Sandbox: wdx causes

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Differential Diagnosis

Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C - reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time

Etiology Clinical manifestations Paraclinical findings Comments
Symptoms and signs Lab findings Imaging
Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Prerenal causes Alcohol poisoning[1][2] + - +/- - +/- + +/- - - ↑PT ↑BUN, ↑Cr (isopropyl alcohol) ↓Na Not applicable ↓HCO3 LFT Not applicable Not applicable Not applicable Not applicable - Thiamine must be given to prevent Wernicke's encephalopathy
Aspergillosis[3][4] +/- - - - - - - +/- - Not applicable Not applicable Not applicable Not applicable Not applicable Allergy test, ↑IgE (>1000 IU/dl), Direct visualization of fungal hyphae Not applicable Pulmonary infiltrates, Mucus plug, Mass in the upper lobe surrounded by a crescent of air, Solitary or multiple cavities Halo sign, Wedge-shaped pulmonary infarction, Granuloma Not applicable - Polymerase chain reaction (PCR)
Cholera[5][6][6][7] +/- + - - - +/- + - - Leukocytosis, ↑HCT ↑BUN, ↑Cr ↓Na, ↑Ca, ↑Mg Not applicable ↑Lactate, ↓HCO3 Stool PCR, Stool culture, Serotyping Not applicable Not applicable Not applicable Not applicable - -
Congestive heart failure (CHF)[8][9] + - - - - - + - + Anemia, Leukocytosis ↑BUN, ↑Cr ↓Na, ↑K Not applicable ↑Lactate, ↓HCO3, ↑BNP, ↑Troponin Cardiomegaly, Pulmonary hypertension, Pleural effusions Pulmonary edema Not applicable Valvular heart disease Decreased ejection fraction in echocardiography, Heart function and damage in nuclear imaging -
Dehydration[10][11] + + - +/- - +/- +/- - - Not applicable ↑BUN, ↑Cr ↓Na, ↑K, ↓Cl Ketones and glucose, ↑Urine specific gravity ↑Lactate, ↓HCO3 Hypoglycemia Not applicable Not applicable Not applicable Not applicable - -
Diarrhea and/or vomiting[12][13] +/- +/- - - - + + - - Leukocytosis with predominant neutrophilia, ↑ ESR Not applicable Not applicable Ketones, Organic acids, Porphobilinogen, Aminolevulinic acid Not applicable Stool anion gap, Stool pH < 5.5, Stool culture, Serotyping, Enzyme immunoassay (rotavirus or adenovirus), LFT, Amylase, Lipase Normal Not applicable Not applicable Not applicable - -
Drugs/toxins[14][15] +/- +/- +/- +/- +/- +/- +/- +/- +/- Not applicable ↑BUN, ↑Cr, ↑CK ↑K, ↓Mg, ↓Ca, ↓P Ingested drug, Glucose, Aminoacid, Phosphate, Ketone, Hyaline cast, RBC ↑Lactate, Metabolic acidosis Toxicology, Rapid immunoassay Nephropathy Radioopaque substances, Ingested drug packets Not applicable Not applicable - -
Esophageal varices bleeding[16][17] +/- - - - +/- - - - - Normocytic normochromic anemia ↑BUN, ↑Cr Not applicable Not applicable Not applicable Not applicable Velocity and direction of portal flow Abnormal opacities outside ofesophageal wall, Posterior mediastinal or intraparenchymal mass, Dilated azygous vein Entire portal venous system Portrays esophageal varices as flow voids Portal hypertension and esophageal varices in positron emission tomography, Flexible endoscope, Barium swallow of snake-like filling defects -
Heart disease[18][19] +/- - - - - - - +/- +/- ↑ESR and CRP ↑BUN, ↑Cr Not applicable Not applicable Not applicable Throat culture, Rapid streptococcal antigen test, Hyperoxia test, Pulse oximetry Not applicable Cardiomegaly, Dextrocardia Not applicable Not applicable Ventricular dysfunction, Left and right ventricular hypertrophy, Valvular disease in echocardiography -
Hemorrhage[20][21] - - - - - - - - - Normocytic normochromic anemia, ↑PT, ↑PTT ↑BUN, ↑Cr ↑Na, ↑Cl, ↓Ca Not applicable Metabolic acidosis Not applicable Peritoneal cavity fluid in FAST Bilateral opacities in the lung field, Hemothorax, Hemoperitoneum, Ruptured abdominal aortic aneurysm Intrathoracic, intra-abdominal, and retroperitoneal bleeding Not applicable Source of bleeding in the upper GI in EGD, Angiography -
Hemolysis[22][23] +/- - - - - - - - - Thrombocytopenia, Microcytic hypochromic anemia, ↑RDW, ↑Retic count Not applicable Not applicable Not applicable Not applicable ↑LDH, ↓Haptoglobin, ↑Unconjugated bilirubin Hepatomegaly,Splenomegaly Not applicable Not applicable Not applicable - -
