Acute adrenal insufficiency steroid withdrawal

Diagnosing acute pancreatitis can be difficult because the signs and symptoms of pancreatitis are similar to other medical conditions. The diagnosis is usually based upon a medical history, physical examination, and the results of diagnostic tests. Two of the following three are required to make a diagnosis: (1) typical abdominal pain; (2) threefold or more elevation of pancreatic enzyme values in the blood; and (3) inflammation of the gland on computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. The number and type of tests is tailored to the severity of acute pancreatitis and the most likely underlying causes. (See "Clinical manifestations and diagnosis of acute pancreatitis" .)


In patients with grade I or II encephalopathy, enteral feeding should be initiated early. Parenteral nutrition should be used only if enteral feeding is contraindicated as it increases the risk of infection. Severe restriction of protein is not beneficial; 60 g/day of protein is generally reasonable. Fluid replacement with colloid (. albumin) is preferred rather than crystalloid (. saline); all solutions should contain dextrose to maintain euglycemia. Multiple electrolyte abnormalities are common in ALF. Correction of hypokalemia is essential as hypokalemia increases the kidneys' ammonia production, potentially exacerbating encephalopathy. Hypophosphatemia is especially common in patients with acetaminophen-induced ALF and in those with intact renal function. Hypoglycemia occurs in many patients with ALF and is often due to depletion of hepatic glycogen stores and impaired gluconeogenesis. Plasma glucose concentration should be monitored and hypertonic glucose administered as needed. [25]

Acute adrenal insufficiency steroid withdrawal

acute adrenal insufficiency steroid withdrawal


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