Cannot miss / life threats
Cannot miss / life threats
Differential diagnosis — checklist
0/23
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Dehydration / volume loss0/4
Medications / toxins0/5
Autoimmune / salivary0/4
Iatrogenic / structural0/3
Endocrine / systemic0/4
Infectious0/3
Initial ED workup
Bedside0/5
- Vitals + orthostatics
- Mucous membrane and skin turgor exam
- Point-of-care glucose
- Oral / salivary gland exam
- Medication reconciliation
Labs0/6
- BMP (Na⁺, K⁺, BUN/Cr, glucose)
- VBG + lactate if ill-appearing
- Serum + urine osmolality if DI suspected
- Calcium, magnesium
- TSH if endocrine suspected
- Autoimmune panel (ANA, anti-Ro/La) if chronic
Imaging0/2
- Bedside US of salivary glands if swelling
- CT neck (with IV contrast) for sialolithiasis / abscess
Initial management0/5
- IV fluids if dehydrated (balanced crystalloid)
- Treat underlying cause (insulin for DKA, stop offending med)
- Sugar-free gum / lozenges, frequent sips of water
- Saliva substitutes; pilocarpine or cevimeline for chronic xerostomia
- Oral hygiene to prevent caries and candidiasis
Pearls / pitfalls
Pearls
- Always check a glucose — new DM and DKA classically present with dry mouth and polyuria.
- Anticholinergic toxidrome: 'dry as a bone, hot as a hare, red as a beet, mad as a hatter, blind as a bat.'
- Chronic bilateral parotid swelling + dry eyes → think Sjögren.