Etiology Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other Comments
Hepatorenal syndrome[24][25] +/- - - - +/- +/- - - +/- Leukocytosis, ↑PT ↓GFR, ↑BUN, ↑Cr ↓Na Proteinuria, Na < 10 mEq/L, Urine osmolality > plasma osmolality Not applicable Alpha feto-protein, Cryoglobulinemia Exclude hydronephrosis and intrinsic renal disease Not applicable Not applicable Not applicable Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography -
Ischemic cardiomyopathy[26][27] +/- - - - - - - +/- +/- Anemia ↑Cr ↓Na, ↓K, ↓Mg Not applicable Not applicable Troponin, Creatine kinase, Creatine kinase - MB, BNP Not applicable Abnormal cardiac silhouette Biventricular volume, Wall motion abnormality, Myocardial perfusion, Hypertrophic cardiomyopathy Mid-wall fibrosis in MRI Ejection fraction ≤35%, Pulmonary embolism, Right ventricular dilation or pericardial effusion with tamponade in echocardiography -
Liver cirrhosis[28][29] +/- - +/- +/- +/- - - - +/- Not applicable Not applicable Not applicable Not applicable Not applicable LFT, Aspartate aminotransferase to platelet ratio, FibroTest/FibroSure, Hepascore, FibroSpectatio Portal blood flow velocity, Hepatic artery enlargement, Multifocal lesions or masses, Hepatic contour, Ascites, Splenomegaly Bowel perforation, Gynecomastia, Azygos vein enlargement, Pleural effusion Morphologic changes in the liver, Collaterals and shunts, Hyperattenuating nodule of hepatocellular carcinoma, Portal vein thrombosis Vacular patency, Tumor invasion, Portal vein thrombosis, Steatosis Hepatic function and portal hypertension in nuclear imaging, Hepatic perfusion and the development of shunts and tumors in angiography Irreversible and a transplant is usually needed
Malignant hypertension[30][31] +/- - + - - +/- - +/- +/- Microangiopathic hemolytic anemia ↑BUN, ↑Cr ↑Na, ↑K, ↑P Proteinuria, Microscopic hematuria Acidosis Cardiac enzymes, Urinary catecholamines, TSH, ↑Renin Not applicable Cardiomegaly, Pulmonary edema, Rib notching, Aortic coarctation, Mediastinal widening, Aortic dissection Not applicable Not applicable Left atrial enlargement and left ventricular hypertrophy in echocardiography -
Myocarditis[32] +/- - - - +/- - - +/- - Leukocytosis (eosinophilia),↑ESR and CRP Not applicable Not applicable Not applicable Not applicable Cardiac enzymes, Viral antibodies Not applicable Not applicable Not applicable Inflammatory edema, Degree of scarring Endomyocardial biopsy, Echocardiography, Scintigraphy Not applicable
Peritonitis[33][34] +/- - +/- - +/- +/- +/- - - Leukocytosis Not applicable Not applicable Not applicable Not applicable Ascitic fluid neutrophil count > 500 cells/µL Not applicable Not applicable Not applicable Not applicable - -
Polycythemia[35][36] +/- - - - - - - +/- - ↑RBC, ↑HCT, ↑HGB, Thrombocytosis, Leukocytosis, ↑PT and aPTT ↓Erythropoietin Not applicable Not applicable Not applicable Hyperuricemia Splenomegaly Not applicable Not applicable Not applicable - Phlebotomy is the usual treatment
Respiratory distress syndrome[37] + - +/- - - - - + - Not applicable Not applicable Not applicable Not applicable Metabolic and respiratory acidosis Pulse oximetry Not applicable Bilateral, diffuse, reticular granular or ground-glass appearance +/- Cardiomegaly Not applicable Not applicable Patent ductus arteriosus in echocardiography -
Shock[38] +/- +/- +/- +/- +/- +/- - +/- - ↑HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis ↓GFR, ↑BUN, ↑Cr Not applicable Not applicable ↑Lactate LFT, ↑BNP, ↑Troponin, D-dimer, Fibrinogen Pulmonary embolism, Pericardial effusion, Cardiac tamponade, Pneumothorax, Thoracic or abdominal aortic aneurysm in RUSH (Rapid Ultrasound for Shock and Hypotension) Pneumonia, Pneumothorax, Pulmonary edema, Widened mediastinum, Free air under the diaphragm Traumatic brain injury, Stroke, Spinal injury, Pneumonia, Pneumothorax, Ruptured aneurysm, Aortic dissection, Pulmonary embolism Not applicable - -
  1. ↑ Pletcher MJ, Maselli J, Gonzales R (December 2004). "Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey". Am. J. Med. 117 (11): 863–7. doi:10.1016/j.amjmed.2004.07.042. PMID 15589492.
