Metabolic syndrome: Difference between revisions

Revision as of 02:00, 27 January 2019

Background

Prothrombotic, proimflammatory state
May be associated with elevated CRP, IL-6, and tissue plasminogen activator, which may be associated with increased risk of cardiovascular disease and type 2 diabetes
- Markers not shown to be of utility in the ED

Clinical Features

Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)

Diagnostic Criteria - 3 or more of the following:
- Waist circumference >/=102 cm in men or >/=88 cm in women
- Plus 3 of the following:
- Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
- HDL </=40 in men or </=50 in women
- TGs >/=150 mg/dL
- BP >/= 130/85 or requiring drug treatment for HTN

Differential Diagnosis

Hypertension
Hyperlipidemia
Hyperglycemia
Hypothyroidism
Obstructive Sleep Apnea
Type 2 DM
Rarer Diagnoses
Pheochromacytoma
Glucagonoma

Evaluation

Not an ED diagnosis!
Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
Non-ED workup may include:
- BMP
- HbA1c
- Lipid panel
- TSH
- +/- Polysomnography to evaluate for OSA

Management

Lifestyle modification
Metformin
BP control(e.g. ACEi or ARBs}
OSA treatment
Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient

Disposition

Discharge with outpatient follow-up

External Links

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Considered to be a prothrombotic, proimflammatory state. As such, it may be associated with elevated CRP, IL-6 and tissue plasminogen activator. The elevated inflammatory markers may be associated with increased risk for CVD and Type 2 Diabetes Mellitus. However, these markers have not been shown of any benefit in the ED. Rather, they should be used for evaluation of risk of CVD in the outpatient setting.
+*Prothrombotic, proimflammatory state
+*May be associated with elevated CRP, IL-6, and tissue plasminogen activator, which may be associated with increased risk of cardiovascular disease and type 2 diabetes
+**Markers not shown to be of utility in the ED
 ==Clinical Features==
@@ Line 7: / Line 9: @@
 **Waist circumference >/=102 cm in men or >/=88 cm in women
 **Plus 3 of the following:
-**Fasting blood glucose >/= to 100 mg/dL or requiring treamtment for elevated blood glucose
+**Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
 **HDL </=40 in men or </=50 in women
 **TGs >/=150 mg/dL
@@ Line 24: / Line 26: @@
 ==Evaluation==
-*Metabolic Panel
+*Not an ED diagnosis!
-*HbA1c
+*Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
-*Lipid panel
+*Non-ED workup may include:
-*TSH
+**BMP
-*+/- Polysomnography - This is becoming more widely used in recent years as OSA has a confounding effect on obesity. If patient presents with excessive daytime somnolence or partner reported nighttime pauses in respiration, this test maybe helpful to obtain.
+**HbA1c
+**Lipid panel
+**TSH
+**+/- Polysomnography to evaluate for OSA
 ==Management==
 *Lifestyle modification
-*Metformin
+*[[Metformin]]
-*BP control using ACEi or ARBs
+*BP control(e.g. [[ACEi]] or ARBs}
-*Treatment of any underlying OSA
+*OSA treatment
 *Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient