Hypoaldosteronism physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hypoaldosteronism}} | {{Hypoaldosteronism}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{Akshun}} | ||
==Overview== | ==Overview== | ||
Patients with | [[Patients]] with hypoaldosteronism usually appear [[Fatigue|fatigued]]. [[Physical examination]] of [[patients]] with hypoaldosteronism is usually unremarkable, unless there is severe [[hyperkalemia]]. Increased level of serum [[potassium]] level may present with muscle [[tenderness]], [[hyporeflexia]]/[[areflexia]] and [[cardiac arrhythmias]]. The physical exam may also represent findings of underlying condition such as [[chronic kidney disease]] or [[diabetic nephropathy]]. | ||
==Physical Examination== | ==Physical Examination== | ||
[[Patients]] with hypoaldosteronism usually appear [[Fatigue|fatigued]]. [[Physical examination]] of [[patients]] with hypoaldosteronism is usually unremarkable, unless there is severe [[hyperkalemia]]. Increased level of serum [[potassium]] level may present with muscle [[tenderness]], [[hyporeflexia]]/[[areflexia]] and [[cardiac arrhythmias]]. The physical exam may also represent findings of underlying condition such as [[chronic kidney disease]] or [[diabetic nephropathy]].<ref name="pmid23633816">{{cite journal |vauthors=Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S |title=Addison's disease |journal=Contemp Clin Dent |volume=3 |issue=4 |pages=484–6 |year=2012 |pmid=23633816 |pmc=3636818 |doi=10.4103/0976-237X.107450 |url=}}</ref><ref name="pmid18235147">{{cite journal |vauthors=Montague BT, Ouellette JR, Buller GK |title=Retrospective review of the frequency of ECG changes in hyperkalemia |journal=Clin J Am Soc Nephrol |volume=3 |issue=2 |pages=324–30 |year=2008 |pmid=18235147 |pmc=2390954 |doi=10.2215/CJN.04611007 |url=}}</ref><ref name="pmid15261358">{{cite journal |vauthors=Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC |title=Electrocardiographic manifestations: electrolyte abnormalities |journal=J Emerg Med |volume=27 |issue=2 |pages=153–60 |year=2004 |pmid=15261358 |doi=10.1016/j.jemermed.2004.04.006 |url=}}</ref><ref name="pmid17902552">{{cite journal |vauthors=Humphreys M |title=Potassium disturbances and associated electrocardiogram changes |journal=Emerg Nurse |volume=15 |issue=5 |pages=28–34 |year=2007 |pmid=17902552 |doi=10.7748/en2007.09.15.5.28.c4252 |url=}}</ref> | |||
Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. The physical findings | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with hypoaldosteronism usually appear fatigued. | *[[Patients]] with hypoaldosteronism usually appear [[Fatigue|fatigued]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
| Line 30: | Line 18: | ||
===Skin=== | ===Skin=== | ||
If hypoaldosteronism is from | If hypoaldosteronism is from [[Addison's disease]], changes in [[skin]] and [[hair]] may be observed such as: | ||
* Pigmented skin and mucous membranes - darkening ([[hyperpigmentation]]) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken. | * [[Skin pigmentation|Pigmented skin]] and [[mucous membranes]] - darkening ([[hyperpigmentation]]) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the [[hands]]), [[nipples]], and the inside of the [[cheek]] ([[buccal mucosa]]), also old scars may darken. | ||
* Absence of axillary and pubic hair in females as a result of loss of adrenal [[androgens]] | * Absence of [[axillary]] and [[pubic hair]] in [[females]] as a result of loss of adrenal [[androgens]]. | ||
===Heart=== | |||
[[Hyperkalemia]] can lead to: | |||
* [[Irregular heart rhythms]] | |||
* [[Bradycardia]] | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Hyponatremia is unusual in isolated hypoaldosteronism since ADH is under inhibitory control of cortisol. However, in patients of Addison's disease there is decreased level of cortisol and aldosterone. Since there is no inhibition of ADH from cortisol, this leads to increased free water absorption and hyponatremia. Patients with hyponatremia may present with confusion when serum sodium level is <115 mmol/L | *[[Hyponatremia]] is unusual in isolated hypoaldosteronism since [[ADH]] is under [[inhibitory]] control of [[cortisol]]. However, in patients of [[Addison's disease]] as a cause of hypoaldosteronism, there is decreased level of [[cortisol]] and [[aldosterone]]. Since there is no [[inhibition]] of [[Antidiuretic hormone|ADH]] from [[cortisol]], this leads to increased free water [[absorption]] and [[hyponatremia]]. Patients with [[hyponatremia]] may present with [[confusion]] when serum [[sodium]] level is <115 mmol/L. | ||
*Hyporeflexia / areflexia | *[[Hyporeflexia]]/[[areflexia]] | ||
===Extremities=== | ===Extremities=== | ||
*Muscle weakness | *[[Muscle weakness]] | ||
*Muscle tenderness | *Muscle [[tenderness]] | ||
*Depressed deep tendon reflexes | *[[Fasciculations]] | ||
*Depressed [[Deep tendon reflex|deep tendon reflexes]] | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Endocrinology]] | |||
[[Category:Nephrology]] | |||
[[Category:Emergency medicine]] | |||
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Latest revision as of 16:40, 18 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Patients with hypoaldosteronism usually appear fatigued. Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. Increased level of serum potassium level may present with muscle tenderness, hyporeflexia/areflexia and cardiac arrhythmias. The physical exam may also represent findings of underlying condition such as chronic kidney disease or diabetic nephropathy.
Physical Examination
Patients with hypoaldosteronism usually appear fatigued. Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. Increased level of serum potassium level may present with muscle tenderness, hyporeflexia/areflexia and cardiac arrhythmias. The physical exam may also represent findings of underlying condition such as chronic kidney disease or diabetic nephropathy.[1][2][3][4]
Appearance of the Patient
Vital Signs
Skin
If hypoaldosteronism is from Addison's disease, changes in skin and hair may be observed such as:
- Pigmented skin and mucous membranes - darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
- Absence of axillary and pubic hair in females as a result of loss of adrenal androgens.
Heart
Hyperkalemia can lead to:
Neuromuscular
- Hyponatremia is unusual in isolated hypoaldosteronism since ADH is under inhibitory control of cortisol. However, in patients of Addison's disease as a cause of hypoaldosteronism, there is decreased level of cortisol and aldosterone. Since there is no inhibition of ADH from cortisol, this leads to increased free water absorption and hyponatremia. Patients with hyponatremia may present with confusion when serum sodium level is <115 mmol/L.
- Hyporeflexia/areflexia
Extremities
- Muscle weakness
- Muscle tenderness
- Fasciculations
- Depressed deep tendon reflexes
References
- ↑ Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
- ↑ Montague BT, Ouellette JR, Buller GK (2008). "Retrospective review of the frequency of ECG changes in hyperkalemia". Clin J Am Soc Nephrol. 3 (2): 324–30. doi:10.2215/CJN.04611007. PMC 2390954. PMID 18235147.
- ↑ Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC (2004). "Electrocardiographic manifestations: electrolyte abnormalities". J Emerg Med. 27 (2): 153–60. doi:10.1016/j.jemermed.2004.04.006. PMID 15261358.
- ↑ Humphreys M (2007). "Potassium disturbances and associated electrocardiogram changes". Emerg Nurse. 15 (5): 28–34. doi:10.7748/en2007.09.15.5.28.c4252. PMID 17902552.