  2. ↑ Cherpitel CJ (March 1989). "Breath analysis and self-reports as measures of alcohol-related emergency room admissions". J. Stud. Alcohol. 50 (2): 155–61. PMID 2927129.
  3. ↑ Marr KA, Carter RA, Crippa F, Wald A, Corey L (April 2002). "Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients". Clin. Infect. Dis. 34 (7): 909–17. doi:10.1086/339202. PMID 11880955.
  4. ↑ Cornillet A, Camus C, Nimubona S, Gandemer V, Tattevin P, Belleguic C, Chevrier S, Meunier C, Lebert C, Aupée M, Caulet-Maugendre S, Faucheux M, Lelong B, Leray E, Guiguen C, Gangneux JP (September 2006). "Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey". Clin. Infect. Dis. 43 (5): 577–84. doi:10.1086/505870. PMID 16886149.
  5. ↑ Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB (November 2009). "Clinical outcomes in household contacts of patients with cholera in Bangladesh". Clin. Infect. Dis. 49 (10): 1473–9. doi:10.1086/644779. PMC 2783773. PMID 19842974.
  6. ↑ 6.0 6.1 Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB (January 1974). "Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum". J. Infect. Dis. 129 (1): 45–52. PMID 4809112.
  7. ↑ Harris JB, Ivers LC, Ferraro MJ (June 2011). "Case records of the Massachusetts General Hospital. Case 19-2011. A 4-year-old Haitian boy with vomiting and diarrhea". N. Engl. J. Med. 364 (25): 2452–61. doi:10.1056/NEJMcpc1100927. PMID 21696312.
  8. ↑ Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA (September 2007). "Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure". Circulation. 116 (13): 1482–7. doi:10.1161/CIRCULATIONAHA.107.696906. PMID 17724259.
  9. ↑ Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ (February 2005). "Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis". JAMA. 293 (5): 572–80. doi:10.1001/jama.293.5.572. PMID 15687312.
  10. ↑ Steiner MJ, DeWalt DA, Byerley JS (June 2004). "Is this child dehydrated?". JAMA. 291 (22): 2746–54. doi:10.1001/jama.291.22.2746. PMID 15187057.
  11. ↑ Vega RM, Avner JR (June 1997). "A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children". Pediatr Emerg Care. 13 (3): 179–82. PMID 9220501.
  12. ↑ Carpenter DO (February 1990). "Neural mechanisms of emesis". Can. J. Physiol. Pharmacol. 68 (2): 230–6. PMID 2178747.
  13. ↑ Bresee JS, Marcus R, Venezia RA, Keene WE, Morse D, Thanassi M, Brunett P, Bulens S, Beard RS, Dauphin LA, Slutsker L, Bopp C, Eberhard M, Hall A, Vinje J, Monroe SS, Glass RI (May 2012). "The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States". J. Infect. Dis. 205 (9): 1374–81. doi:10.1093/infdis/jis206. PMID 22454468.
  14. ↑ Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA (October 1991). "Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis". Ann. Intern. Med. 115 (7): 513–9. PMID 1883120.
  15. ↑ Bismuth C, Gaultier M, Conso F, Efthymiou ML (1973). "Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications". Clin. Toxicol. 6 (2): 153–62. doi:10.3109/15563657308990513. PMID 4715199.
  16. ↑ Graham DY, Smith JL (April 1981). "The course of patients after variceal hemorrhage". Gastroenterology. 80 (4): 800–9. PMID 6970703.
