Hypothermia in adults: A strategy for detection and Tx.

Whether hypothermia is a result of environmental exposure or illness, it's important to identify predictable patterns of physiologic response and focus on proper Tx.

Zany Over Zika Virus: An Overview of Diagnosis and Treatment Modalities.

Zika virus has been a recent international public health concern with outbreaks occurring in the Americas, Caribbean, and Pacific. The zoonotic infection is primarily spread to humans by the bite of an infected Aedes mosquito. The virus also can be transmitted via bodily fluids, sexual intercourse, and maternal-fetal vertical transmission. Asymptomatic presentation is common. If symptoms do occur, individuals display a low-grade fever, maculopapular rash, arthralgia, or conjunctivitis 2 to 7 d after infection. Infection is concerning due to its associated fetal effects in pregnant women and relationship with Guillain-Barre syndrome. Diagnosis should be suspected in individuals with the appropriate symptomatology and exposure history. Diagnostic tests for the Zika virus are available and vary based on symptom duration. Treatment is supportive, and surveillance is suggested for all pregnant women. Prior infection is thought to provide immunity toward future exposures. Prevention and education is key in decreasing the spread of disease.

Tick-Borne Illnesses.

Tick-borne diseases are prevalent throughout the United States. These illnesses are caused by a variety of different pathogens that use ticks as vectors, including bacteria, viruses, rickettsia, and protozoa. Some of the most common illnesses caused by ticks are Lyme disease, Rocky Mountain spotted fever, babesiosis, ehrlichiosis, anaplasmosis, tularemia, Colorado tick fever, tick-borne relapsing fever, and Powassan disease. Unique skin changes, fever, and influenza-like symptoms may indicate tick-borne disease. Early diagnosis can be difficult as well as nonspecific and can resemble overtraining syndrome. Diagnosis is important to facilitate early treatment to decrease morbidity and mortality and should often be initiated before a definitive diagnosis is made. Treatment guidelines are published by the Centers for Disease Control and Prevention. As tick-borne diseases increase and their geographic regions expand, it is important for providers to distinguish the often overlapping and diverse presentations of these diseases.

Wilderness Travel in Nonpregnant Females: Differences in Physiology, Counseling, and Common Issues.

Interest in wilderness travel has been increasing in women of all ages and can lead to multiple health benefits. In order to optimize a woman's experience in the wilderness, providers should be aware of both common and special conditions unique to women that may be impacted by wilderness travel. Both anatomic and physiologic differences set women apart from men and should be carefully considered in a wilderness setting. Special conditions pertaining to women in the wilderness include high altitude exposure and temperature sensitivity. Before wilderness travel, each patient should complete a physical examination, review medical history with a provider, and receive an overview of counseling for their desired area of travel.

Diagnosis and management of sodium disorders: hyponatremia and hypernatremia.

Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit.