Skip to main content
Symptom
dx.
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Calculators
Clinical calculators
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Symptom
dx.
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Calculators
Clinical calculators
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Get Started
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Calculators
Clinical calculators
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Loading...
Pruritus Without Rash
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Pruritus Without Rash
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI overview
Pruritus characterization
▶
Onset context
Course pattern
Continuous
Intermittent
Diurnal pattern
Nocturnal predominance
Triggered episodes
Functional impact
Sleep disruption
Work or school disruption
OPQRST
▶
Onset
▶
Sudden
Gradual
Provocation and palliation
▶
Worse with heat
Worse after hot shower
Worse with sweating
Worse with wool
Worse with water exposure
Relief with cooling
Relief with moisturizers
Relief with antihistamines
Quality
▶
Burning
Tingling
Crawling sensation
Pure itch sensation
Region and radiation
▶
Generalized
Localized
Scalp
Trunk
Extremities
Anogenital
Palms and soles
Severity
▶
Mild
Moderate
Severe
Worst imaginable itch
Timing
▶
Duration per episode
Total duration
Associated symptoms
▶
Jaundice symptoms
▶
Dark urine
Pale stools
RUQ discomfort
Systemic symptoms
▶
Fever
Night sweats
Unintentional weight loss
Fatigue
Renal symptoms
▶
Decreased urine output
Uremic symptoms
Endocrine symptoms
▶
Heat intolerance
Cold intolerance
Polyuria
Polydipsia
Hematologic symptoms
▶
Easy bruising
Bleeding
Thrombosis symptoms
Neuropathic symptoms
▶
Dermatomal pain
Numbness
Paresthesias
Exposure history
Skin and contact exposures
▶
New soaps
New detergents
New lotions
New fragrances
New clothing fabrics
Occupational irritants
Home cleaning agents
Infectious and infestation exposures
▶
Household itching
Close contacts with rash
Recent travel
Shelter or dorm exposures
Bed bugs exposure risk
Scabies exposure risk
Environmental factors
▶
Dry indoor heat
Low humidity
Cold season flare
Excessive bathing
Alarm Features
Immediate escalation triggers
Anaphylaxis or airway concern
▶
Lip or tongue swelling
Voice change
Stridor
Wheeze
Hypotension
Severe systemic illness concern
▶
Fever with toxicity
Altered mental status
Hypotension
Tachycardia with poor perfusion
High risk etiologies signals
Hepatobiliary obstruction or severe cholestasis
▶
Jaundice
RUQ pain
Dark urine
Pale stools
Marked bilirubin elevation
Malignancy concern
▶
Unintentional weight loss
Night sweats
Persistent lymphadenopathy
Hepatosplenomegaly
Hematologic emergency patterns
▶
Hyperviscosity symptoms
Thrombosis symptoms
Marked eosinophilia with organ symptoms
Pregnancy specific red flags
▶
Pruritus in third trimester with palms or soles involvement
RUQ pain
Elevated bile acids or transaminases
Skin integrity complications
▶
Extensive excoriations with cellulitis signs
Signs of secondary infection
Rapidly progressive pain out of proportion
Medications
Medication triggers
Recent additions or dose changes
▶
New prescription within 6 weeks
Dose escalation within 6 weeks
Common pruritus associated classes
▶
Opioids
ACE inhibitors
Statins
NSAIDs
Antibiotics
Antimalarials
Calcium channel blockers
Hormonal therapies
Contrast exposure
Biologics and immunotherapies
OTC and supplements
▶
Herbal products
Niacin
Protein supplements
New vitamins
Substance exposures
▶
Alcohol
Cannabis products
Stimulants
Treatment compatibility and cautions
Antihistamine risks
▶
Sedation risk
QT prolongation risk
Anticholinergic burden
Cholestyramine interactions
▶
Binding other oral meds
Separate dosing windows
Opioid related pruritus management considerations
▶
Dose reduction feasibility
Alternative analgesics
Diet
Dietary and hydration patterns
Hydration status clues
▶
Low oral intake
Diuretics and dehydration risk
Potential triggers
▶
Alcohol exposure pattern
High spice exposure
