Essential Facts on the Go: Internal Medicine (29 page)

Primary AI = elevated ACTH, secondary = decreased or inappropriately normal ACTH

Cosyntropin (ACTH) 250 mcg IM/IV × 1 dose

Check cortisol at 30 min and 60 min

Cortisol should increase to > 18–29 mcg/dL, if it does not = AI

Treatment

Do not delay treatment for testing

Dexamethasone will not interfere with testing, dose 4–6 mg IV q 6 hrs

Once diagnosis is made, switch to hydocortisone 50–100 mg IV q 6 hrs

Will need daily maintenance therapy

Hydrocortisone 10–30 mg po qd divided in twice daily dosing

INFECTIOUS DISEASES

VII_1_a
Infective Endocarditis

VII_1_b
Infective Endocarditis