A 42-year-old man on warfarin for atrial fibrillation presents to the emergency department with acute onset severe left flank pain, fever (38.9°C), and hypotension (BP 88/54 mmHg). He reports nausea and vomiting for 6 hours. His INR is 8.2 (therapeutic range 2-3). Laboratory studies show: hemoglobin 9.8 g/dL (previous 12.2 g/dL one week ago), serum cortisol 3 µg/dL (normal 10-20 µg/dL at 8 AM), ACTH 220 pg/mL (normal 10-46 pg/mL), and potassium 5.8 mEq/L. Abdominal CT imaging is pending. Which of the following is the most likely diagnosis?
- A)Acute pancreatitis with disseminated intravascular coagulation
- B)Meningococcal sepsis with secondary adrenal insufficiency
- C)Acute myocardial infarction with cardiogenic shock and elevated potassium
- D)Acute adrenal hemorrhage with secondary adrenal insufficiencyGABARITO
- E)Retroperitoneal hematoma from warfarin overdose
Explicação
Acute adrenal hemorrhage (often bilateral) is the most likely diagnosis. The clinical presentation is classic: acute shock with fever, severe abdominal/flank pain, and a coagulopathic state (elevated INR from warfarin). The labs show primary adrenal insufficie... Ver explicação completa e trilha adaptativa →