Caffeine or energy drink exposure
Liver risk dietary context
▶
Heavy alcohol use pattern
Recent binge use
Review of Systems
System focused symptom screen
Constitutional
▶
Fever
Night sweats
Weight loss
Fatigue
Hepatobiliary
▶
Jaundice
Dark urine
Pale stools
RUQ pain
Nausea
Renal
▶
Oliguria
Edema
Uremic symptoms
Endocrine
▶
Heat intolerance
Tremor
Palpitations
Diarrhea
Constipation
Hematologic and oncologic
▶
Lymph node swelling
Easy bruising
Bleeding
Bone pain
Dermatologic
▶
Dry skin
New rash history
Hives history
Scalp scale
Neurologic
▶
Dermatomal pain
Paresthesias
Weakness
Collateral History and Family History
Collateral sources and reliability
Collateral input
▶
Family or caregiver report
Pharmacy records
Prior labs and imaging
Reliability modifiers
▶
Cognitive impairment
Language barriers
Family history patterns
Liver and biliary disease
▶
Primary biliary cholangitis
Primary sclerosing cholangitis
Hematologic disease
▶
Polycythemia vera (D45)
Lymphoma history
Atopy and dermatologic predisposition
▶
Atopic dermatitis (L20.9)
Allergic disease history
Risk Factors
Systemic disease risk
Hepatobiliary risk
▶
Viral hepatitis exposure
Known gallstones
Prior cholestasis episodes
Heavy alcohol use
Renal risk
▶
Chronic kidney disease (N18.9)
Dialysis status
Diabetes mellitus (E11.9)
Hematologic and malignancy risk
▶
Prior malignancy
Immunosuppression
B symptoms
Endocrine risk
▶
Thyroid disease
Poorly controlled diabetes
Pregnancy and postpartum
▶
Current pregnancy
Prior intrahepatic cholestasis of pregnancy history
Exposure and environment risk
Infestation risk
▶
Crowded living
Shelter or dorm residence
Household itching
Occupational and contact risk
▶
Healthcare exposure
Childcare exposure
Chemical exposure at work
Differential Diagnosis
Life threatening
Obstructive cholestasis
▶
Choledocholithiasis (K80.5)
Cholangitis (K83.0)
Pancreatic malignancy (C25.9)
Clinical clues
▶
Jaundice
Pale stools
Dark urine
RUQ pain
Severe systemic allergic reaction
▶
Anaphylaxis (T78.2)
Clinical clues
▶
Airway symptoms
Hypotension
Wheeze
Hematologic malignancy
▶
Hodgkin lymphoma (C81.90)
Leukemia (C95.90)
Clinical clues
▶
Night sweats
Weight loss
Lymphadenopathy
Uremia
▶
Advanced kidney failure (N18.5)
Clinical clues
▶
Known CKD
Pruritus with dialysis
Uremic symptoms
Common
Xerosis and asteatotic eczema
▶
Age related xerosis
Low humidity exposure
Frequent bathing
Clinical clues
▶
Fine scale
Excoriations
Drug induced pruritus
▶
Opioid related
Antibiotic related
NSAID related
Clinical clues
▶
Temporal relationship to start
No primary rash
Atopic diathesis without obvious rash
▶
History of atopy
Seasonal flares
Infestation with subtle findings
▶
Scabies (B86)
Bed bugs exposure
Clinical clues
▶
Nocturnal itch
Household itching
Burrows in finger webs
Less common
Cholestatic liver diseases
▶
Primary biliary cholangitis (K74.3)
Primary sclerosing cholangitis (K83.01)
Clinical clues
▶
Elevated alkaline phosphatase
Fatigue
Endocrine and metabolic
▶
Hyperthyroidism (E05.90)
Hypothyroidism (E03.9)
Diabetes mellitus (E11.9)
Iron deficiency
Hematologic
▶
Polycythemia vera (D45)
Aquagenic pruritus
Clinical clues
▶
Itch after warm water exposure
Headache
Thrombosis history
Neuropathic pruritus
▶
Brachioradial pruritus
Notalgia paresthetica
Postherpetic itch
Clinical clues
▶
Localized dermatomal distribution
Tingling or burning quality
Psychogenic pruritus
▶
Anxiety disorder (F41.9)
Somatic symptom disorder (F45.1)
Clinical clues
▶
Stress correlation
Normal objective workup
Past Medical History
Relevant chronic conditions
Liver disease history
▶
Cirrhosis (K74.60)
Chronic hepatitis (K73.9)
Kidney disease history
▶
CKD stage
Dialysis modality
Dermatologic history
▶
Atopic dermatitis (L20.9)
Chronic urticaria (L50.8)
Endocrine history
▶
Thyroid disease
Diabetes mellitus (E11.9)
Hematologic history
▶
Myeloproliferative disorders
Prior malignancy
Prior episodes and procedures
Prior pruritus episodes
▶
Similar prior workups
Response to therapies
Surgeries and devices
▶
