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Old 06-14-2012
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Question Acute decompensation in anticoagulated patient!

A 63-year-old woman presents to the emergency department with confusion and mental status changes for the last two days. Her family says she has had symptoms of nausea, vomiting, abdominal pain, and diarrhea over the past few days. The patient has a history of cervical cancer, leading to clots in the legs and lungs several months prior to this admission. After a Greenfield filter was placed, she was sent home on coumadin. On this admission, she is found to be febrile with a temperature of 101.5 F orally, a pulse of 115/min, and a blood pressure of 90/60 mm Hg.
Laboratory studies show:
White cell count 11,000/mm3; hematocrit 31%; platelets 177,000/mm3; sodium 126 mEq/L; potassium 5.7 mEq/L; chloride 114 mEq/L, bicarbonate 22 mEq/L; BUN 33 mg/dL; creatinine 1.2 mg/dL; glucose 57 mg/dL. Prothrombin time 24 seconds; INR 2.2, aPTT 68 seconds.

What would be the best initial test?

(A) Plasma renin level
(B) Cosyntropin stimulation test
(C) Serum cortisol level
(D) Lumbar puncture
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Old 06-14-2012
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Stuck btwn C & D..

Ill guess C....
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Old 06-15-2012
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-ithink it's addison ,not sure is it b,or,c ,lwill go forB.
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(C) Serum cortisol level
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Old 06-15-2012
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I want to change my answer

I think C) is never the right answer because cortisol levels tend to vary throughout the day and will give you a misleading diagnosis.

The Cosyncotropin test is much better because we will either see a an increase in cortisol, or no change and thus will give us the diagnosis if this is infact adrenal insufficiency.

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ans is B. but patient is unstable. and stimulation test takes time? still we do that??

may i know why not C ?

in other words, what is best initial test for acute adrenal insufficiency ?
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Quote:
Originally Posted by tyagee View Post
ans is B. but patient is unstable. and stimulation test takes time? still we do that??

may i know why not C ?

in other words, what is best initial test for acute adrenal insufficiency ?
Cosyncotrophin Stim Test I believe...
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Quote:
Originally Posted by tyagee View Post
ans is B. but patient is unstable. and stimulation test takes time? still we do that??

may i know why not C ?

in other words, what is best initial test for acute adrenal insufficiency ?
buz=crtoson level vary from morning to evening
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