Adrenal insufficiency following traumatic brain injury in adults

Powner, David J.; Boccalandro, Cristina

doi:10.1097/mcc.0b013e3282f57528

Cited by 43 publications

(23 citation statements)

References 19 publications

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“…A critical feature in this case is to recognize the gradual development of secondary adrenal insufficiency, which occurs with an incidence as high as 20% in patients with traumatic brain injury (3). The onset of the disorder is not always apparent immediately after the traumatic event but only becomes demonstrable days to weeks thereafter.…”

Section: Discussion Of Questionmentioning

confidence: 99%

“…A decrease in serum Cl 2 with respect to the serum Na + -as present in this case-suggests the presence of either chronic respiratory acidosis or metabolic alkalosis. The fall in serum Cl 2 will be accompanied by an increase in the serum bicarbonate concentration (HCO 3 2 ) in these conditions. The next step is to calculate the serum anion gap.…”

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

“…In general, the serum HCO 3 2 concentration will fall by an amount equal to the increase in anion gap. Assuming a normal value of 12, the anion gap has increased by 13 in this case.…”

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

“…Assuming a normal value of 12, the anion gap has increased by 13 in this case. One would predict that the serum HCO 3 2 should be approximately 11 mEq/L assuming a normal value of 24 mEq/L (24213=11). To explain the normal serum HCO 3 2 in this setting, one concludes that a metabolic alkalosis is also present.…”

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

“…Given the presence of an anion gap metabolic acidosis, the next step is to determine if the measured serum HCO 3 2 is equal to the predicted serum HCO 3 2 . In general, the serum HCO 3 2 concentration will fall by an amount equal to the increase in anion gap.…”

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

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American Society of Nephrology Quiz and Questionnaire 2012

Palmer

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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SummaryPresentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, with the answers of program directors of nephrology training programs in the United States acquired through an Internet-based questionnaire. Topics presented here include fluid and electrolyte disorders, transplantation, and ESRD and dialysis. Cases representing each of these categories along with single best answer questions were prepared by a panel of experts (B.F.P. and Drs. Fervenza, Brennan, and Mehrotra, respectively). The correct and incorrect answers then were briefly discussed after the audience responses, and the results of the questionnaire were displayed. This article tries to recapitulate the session and reproduce its educational value for a larger audiencethe readers of CJASN.Clin J Am Soc Nephrol 8: 1048-1053, 2013. doi: 10.2215/CJN.00460113 Electrolytes Case 1A 50-year-old man presents with weakness and lightheadedness; 2 months ago, he was diagnosed with central diabetes insipidus attributed to head trauma sustained during a motor vehicle accident. He was subsequently discharged on 10 mg intranasal desmopressin two times daily, which effectively controlled his polyuria. His discharge laboratory values were normal. Over the last 3-4 weeks, he has noticed the gradual onset of increasing fatigue, generalized weakness, and progressive anorexia; 1 week ago, he began to complain of lightheadedness on standing. The dose of desmopressin required to control his polyuria has decreased to 5 mg one time daily. His past medical history is significant for pulmonary sarcoidosis diagnosed by bronchoscopy 5 years ago but never treated. Physical examination shows a well developed, slightly lethargic man in no acute distress. He is afebrile, and his BP and pulse are 90/58 mmHg and 110/min, respectively.

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Section: Discussion Of Questionmentioning

confidence: 99%

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

“…In general, the serum HCO 3 2 concentration will fall by an amount equal to the increase in anion gap. Assuming a normal value of 12, the anion gap has increased by 13 in this case.…”

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

Section: Discussion Of Questions 2 Andmentioning

confidence: 99%

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