Approach to the Critical Patient

Immediate priorities

Airway and breathing threats

Circulation threats

Key early branching

Monitoring and targets

Monitoring bundle

Escalation triggers

Immediate consults

Consultation triggers

History

Presentation pattern

Core symptoms

Respiratory symptoms

Intake and fasting history

Duration and degree of oral restriction

Important negatives

Risk factors

High-risk populations

Comorbid contributors

Social and collateral history

Collateral history often essential

Family history

Physical Exam

Vitals and general

Vital sign pattern

General appearance

Focused examination

Hydration and perfusion

HEENT and oral

Neurological assessment

Abdominal exam

PITFALLS

Missed diagnoses

Differential Diagnosis

Ketoacidotic states

Diabetic ketoacidosis

Alcoholic ketoacidosis

SGLT2 inhibitor-related euglycemic DKA

Toxic and metabolic causes of high anion gap

Lactic acidosis

Toxic alcohol ingestion

Salicylate toxicity

Other metabolic and systemic causes

Uremic acidosis

Inborn errors of metabolism

Thyrotoxic crisis

Laboratory Tests

Core metabolic panel

Point-of-care glucose

Anion gap calculation

Electrolytes

Ketone and acid-base markers

Beta-hydroxybutyrate serum level

Venous blood gas

Additional targeted labs

Complete blood count

Renal function

Liver function tests

Thiamine level if available

Diagnostic Tests

Scoring Systems

Ketoacidosis severity assessment

Refeeding syndrome risk stratification using NICE criteria

MRI

MRI role in starvation ketosis

CT

CT indications in starvation ketosis

CT protocol considerations

Ultrasound

Bedside point-of-care ultrasound

Obstetric ultrasound in pregnancy

Disposition

Admission indications

Hospital admission criteria

ICU admission criteria

Discharge criteria

Criteria for discharge

Discharge follow-up

Treatment

Carbohydrate repletion

Dextrose-containing IV fluids as cornerstone

Insulin considerations

Fluid resuscitation

Volume replacement strategy

Thiamine and micronutrient repletion

Thiamine administration

Electrolyte repletion

Refeeding syndrome prevention

Risk identification

Monitoring during refeeding

Caloric prescription

SGLT2 inhibitor management

Sick-day rules for SGLT2 inhibitor patients

Special Populations

Pregnancy

Accelerated starvation physiology

Management in pregnancy

Fetal considerations

Geriatric

Atypical presentations in older adults

Management modifications in elderly

Disposition considerations for elderly

Pediatrics

Pediatric vulnerability

Pediatric clinical features

Pediatric management

Background

Epidemiology

Population data

Pathophysiology

Metabolic cascade of starvation

Ketone body metabolism and acid-base effects

Therapeutic Considerations

Carbohydrate as primary therapy rationale

Evidence base for management

Prevention framework

Patient Discharge Instructions

copy discharge instructions

What happened

What to eat and drink at home

Medications at home

Warning signs to return to emergency immediately

Follow-up

References

Guidelines and key sources

Primary evidence sources

Supporting references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.