Katie Selman, MD
A patient presents with HIV and a fever...what's in the differential? Below is simple review of the differentials to consider for patients with HIV who present to the ED with a fever based on CD4 counts.
· Temperatures above freezing + wet conditions = immersion injury
· Commonly from continuously wearing wet socks and shoes
· Repeated exposure to wet and cold
o Homeless, military, outdoor workers
· Occurs over several days to weeks
· Tingling or numbness most common symptom
· Damp, pale or mottled in color
HINTS Testing: series of three physical exam maneuvers to differentiate peripheral and central causes of vertigo
Head Impulse test: tests vestibulo-ocular reflex
• Patient focuses on visual spot directly in front of them
• Rotate patient’s head rapidly from center to 40 degrees to the left and back again to center, repeat on the right
Last week we wrote about how to approach hyponatremia, the differential and signs and symptoms to watch out for. The post this week reviews the treatment of hyponatremia including the dreaded osmotic demyelination syndrome. Read on for more!