 mL)
• Severe leukocytosis (white blood cell count >105 mL)
• Fist clenching during phlebotomy
EXCESSIVE POTASSIUM INTAKE (OFTEN IN SETTING OF
IMPAIRED EXCRETION)
• Potassium replacement therapy
• High-potassium diet
• Salt substitutes with potassium
• Potassium salts of antibiotics
DECREASED RENAL EXCRETION
• Potassium-sparing diuretics (e.g., spironolactone, triamterene,
amiloride)
• Renal insufficiency
• Mineralocorticoid deficiency
• Hyporeninemic hypoaldosteronism (diabetes mellitus [DM])
• Tubular unresponsiveness to aldosterone (e.g., systemic lupus
erythematosus [SLE], multiple myeloma, sickle cell disease)
• Type 4 renal tubular acidosis (RTA)
• Angiotensin-converting enzyme (ACE) inhibitors
• Heparin administration
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Trimethoprim-sulfamethoxazole
• β-Blockers
• Pentamidine
REDISTRIBUTION (EXCESSIVE CELLULAR RELEASE)
• Acidemia (each 0.1 decrease in pH increases the serum potassium
by 0.4 to 0.6 mEq/L). Lactic acidosis and ketoacidosis cause
minimal redistribution.
• Insulin deficiency
• Drugs (e.g., succinylcholine, markedly increased digitalis level,
arginine, β-adrenergic blockers)
• Hypertonicity
• Hemolysis
• Tissue necrosis, rhabdomyolysis, burns
PSEUDOHYPERKALEMIA
• Hemolyzed specimen
• Severe thrombocytosis (platelet count >106 mL)
• Severe leukocytosis (white blood cell count >105 mL)
• Fist clenching during phlebotomy
EXCESSIVE POTASSIUM INTAKE (OFTEN IN SETTING OF
IMPAIRED EXCRETION)
• Potassium replacement therapy
• High-potassium diet
• Salt substitutes with potassium
• Potassium salts of antibiotics
DECREASED RENAL EXCRETION
• Potassium-sparing diuretics (e.g., spironolactone, triamterene,
amiloride)
• Renal insufficiency
• Mineralocorticoid deficiency
• Hyporeninemic hypoaldosteronism (diabetes mellitus [DM])
• Tubular unresponsiveness to aldosterone (e.g., systemic lupus
erythematosus [SLE], multiple myeloma, sickle cell disease)
• Type 4 renal tubular acidosis (RTA)
• Angiotensin-converting enzyme (ACE) inhibitors
• Heparin administration
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Trimethoprim-sulfamethoxazole
• β-Blockers
• Pentamidine
REDISTRIBUTION (EXCESSIVE CELLULAR RELEASE)
• Acidemia (each 0.1 decrease in pH increases the serum potassium
by 0.4 to 0.6 mEq/L). Lactic acidosis and ketoacidosis cause
minimal redistribution.
• Insulin deficiency
• Drugs (e.g., succinylcholine, markedly increased digitalis level,
arginine, β-adrenergic blockers)
• Hypertonicity
• Hemolysis
• Tissue necrosis, rhabdomyolysis, burns
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Symptoms and Signs – Differential Diagnosis of Hyperkinetic Movement Disorders
• Chorea, choreoathetosis: drug induced, Huntington’s chorea, Sydenham’s chorea
• Dystonia (idiopathic, familial, drug induced [prochlorperazine, metoclopramide]), Wilson’s disease
• Hemiballismus (lacunar cerebrovascular accident [CVA] near subthalamic nuclei in basal ganglia, metastatic lesions, toxoplasmosis [in AIDS])
• Liver failure
• Systemic lupus erythematosus (SLE), polycythemia
• Tardive dyskinesia (e.g., phenothiazines)
• Thyrotoxicosis
• Chorea, choreoathetosis: drug induced, Huntington’s chorea, Sydenham’s chorea
• Dystonia (idiopathic, familial, drug induced [prochlorperazine, metoclopramide]), Wilson’s disease
• Hemiballismus (lacunar cerebrovascular accident [CVA] near subthalamic nuclei in basal ganglia, metastatic lesions, toxoplasmosis [in AIDS])
• Liver failure
• Systemic lupus erythematosus (SLE), polycythemia
• Tardive dyskinesia (e.g., phenothiazines)
• Thyrotoxicosis
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Symptoms and Signs – Differential Diagnosis of Primary Hyperlipoproteinemia
• Alcohol
• Diabetes mellitus (DM)
• Diet high in saturated fats
• Glucocorticoid use/excess
• Glycogen storage diseases
• Hepatic dysfunction
• Lipodystrophies
• Oral contraceptives
• Renal disease
• Alcohol
• Diabetes mellitus (DM)
• Diet high in saturated fats
• Glucocorticoid use/excess
• Glycogen storage diseases
• Hepatic dysfunction
• Lipodystrophies
• Oral contraceptives
• Renal disease
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Symptoms and Signs – Differential Diagnosis of Hypernatremia
ISOVOLEMIC HYPERNATREMIA
Decreased total body water, normal total body sodium and extracellular fluid
• Diabetes insipidus (neurogenic and nephrogenic)
• Skin loss (hyperemia), iatrogenic, reset osmostat
HYPERVOLEMIC HYPERNATREMIA
Increased total body water, markedly increased total body sodium and extracellular fluid
• Iatrogenic (administration of hypernatremic solutions)
• Mineralocorticoid excess (Conn’s syndrome, Cushing’s syndrome)
• Salt ingestion
HYPOVOLEMIC HYPERNATREMIA
Loss of H2O and Na+ (H2O Loss > Na+)
• Renal losses (e.g., diuretics, glycosuria)
• GI, respiratory, skin losses
• Adrenal deficiencies
ISOVOLEMIC HYPERNATREMIA
Decreased total body water, normal total body sodium and extracellular fluid
• Diabetes insipidus (neurogenic and nephrogenic)
• Skin loss (hyperemia), iatrogenic, reset osmostat
HYPERVOLEMIC HYPERNATREMIA
Increased total body water, markedly increased total body sodium and extracellular fluid
• Iatrogenic (administration of hypernatremic solutions)
• Mineralocorticoid excess (Conn’s syndrome, Cushing’s syndrome)
• Salt ingestion
HYPOVOLEMIC HYPERNATREMIA
Loss of H2O and Na+ (H2O Loss > Na+)
• Renal losses (e.g., diuretics, glycosuria)
• GI, respiratory, skin losses
• Adrenal deficiencies
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Symptoms and Signs – Differential Diagnosis of Serum Hyperosmolality
• Uremia
• Mannitol therapy
• Ingestion of toxins (ethylene glycol, methanol, ethanol), hypercalcemia, diuretics
• Hypernatremia
• Hyperglycemia
• Diabetes insipidus (DI)
• Dehydration
• Uremia
• Mannitol therapy
• Ingestion of toxins (ethylene glycol, methanol, ethanol), hypercalcemia, diuretics
• Hypernatremia
• Hyperglycemia
• Diabetes insipidus (DI)
• Dehydration
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Symptoms and Signs – Differential Diagnosis of Urine Hyperosmolality
• Syndrome of inappropriate antidiuretic hormone (SIADH)
• High-protein diet
• Glycosuria
• Dehydration
• Adrenal insufficiency
• Syndrome of inappropriate antidiuretic hormone (SIADH)
• High-protein diet
• Glycosuria
• Dehydration
• Adrenal insufficiency