Cholecystectomy history
Biliary stent history
Central lines
Baseline function
▶
Baseline sleep quality
Baseline skin care routine
Physical Exam
General and vitals
Appearance and distress
▶
Agitation from itch
Sleep deprived appearance
Vital sign patterns
▶
Fever
Tachycardia
Hypotension
Hypoxia
Skin focused exam
Primary lesion assessment
▶
No primary rash
Excoriations pattern
Lichenification
Dry skin scale
Infestation signs
▶
Burrows
Finger web involvement
Wrist flexor involvement
Genital involvement
Urticaria or dermographism
▶
Wheals after scratching
Dermatographism
System exam for systemic causes
HEENT
▶
Scleral icterus
Conjunctival pallor
Lymphatic
▶
Cervical lymphadenopathy
Axillary lymphadenopathy
Inguinal lymphadenopathy
Abdomen
▶
Hepatomegaly
Splenomegaly
RUQ tenderness
Ascites
Cardiopulmonary
▶
Wheeze
Signs of heart failure
Neurologic
▶
Focal sensory changes
Dermatomal distribution
Lab Studies
Initial lab panel selection
CBC
▶
Eosinophilia
Anemia
Leukocytosis
Thrombocytosis
CMP with liver panel
▶
AST and ALT
Alkaline phosphatase
Total bilirubin
Direct bilirubin
Albumin
Creatinine
Urea
Thyroid testing
▶
TSH
Free T4 if abnormal TSH
Glucose evaluation
▶
Random glucose
HbA1c if chronic concern
Targeted labs by suspicion
Cholestatic pattern evaluation
▶
GGT
INR
Hepatitis serologies
Renal and uremic itch evaluation
▶
Phosphate
Calcium
Hematologic and malignancy screening
▶
Ferritin
Iron studies
LDH
Pregnancy specific testing
▶
Pregnancy test if applicable
Serum bile acids if suspected intrahepatic cholestasis of pregnancy
Infection risk testing when indicated
▶
HIV
Strongyloides serology if eosinophilia with exposure risk
Imaging
Scoring Systems
Risk stratification context
▶
Not routinely indicated for isolated pruritus without systemic features
Use targeted imaging based on cholestasis or malignancy red flags
MRI
Hepatobiliary MRI considerations
▶
MRCP for suspected biliary obstruction with nondiagnostic ultrasound
Contraindications
▶
Non MRI compatible device
Severe claustrophobia without support
CT
CT abdomen indications
▶
Suspected malignancy with cholestasis or weight loss
Obstructive jaundice with unclear source after ultrasound
Contrast cautions
▶
CKD and contrast nephropathy risk
Prior contrast reaction
Ultrasound
RUQ ultrasound indications
▶
Cholestatic labs
Jaundice symptoms
Ultrasound interpretation pearls
▶
Biliary duct dilation suggests obstruction
No dilation does not exclude intrahepatic cholestasis
Special Tests
Bedside and clinic tests
Scabies evaluation adjuncts
▶
Dermoscopy for burrows
Skin scraping microscopy when available
Allergy and urticaria pattern assessment
▶
Dermatographism check
Trigger reproducibility
Specialty directed testing
Cholestasis etiologic testing
▶
Antimitochondrial antibody for primary biliary cholangitis
IgG4 testing if IgG4 related disease suspected
Hematologic evaluation
▶
JAK2 mutation testing via outpatient hematology when polycythemia vera suspected
Peripheral smear review when cytopenias or blasts suspected
ECG
Indications in pruritus presentations
ECG triggers
▶
Tachycardia with systemic illness
Palpitations with hyperthyroid symptoms
Medication safety checks
▶
Baseline QT interval when using QT prolonging agents
Repeat ECG if multiple QT risk factors
Assessment
Problem representation
Pruritus without primary rash
▶
Localized vs generalized
Acute vs chronic
Systemic features present vs absent
Most likely category
▶
Xerosis predominant
Medication related
Cholestatic pattern
Uremic pattern
Infestation risk
Neuropathic pattern
Severity and risk stratification
Low risk profile
▶
Normal vitals
No jaundice
No B symptoms
Normal screening labs
Higher risk profile
▶
Cholestatic labs
Renal failure markers
B symptoms
Marked eosinophilia
Pregnancy with palms or soles involvement
Plan
First 5 minutes critical patient workflow
Immediate stabilization
▶
Airway compromise signs
Oxygen for hypoxia
Cardiac monitoring for hypotension or tachyarrhythmia
IV access for unstable vitals
Immediate treatment triggers
▶
