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Symptoms and Signs – Differential Diagnosis of Hypertrophic Osteoarthropathy
• Rheumatoid arthritis (RA)
• Reiter’s syndrome
• Psoriasis
• Paget’s disease
• Osteomyelitis
• Osteoarthritis
• Rheumatoid arthritis (RA)
• Reiter’s syndrome
• Psoriasis
• Paget’s disease
• Osteomyelitis
• Osteoarthritis
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Symptoms and Signs – Differential Diagnosis of Hyperuricemia
• Renal failure
• Myeloproliferative disorders
• Lead poisoning
• Hypothyroidism
• Hereditary enzyme deficiency (hypoxanthine-guanine phosphoribosyltransferase)
• Gout
• Excessive cell lysis (chemotherapeutic agents, radiation therapy, leukemia, lymphoma, hemolytic anemia)
• Drugs (diuretics, low doses of aspirin, ethambutol, nicotinic acid)
• Diet high in purines or protein
• Acidosis
• Renal failure
• Myeloproliferative disorders
• Lead poisoning
• Hypothyroidism
• Hereditary enzyme deficiency (hypoxanthine-guanine phosphoribosyltransferase)
• Gout
• Excessive cell lysis (chemotherapeutic agents, radiation therapy, leukemia, lymphoma, hemolytic anemia)
• Drugs (diuretics, low doses of aspirin, ethambutol, nicotinic acid)
• Diet high in purines or protein
• Acidosis
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Symptoms and Signs – Differential Diagnosis of Hyperimmunoglobulinemia
• IgA: lymphoproliferative disorders, Berger’s nephropathy, chronic infections, autoimmune disorders, liver disease
• IgE: allergic disorders, parasitic infections, immunologic disorders, IgE myeloma, AIDS, pemphigoid
• IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease
• IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenström’s macroglobulinemia, liver disease
• IgA: lymphoproliferative disorders, Berger’s nephropathy, chronic infections, autoimmune disorders, liver disease
• IgE: allergic disorders, parasitic infections, immunologic disorders, IgE myeloma, AIDS, pemphigoid
• IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease
• IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenström’s macroglobulinemia, liver disease
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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
• Hyperkalemic periodic paralysis
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
• Hyperkalemic periodic paralysis
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Symptoms and Signs – Differential Diagnosis of Acquired Hypercoagulable State
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
• Most common cause of acquired thrombophilia
• Can present as arterial or venous thrombosis, recurrent pregnancy loss, and adverse pregnancy outcomes
• Thromboembolic events occur in up to 30% of population; high risk of recurrent thrombosis (up to 70% reported).
HYPERHOMOCYSTEINEMIA
• Can be inherited (most commonly an autosomal recessive mutation in methylene tetrahydrofolate reductase gene) but more frequently acquired; folate, vitamin B6, or vitamin B12 deficiency accounts for two thirds of cases. Other acquired causes include renal disease, hypothyroidism, malignant disease, smoking, and certain medications.
• May be associated with venous thromboembolism (VTE), atherosclerotic disease (cardiovascular, cerebrovascular, and peripheral vascular), and possibly adverse pregnancy outcomes
CONDITIONS ASSOCIATED WITH INCREASED RISK OF THROMBOSIS
• Prior thrombosis
• Trauma
• Medical illness: heart failure, respiratory failure, infection, diabetes mellitus, obesity, nephrotic syndrome, inflammatory bowel disease, paroxysmal nocturnal hemoglobinuria, sickle cell anemia
• Pregnancy (sixfold increased risk of VTE), post partum, OC use (fourfold increased risk, higher risk with third-generation OCs), transdermal contraceptive patch, HRT (twofold increased risk), tamoxifen, raloxifene
• Immobilization, travel
• Surgery (especially orthopedic), central venous catheters
• Hyperviscosity syndromes
• Myeloproliferative disorders
• Malignancy: disease or treatment related
• Heparin-induced thrombocytopenia and thrombosis
• Smoking
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
• Most common cause of acquired thrombophilia
• Can present as arterial or venous thrombosis, recurrent pregnancy loss, and adverse pregnancy outcomes
• Thromboembolic events occur in up to 30% of population; high risk of recurrent thrombosis (up to 70% reported).
HYPERHOMOCYSTEINEMIA
• Can be inherited (most commonly an autosomal recessive mutation in methylene tetrahydrofolate reductase gene) but more frequently acquired; folate, vitamin B6, or vitamin B12 deficiency accounts for two thirds of cases. Other acquired causes include renal disease, hypothyroidism, malignant disease, smoking, and certain medications.