  17. ↑ de Franchis R (October 2010). "Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension". J. Hepatol. 53 (4): 762–8. doi:10.1016/j.jhep.2010.06.004. PMID 20638742.
  18. ↑ LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, Curb JD, Evans D, Hennekens CH (June 1991). "Smoking and mortality among older men and women in three communities". N. Engl. J. Med. 324 (23): 1619–25. doi:10.1056/NEJM199106063242303. PMID 2030718.
  19. ↑ Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH, Grosse SD (August 2009). "Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP". Pediatrics. 124 (2): 823–36. doi:10.1542/peds.2009-1397. PMID 19581259.
  20. ↑ Achneck HE, Sileshi B, Parikh A, Milano CA, Welsby IJ, Lawson JH (November 2010). "Pathophysiology of bleeding and clotting in the cardiac surgery patient: from vascular endothelium to circulatory assist device surface". Circulation. 122 (20): 2068–77. doi:10.1161/CIRCULATIONAHA.110.936773. PMID 21098468.
  21. ↑ Gralnick HR, Rick ME, McKeown LP, Williams SB, Parker RI, Maisonneuve P, Jenneau C, Sultan Y (July 1986). "Platelet von Willebrand factor: an important determinant of the bleeding time in type I von Willebrand's disease". Blood. 68 (1): 58–61. PMID 3487361.
  22. ↑ Liesveld JL, Rowe JM, Lichtman MA (March 1987). "Variability of the erythropoietic response in autoimmune hemolytic anemia: analysis of 109 cases". Blood. 69 (3): 820–6. PMID 3814817.
  23. ↑ Marchand A, Galen RS, Van Lente F (May 1980). "The predictive value of serum haptoglobin in hemolytic disease". JAMA. 243 (19): 1909–11. PMID 7365971.
  24. ↑ Ginès P, Schrier RW (September 2009). "Renal failure in cirrhosis". N. Engl. J. Med. 361 (13): 1279–90. doi:10.1056/NEJMra0809139. PMID 19776409.
  25. ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (January 1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.
  26. ↑ Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB (April 2006). "Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention". Circulation. 113 (14): 1807–16. doi:10.1161/CIRCULATIONAHA.106.174287. PMID 16567565.
  27. ↑ Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G (March 2005). "Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology". Eur. Heart J. 26 (5): 516–24. doi:10.1093/eurheartj/ehi108. PMID 15689345.
  28. ↑ Ge PS, Runyon BA (March 2014). "The changing role of beta-blocker therapy in patients with cirrhosis". J. Hepatol. 60 (3): 643–53. doi:10.1016/j.jhep.2013.09.016. PMID 24076364.
  29. ↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
  30. ↑ Johnson W, Nguyen ML, Patel R (November 2012). "Hypertension crisis in the emergency department". Cardiol Clin. 30 (4): 533–43. doi:10.1016/j.ccl.2012.07.011. PMID 23102030.
  31. ↑ Elliott WJ (2006). "Clinical features in the management of selected hypertensive emergencies". Prog Cardiovasc Dis. 48 (5): 316–25. doi:10.1016/j.pcad.2006.02.004. PMID 16627047.
  32. ↑ Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.
  33. ↑ Such J, Runyon BA (October 1998). "Spontaneous bacterial peritonitis". Clin. Infect. Dis. 27 (4): 669–74, quiz 675–6. PMID 9798013.
  34. ↑ Runyon BA (October 1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
  35. ↑ Gregg XT, Prchal JT (January 1997). "Erythropoietin receptor mutations and human disease". Semin. Hematol. 34 (1): 70–6. PMID 9025165.
  36. ↑ Kralovics R, Indrak K, Stopka T, Berman BW, Prchal JF, Prchal JT (September 1997). "Two new EPO receptor mutations: truncated EPO receptors are most frequently associated with primary familial and congenital polycythemias". Blood. 90 (5): 2057–61. PMID 9292543.
  37. ↑ Hooper SB, Te Pas AB, Kitchen MJ (May 2016). "Respiratory transition in the newborn: a three-phase process". Arch. Dis. Child. Fetal Neonatal Ed. 101 (3): F266–71. doi:10.1136/archdischild-2013-305704. PMID 26542877.
  38. ↑ Vincent JL, De Backer D (October 2013). "Circulatory shock". N. Engl. J. Med. 369 (18): 1726–34. doi:10.1056/NEJMra1208943. PMID 24171518.
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