If anaphylaxis features then IM epinephrine per local protocol dependent
If hypotension then IV fluids per shock pathway
Time targets
▶
If systemic allergic reaction concern then epinephrine within minutes
If sepsis concern then lactate and cultures within 1 hour per local protocol dependent
Symptom control
Skin care and barrier support
▶
Thick emollient multiple times daily
Lukewarm showers
Avoid fragranced products
Antihistamine strategy
▶
Non sedating daytime option
Cetirizine PO 10 mg daily adult example
Sedating nighttime option when sleep disruption
Hydroxyzine PO 25 mg at bedtime adult example
Topical antipruritic options
▶
Pramoxine topical as needed
Menthol camphor lotion as needed
Neuropathic itch options
▶
Consider gabapentin when neuropathic pattern and no contraindications
Renal dosing adjustment required
Etiology directed management
Cholestasis pathway
▶
RUQ ultrasound if cholestatic labs or jaundice
Early GI or surgery discussion if obstruction suspected
Uremic pruritus pathway
▶
Renal function optimization
Dialysis adequacy review via nephrology for dialysis patients
Infestation pathway
▶
Permethrin 5 percent topical for scabies suspected
Treat close contacts and bedding
Medication induced pruritus pathway
▶
Stop suspected offending agent when safe
Alternative medication plan via prescriber
Reassessment loop
Recheck interval
▶
30 to 60 minutes after initial symptom therapy
Earlier if unstable vitals
Recheck elements
▶
Vitals
Airway symptoms
Pruritus severity score
New rash or hives emergence
Disposition
Level of care criteria
ICU or resuscitation area
▶
Anaphylaxis with airway compromise
Persistent hypotension
Altered mental status
Inpatient admission
▶
Suspected cholangitis
Obstructive jaundice requiring urgent intervention
Acute kidney injury with severe symptoms
Severe pruritus with inability to maintain hydration or sleep and unsafe home supports
Observation pathway
▶
Moderate cholestatic lab abnormalities with pending imaging
Marked eosinophilia with symptoms requiring short interval reassessment
Discharge criteria and follow up
Copy
Discharge criteria
▶
Stable vitals
No airway symptoms
No jaundice signs
Labs reassuring or plan for close follow up
Follow up timing
▶
Primary care within 3 to 7 days for chronic pruritus
Earlier within 24 to 72 hours if abnormal labs
Specialty follow up
▶
GI for cholestatic pattern
Nephrology for CKD and uremic itch
Hematology for polycythemia or concerning CBC
Discharge Instructions
Copy discharge instructions
Copy
Summary
▶
You were seen for itching without a clear rash
Today your vital signs were stable and there were no signs of a dangerous allergic reaction
Skin care
▶
Use a thick fragrance free moisturizer at least twice daily
Use lukewarm showers and avoid hot water
Avoid new scented soaps detergents and lotions until symptoms improve
Medications
▶
Take cetirizine 10 mg once daily if approved for you
If itching prevents sleep you may take hydroxyzine 25 mg at bedtime if approved for you
Do not drive or operate machinery after sedating medications
Follow up
▶
See your primary care clinician within 3 to 7 days
If blood tests were abnormal follow up within 24 to 72 hours as instructed
Return to the ER now if
▶
Trouble breathing
Lip tongue or throat swelling
Fainting
New fever
Yellow eyes or skin
Dark urine or pale stools
New severe abdominal pain
Rapidly spreading redness warmth or pus from scratched areas
References
Guidelines and core sources
Pruritus evaluation and management references
▶
British Association of Dermatologists guidance on pruritus and chronic pruritus 2018
European S2k guideline on chronic pruritus 2019
AASLD guidance on cholestatic liver diseases evaluation and cholestasis workup 2021
KDIGO chronic kidney disease guidance and CKD associated symptom management 2024
ACOG guidance on intrahepatic cholestasis of pregnancy 2020
Project instructions
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
← Clinical Approaches
Home
Clinical Approaches
Pruritus Without Rash