Endocrine System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient has presented with hypotension and confusion (suggesting hypoperfusion). This is an acute shock state, which is a medical emergency.\n\nHe is dehydrated, with cold and clammy peripheries and a prolonged capillary refill time (CRT). These signs favor hypovolemic shock.\n\nHowever, there does not appear to be a clear cause for hypovolemic shock - while dehydration (secondary to the the diarrhea and vomiting) is a possibility, this would be quite unusual in a patient of this age.\n\nDistributive shock secondary to sepsis is an alternate possibility, given the history of infection.\n\nWhile distributive shock classically presents with peripheral vasodilation and bounding pulses, these signs may be masked if these is an associated element of hypovolemia, and are absent in the late stages (where there is critical organ dysfunction).\n\nCardiogenic shock is unlikely as the jugular venous pressure (JVP) is not elevated.\n\nAt this point, initial resuscitation should take precedence - IV fluid"}]}

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