• May be associated with venous thromboembolism (VTE), atherosclerotic disease (cardiovascular, cerebrovascular, and peripheral vascular), and possibly adverse pregnancy outcomes
CONDITIONS ASSOCIATED WITH INCREASED RISK OF THROMBOSIS
• Prior thrombosis
• Trauma
• Medical illness: heart failure, respiratory failure, infection, diabetes mellitus, obesity, nephrotic syndrome, inflammatory bowel disease, paroxysmal nocturnal hemoglobinuria, sickle cell anemia
• Pregnancy (sixfold increased risk of VTE), post partum, OC use (fourfold increased risk, higher risk with third-generation OCs), transdermal contraceptive patch, HRT (twofold increased risk), tamoxifen, raloxifene
• Immobilization, travel
• Surgery (especially orthopedic), central venous catheters
• Hyperviscosity syndromes
• Myeloproliferative disorders
• Malignancy: disease or treatment related
• Heparin-induced thrombocytopenia and thrombosis
• Smoking
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Symptoms and Signs – Differential Diagnosis of Hypercoagulable State, Associated Disorders
• Systemic lupus erythematosus in association with the presence of a lupus anticoagulant or antiphospholipid antibodies
• Malignant neoplasm
• Disease related: includes migratory superficial thrombophlebitis (Trousseau’s syndrome), nonbacterial thrombotic endocarditis,thrombosis associated with chronic DIC, thrombotic
microangiopathy
• Treatment related: associated with the administration of various chemotherapeutic agents (asparaginase, mitomycin, someadjuvant chemotherapeutic agents for treatment of breast cancer,thalidomide or lenalidomide in conjunction with high doses of dexamethasone)
• Infusion of prothrombin complex concentrates
• Nephrotic syndrome
• Heparin-induced thrombocytopenia
• Myeloproliferative disorders
• Paroxysmal nocturnal hemoglobinuria
• Systemic lupus erythematosus in association with the presence of a lupus anticoagulant or antiphospholipid antibodies
• Malignant neoplasm
• Disease related: includes migratory superficial thrombophlebitis (Trousseau’s syndrome), nonbacterial thrombotic endocarditis,thrombosis associated with chronic DIC, thrombotic
microangiopathy
• Treatment related: associated with the administration of various chemotherapeutic agents (asparaginase, mitomycin, someadjuvant chemotherapeutic agents for treatment of breast cancer,thalidomide or lenalidomide in conjunction with high doses of dexamethasone)
• Infusion of prothrombin complex concentrates
• Nephrotic syndrome
• Heparin-induced thrombocytopenia
• Myeloproliferative disorders
• Paroxysmal nocturnal hemoglobinuria
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Symptoms and Signs – Differential Diagnosis of Hypercortisolemia
• Stress
• Pregnancy
• Loss of normal diurnal variation
• Iatrogenic
• Ectopic adrenocorticotropic hormone (ACTH) production (e.g., small cell carcinoma of lung)
• Chronic renal failure
• Adrenal or pituitary hyperplasia or adenomas
• Stress
• Pregnancy
• Loss of normal diurnal variation
• Iatrogenic
• Ectopic adrenocorticotropic hormone (ACTH) production (e.g., small cell carcinoma of lung)
• Chronic renal failure
• Adrenal or pituitary hyperplasia or adenomas
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Symptoms and Signs – Differential Diagnosis of Hyperemesis Gravidarum
• Pyelonephritis
• Pancreatitis
• Hepatitis
• Cholecystitis
• Pyelonephritis
• Pancreatitis
• Hepatitis
• Cholecystitis
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Symptoms and Signs – Differential Diagnosis of Hypereosinophilia
• Warfarin sensitivity
• Urticaria
• Radiation therapy
• Pernicious anemia
• Pemphigus
• Parasitic infestations (trichinosis, aspergillosis, hydatidosis)
• Non-Hodgkin’s lymphoma
• Myeloproliferative disorders
• L-Tryptophan ingestion
• Inflammatory bowel disease (IBD)
• Hodgkin’s disease
• Eosinophilic nonallergic rhinitis
• Drug reactions
• Collagen-vascular diseases
• Bronchial asthma
• Angioneurotic edema
• Allergy
• Acute hypereosinophilic syndrome
• Warfarin sensitivity
• Urticaria
• Radiation therapy
• Pernicious anemia
• Pemphigus
• Parasitic infestations (trichinosis, aspergillosis, hydatidosis)
• Non-Hodgkin’s lymphoma
• Myeloproliferative disorders
• L-Tryptophan ingestion
• Inflammatory bowel disease (IBD)
• Hodgkin’s disease
• Eosinophilic nonallergic rhinitis
• Drug reactions
• Collagen-vascular diseases
• Bronchial asthma
• Angioneurotic edema
• Allergy
• Acute hypereosinophilic syndrome
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Symptoms and Signs-Differential Diagnosis of Hypergastrinemia
• Rheumatoid arthritis (RA)
• Pyloric obstruction
• Hypochlorhydria due to atrophic gastritis, gastric carcinoma,pernicious anemia
• Hyperplasia of antral G cells
• Gastrinoma (Zollinger-Ellison syndrome)
• Decreased gastrin release inhibition from medications (proton pump inhibitors [PPIs], H2 receptor antagonists), vagotomy
• Chronic renal failure
• Rheumatoid arthritis (RA)
• Pyloric obstruction
• Hypochlorhydria due to atrophic gastritis, gastric carcinoma,pernicious anemia
• Hyperplasia of antral G cells
• Gastrinoma (Zollinger-Ellison syndrome)
• Decreased gastrin release inhibition from medications (proton pump inhibitors [PPIs], H2 receptor antagonists), vagotomy
• Chronic renal failure
