Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sex Differentiation Disorders Shock 1339

■Maintenance medications in CAH:

➣Hydrocortisone: monitor 17-OHP, testosterone

➣Mineralocorticoids for salt losers: fludrocortisone; monitor

plasma renin activity and BP

specific therapy

n/a

follow-up

n/a

complications and prognosis

n/a

SHOCK

THOMAS SHAUGHNESSY, MD

history & physical

History

■Hypoperfusion resulting in inadequate oxygen delivery to vital

organs

■Hypovolemia – dehydration, hemorrhage

■Cardiogenic – myocardial infarction, cardiomyopathy

■Septic – endotoxemia, abscess+/−drainage

■Neurogenic – cervical spinal cord lesion

Signs & Symptoms

■Oliguria, altered mental status, tachypnea, pallor, tachycardia

■Hypovolemic, Cardiogenic:

➣Cold, clammy, diaphoretic decreased pulse pressure (SBP-DBP)

and capillary refill

■Septic, Neurogenic:

➣Bounding pulse, dry skin, increased pulse pressure

tests

■Shock is predominately diagnosed by clinical observations

Laboratory

■Basic Studies:

➣Anion Gap (Na – [Cl+HCO 3 ])

Normal: 13–15 mEq/L