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CPE-008 · synthetic case ADR-FX-14
Known adrenal insufficiency with fever
Sick-day rules.
Purpose: Sick-day rules.
Inputs the engine received
Chemistry and vitals
- Age
- 43 years
- Systolic BP
- 112 mmHg
Exposures, history and context
- Known adrenal insufficiency
- Yes
- Fever, vomiting, diarrhea, trauma or surgery
- Yes
What the engine reports
Sick-day rules apply: glucocorticoid cover is increased per the patient's own plan, and parenteral treatment is needed if vomiting. Dose and route belong to the treating physician and the written plan.
Detected clinical pattern
No Adrenal Screening Trigger
The values entered do not meet a screening pattern. Fatigue alone does not justify adrenal testing.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Apply the patient's sick-day plan; parenteral glucocorticoid is needed if vomiting.
Evidence and rule trace · 1 rules
AI-13Known adrenal insufficiency with intercurrent illness
Inputs: known adrenal insufficiency · fever, vomiting, diarrhea, trauma or surgery
Sick-day rules apply.
Evidence
- EV-ES-PAI-2016 · Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety situations. It does not diagnose adrenal insufficiency, name a glucocorticoid dose, or replace emergency treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Cortisol testing
- <5 very likely
- 5–14.9 indeterminate
- ≥15 unlikely
46 pg/mL is assumed when empty.
Chemistry and vitals
Symptoms and signs
Exposures, history and context
More adrenal cases
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
ADR-FX-04
Cortisol 2.1 with ACTH 180
Low cortisol and high ACTH: a primary pattern.
ADR-FX-05
Morning cortisol 9 µg/dL
Indeterminate.
ADR-FX-06
Morning cortisol 17 µg/dL
Unlikely.
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