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The most common phototoxic sunburn reactions are usually benign and self-limiting except when the burn is severe or when it occurs as an associated finding in a more serious disorder PMLE and some cases of photoallergy can persist for years

Hearn R Recognition and management of cutaneous photosensitivity Practitioner 2005 Jun:249(1671):418 24 [PMID: 15966276] Morison WL Clinical practice Photosensitivity N Engl J Med 2004 Mar 11;350(11):1111 7 [PMID: 15014184]



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The differential includes vasculitis, pyoderma gangrenosum, arterial ulcerations, infection, trauma, skin cancer, arachnid bites, and sickle cell anemia When the diagnosis is in doubt, a punch biopsy from the border (not base) of the lesion may be helpful

The per unit resistance and reactance of T2 are already on the right base:

Compression stockings to reduce edema are the most important means of prevention Compression should achieve a pressure of 30 mm Hg below the knee and 40 mm Hg at the ankle The stockings should not be used in patients with arterial insufficiency with an anklebrachial pressure index less than 07 Pneumatic sequential compression devices may be of great benefit when edema is refractory to standard compression dressings





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Weakness, abdominal pain, fever, confusion, nausea, vomiting, and diarrhea Low blood pressure, dehydration; skin pigmentation may be increased Serum potassium high, sodium low, BUN high Cosyntropin (ACTH1 24) unable to stimulate a normal increase in serum cortisol

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Acute adrenal insufficiency is an emergency caused by insufficient cortisol Crisis may occur in the course of treatment of

other conditions (eg, hypothyroidism, diuretic use, heart failure, cirrhosis, vomiting, diarrhea, severe illness, or major surgery) Acute adrenal insufficiency must be distinguished from an acute abdomen in which neutrophilia is the rule, whereas adrenal insufficiency is characterized by a relative lymphocytosis and eosinophilia More than 90% of serum cortisol is protein bound and low serum levels of binding proteins result in misleadingly low serum cortisol determinations by most assays Nearly 40% of critically ill patients, with serum albumin < 25 g/dL, have low serum total cortisol levels but normal serum free cortisol levels and normal adrenal function

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chronic insufficiency, or it may be the presenting manifestation of adrenal insufficiency Acute adrenal crisis is more commonly seen in primary adrenal insufficiency (Addison s disease) than in disorders of the pituitary gland causing secondary adrenocortical hypofunction Adrenal crisis may occur in the following situations: (1) following stress, eg, trauma, surgery, infection, or prolonged fasting in a patient with latent insufficiency; (2) following sudden withdrawal of adrenocortical hormone in a patient with chronic insufficiency or in a patient with temporary insufficiency due to suppression by exogenous corticosteroids or megestrol; (3) following bilateral adrenalectomy or removal of a functioning adrenal tumor that had suppressed the other adrenal; (4) following sudden destruction of the pituitary gland (pituitary necrosis), or when thyroid hormone is given to a patient with hypoadrenalism; and (5) following injury to both adrenals by trauma, hemorrhage, anticoagulant therapy, thrombosis, infection or, rarely, metastatic carcinoma

If the diagnosis is suspected, draw a blood sample for cortisol determination and treat with hydrocortisone, 100 300 mg intravenously, and saline immediately, without waiting for the results Thereafter, give hydrocortisone phosphate or hydrocortisone sodium succinate, 100 mg intravenously immediately, and continue intravenous infusions of 50 100 mg every 6 hours for the first day Give the same amount every 8 hours on the second day and then adjust the dosage in view of the clinical picture Since bacterial infection frequently precipitates acute adrenal crisis, broad-spectrum antibiotics should be administered empirically while waiting for the results of initial cultures Hypoglycemia should be vigorously treated while serum electrolytes, BUN, and creatinine are monitored

The per unit resistance and reactance of M1 are: 194

The patient complains of headache, lassitude, nausea and vomiting, abdominal pain, and often diarrhea Confusion or coma may be present Fever may be 406 C or more The blood pressure is low Recurrent hypoglycemia and reduced insulin requirements may present in patients with preexisting type 1 diabetes mellitus Other signs may include cyanosis, dehydration, skin hyperpigmentation, and sparse axillary hair (if hypogonadism is also present) Meningococcemia may be associated with purpura and adrenal insufficiency secondary to adrenal infarction (Waterhouse Friderichsen syndrome)

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