Acute general physical decline

Specialty: General.

• acute prostration
• sudden general prostration
• acute general condition collapse

Why it occurs

• Hyperacute onset bacterial sepsis or bacteremia due to a minor infectious focus (silent urinary tract infection, occult lobar pneumonia or rapidly progressive cellulitis)
• Acute adrenal crisis or primary adrenal insufficiency acutely decompensated by infection or physical stress (critical cortisol deficiency)
• Acute inferior myocardial infarction with atypical presentation (without classic precordial pain, manifested only by prostration, nausea, hypotension and severe weakness)
• Acute ischemic stroke of the posterior territory or brainstem (affecting the nuclei regulating wakefulness and motor strength)
• Acute poisoning from toxic gases or medications (carbon monoxide, accidental overdose of beta-blockers or sedatives).

Initial workup

Immediate admission to medical emergency: complete blood count with smear, arterial blood gas with serum lactate, complete serum electrolytes, urea, creatinine, liver profile, ultra-sensitive troponins, 12-lead electrocardiogram, chest x-ray, blood cultures and urine cultures.

Standard management

• Hydrocortisone — 100 mg intravenously immediately if acute adrenal insufficiency or refractory shock is suspected or documented
• Cefotaxime — 2 g intravenously every 8 hours, or another broad-spectrum antibiotic according to the local regimen, if sepsis of unexplained origin is suspected after obtaining cultures
• 0.9% physiological sodium chloride solution (rapid intravenous infusion of 1000 mL for initial fluid resuscitation).