salicylates and Thyroid-Diseases

Altered level of consciousness describes the reason for 3% of critical emergency department (ED) visits. Approximately 85% will be found to have a metabolic or systemic cause. Early laboratory studies such as a bedside glucose test, serum electrolytes, or a urine dipstick test often direct the ED provider toward endocrine or metabolic causes. This article examines common endocrine and metabolic causes of altered mentation in the ED via sections dedicated to endocrine-, electrolyte-, metabolic acidosis-, and metabolism-related causes.

Topics: Acidosis; Aged; Child; Consciousness Disorders; Cushing Syndrome; Diabetic Ketoacidosis; Ethylene Glycol; Female; Glucose Metabolism Disorders; Humans; Hyperammonemia; Inappropriate ADH Syndrome; Metabolic Diseases; Methanol; Pregnancy; Salicylates; Thyroid Diseases; Water-Electrolyte Imbalance

Topics: Adrenal Cortex Hormones; Arthritis, Rheumatoid; Autoimmune Diseases; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Myasthenia Gravis; Pemphigoid Gestationis; Polyarteritis Nodosa; Pregnancy; Pregnancy Complications; Salicylates; Scleroderma, Systemic; Thrombocytopenia; Thyroid Diseases

A poor therapeutic response may be explained by incomplete or erroneous diagnostic assessment, by failure to employ optimal drug doses and combinations, or by inadequate attention to the non-pharmacologic aspects of management. Poor compliance and counterproductive patient attitudes may need to be addressed. These problems and the approach to asthma concomitant with other diseases are discussed.

Topics: Asthma; Diabetes Complications; Diagnosis, Differential; Dyspnea, Paroxysmal; Female; Gastroesophageal Reflux; Heart Diseases; Humans; Hyperventilation; Occupational Diseases; Patient Compliance; Physician-Patient Relations; Pregnancy; Pregnancy Complications; Respiratory Tract Diseases; Respiratory Tract Infections; Salicylates; Sleep Wake Disorders; Surgical Procedures, Operative; Sympathomimetics; Theophylline; Thyroid Diseases

Topics: Androgens; Animals; Anticoagulants; Barbiturates; Bilirubin; Carbon Dioxide; Chemical Phenomena; Chemistry, Physical; Diuretics; Estrogens; Glucocorticoids; Humans; Novobiocin; Penicillins; Phenylbutazone; Phenytoin; Salicylates; Thyroid Diseases; Thyroxine; Thyroxine-Binding Proteins; Tolbutamide

Glucocorticoids are used in physiological and pharmacological amounts in the management of a variety of clinical conditions. Concomitant utilisation of other drugs or the presence of some diseases may affect the physiological action of the steroid in the tissues. Phenytoin, phenobarbitone, ephedrine and rifampicin accelerate the metabolism of glucocorticoids thereby decreasing their biological activity. A similar phenomenon occurs in patients with hyperthyroidism. In contrast, glucocorticoid action is enhanced in hypothyroid patients and in those with hepatic damage as the result of a defect in the clearance of the hormone from blood. In turn, glucocorticoids antagonise the effects of cholinesterase inhibitors and ganglion blocking agents. The above mentioned effects should be kept in mind whenever glucocorticoids are utilised in the diagnosis and management of endocrine or non-endocrine conditions.

Topics: Anticonvulsants; Cholinesterase Inhibitors; Contraceptives, Oral; Cushing Syndrome; Dexamethasone; Diuretics; Drug Interactions; Ephedrine; Ganglionic Blockers; Glucocorticoids; Humans; Hypnotics and Sedatives; Insulin; Kinetics; Liver Diseases; Pancuronium; Rifampin; Salicylates; Thyroid Diseases