Differentials
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
GeneesmiddelenverslavingPublished by: Domus Medica | SSMGLast published: 2011Assuétude aux médicamentsPublished by: Domus Medica | SSMGLast published: 2011Alcohol intoxication
SIGNS / SYMPTOMS
History of recent alcohol ingestion.
Alcoholic breath and clinically significant maladaptive behavioral changes during or following alcohol ingestion.
Lack of coordination and unsteady gait.
Nystagmus.
Impaired attention.
Coma.
INVESTIGATIONS
Urine toxicology negative for opioids.
Blood alcohol levels give an indicator of the level of alcohol in the blood.
Sedative intoxication
SIGNS / SYMPTOMS
History of recent sedative ingestion.
Hostility or mood swings.
Poor judgment.
Inappropriate sexual behavior.
Lack of coordination.
Inattention.
Blackouts.
Extreme sluggishness.
Stupor.
Coma.
INVESTIGATIONS
Urine toxicology negative for opioids.
Toxicology screen will show presence of the suspected drug in a blood or urine sample.
Anticholinergic intoxication
SIGNS / SYMPTOMS
History of recent anticholinergic ingestion.
Rapid onset of alteration in mood, cognition, and perception in the presence of a clear sensorium.
Dry flushed skin.
INVESTIGATIONS
Urine toxicology negative for opioids.
If a specific anticholinergic agent is suspected, blood levels should be measured to confirm diagnosis.
Phencyclidine (PCP) intoxication
SIGNS / SYMPTOMS
History of recent PCP use.
Involuntary rapid movements of the eyes, vertically or horizontally.
Palpitations.
Drooling.
Hyperthermia.
Reduced response to pain.
Increased alertness.
Lack of muscle coordination.
Disordered thinking or impaired judgment.
Schizophrenic-like psychoses.
Coma.
Features of rhabdomyolysis (asymptomatic or present with generalized malaise or dark urine).
INVESTIGATIONS
Urine toxicology negative for opioids.
Toxicology screen will show presence of PCP in a blood or urine sample.
Serum CK: more than 5 times normal if rhabdomyolysis is present.
Brain injury
SIGNS / SYMPTOMS
History of brain injury.
Altered sensorium.
Neurologic deficits may or may not be present.
INVESTIGATIONS
Urine toxicology negative for opioids.
Injury seen on MRI or CT brain.
Hepatic encephalopathy
SIGNS / SYMPTOMS
Usually secondary to an underlying medical illness.
Altered consciousness.
Confusion secondary to hepatic dysfunction.
INVESTIGATIONS
Urine toxicology negative for opioids.
Elevated LFTs.
Uremia
SIGNS / SYMPTOMS
Usually a manifestation of underlying medical illness such as renal failure.
Headache.
Skin discoloration.
Pruritus.
INVESTIGATIONS
Urine toxicology negative for opioids.
Fluid, electrolyte, and hormone imbalances, and metabolic abnormalities, will be present, which develop in parallel with deterioration of renal function.
CBC, urinalysis, urine culture and colony count, serum and urine osmolality, chemistry panel, sedimentation rate, arterial blood gas analysis, blood volume, cystoscopy, and retrograde pyelography could be ordered.
Additional studies include abdominal CT scan, ultrasonography, and renal biopsy.
Results of these tests will be specific to the underlying medical illness causing uremia.
Diabetic hypoglycemia
SIGNS / SYMPTOMS
Acutely abnormal behavior in a person with diabetes, such as the inability to complete routine tasks.
Visual disturbances.
Palpitations.
Sweating.
Dizziness.
Tremors.
Anxiety.
Coma and seizures are uncommon.
INVESTIGATIONS
Urine toxicology negative for opioids.
Laboratory definitions vary according to specific patient/clinical situation.
Random serum blood glucose level <70 mg/dL (<3.9 mmol/L) (level 1 hypoglycemia) suggests a need for clinical management.
Diabetic ketoacidosis
SIGNS / SYMPTOMS
Life-threatening condition secondary to diabetes mellitus.
Sluggishness and extreme tiredness.
Polydipsia and polyuria.
Acetone breath.
Hyperventilation.
Agitation.
INVESTIGATIONS
Urine toxicology negative for opioids.
Serum glucose level usually >250 mg/dL (although it is usually much higher).
Blood pH level <7.3.
Serum bicarbonate level <18 mEq/L.
Elevated anion gap.
Alcohol or sedative withdrawal
SIGNS / SYMPTOMS
Anxiety or irritability.
Emotional volatility or agitation.
Depression.
Palpitations.
Clammy skin.
Tremors.
Delirium tremens (a state of confusion and hallucinations).
Convulsions.
Blackouts.
INVESTIGATIONS
Urine toxicology negative for opioids.
Toxicology screen will show presence of the suspected sedative in a blood or urine sample.
Blood alcohol levels give an indicator of the level of alcohol in the blood.
Elevated LFTs.
Anxiety
SIGNS / SYMPTOMS
Usually precipitated by high stress.
Headache.
Palpitations.
INVESTIGATIONS
Urine toxicology negative for opioids.
Clinical confirmation of diagnosis by a psychiatrist.
Depression
SIGNS / SYMPTOMS
Decreased interest and loss of energy.
Sadness.
Feelings of guilt.
Decreased concentration.
Appetite changes.
Psychomotor retardation or agitation.
Suicidal intent/ideation.
INVESTIGATIONS
Urine toxicology negative for opioids.
Clinical confirmation of diagnosis by a psychiatrist.
Hyperthyroidism
SIGNS / SYMPTOMS
Palpitations.
Heat intolerance.
Nervousness.
Amenorrhea.
Fatigue.
Tremors.
Warm moist skin.
Staring gaze.
Weight loss.
INVESTIGATIONS
Urine toxicology negative for opioids.
Thyroid stimulating hormone (TSH) levels will be decreased, along with increased T3 and T4 levels.
Sometimes an iodine uptake scan is done to locate the cause of the hyperactive thyroid.
Pheochromocytoma
SIGNS / SYMPTOMS
Palpitations.
Anxiety.
Diaphoresis.
Pallor.
INVESTIGATIONS
Urine toxicology negative for opioids.
Elevated serum or urine catecholamines and metanephrines.
Neuroimaging (MRI or CT) helps localize the tumor.
Serum glucose level may be elevated.
Use of this content is subject to our disclaimer