When suspected CVA seen, perform dry CT to r/o hemorrhage, tumor, or abscess. CBC, CMP, Lipid, ESR, ANA, Serology, A1c, EKG are indicated as well 1. Overweight or obese patients (body mass index 25 kg/m2) who have one or more of the following additional risk factors:
Race/ethnicity (e.g., Native American, Pacific Islander, Latino, African American, Asian American)
First-degree relative with diabetes
Previously diagnosed impaired fasting glucose (100-125 mg/dL) or impaired glucose tolerance (2-hour plasma glucose > 140 mg/dL following a 75 gram glucose load)
Hypertension (Blood pressure > 140/90 mmHg)
HDL cholesterol < 35 mg/dL and/or triglycerides > 250 mg/dL (2.83 mmol/L)
History of gestational diabetes mellitus, or delivering a baby > 9 lbs.
Polycystic ovarian syndrome
History of cardiovascular disease
A1C ≥5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing
Other clinical conditions associated with insulin resistance (e.g., acanthosis nigricans, severe obesity)
2. In the absence of the above risk factors, screening should begin at 45 years of age.
3. If results are normal, testing should be repeated at least at three-year intervals, with consideration of more frequent testing depending on risk status and initial results.
- sleep apnea, chronic renal disease, renovascular disease, drugs, pheo, primary aldosteronism, chronic steroid use, cushings, thyroid disease, parathyroid disease, coarctation of aorta - SE: headache, diarrhea, abdominal pain, nausea, constipation, bloating
- adverse effects: community aquired pneumonia, c-diff diarrhea, osteoperotic fracture, anti-platelet agent inhibition, iron, Mg and B12 deficieny
- severe hypertension of at least 160 systolic or 110 diastolic, or
- severe proteinuria of at least 5 grams in a 24 hour period or 3-4 + on dipstick, or
signs of fetal compromise (intra-uterine growth restriction or fetal demise, or oligohydramnios), or
persistent signs and symptoms of epigastric or right upper quadrant pain, or the HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), or
persistent neurologic signs and symptoms such as persistent and severe headache, scotoma (visual field defect), or seizures (eclampsia), or
other evidence of end-organ damage such as oliguria (<500 cc in 24 hours), pulmonary edema
- A patient with blood pressure in this range would need an anti-hypertensive in order to prevent sequelae of severe hypertension, such as myocardial infarction or stroke. It would be important, however, not to drop the blood pressure too far or too fast, in order to avoid decreased perfusion to the uterus (as well as the brain and other vital maternal organs).