Internal Medicine

A

• Acute Gout Flare — NSAIDs, Colchicine, Corticosteroids, and When to Start ULT

  Treat acute gout with NSAIDs, colchicine, or corticosteroids (intra-articular or systemic). Exclude septic arthritis when uncertain. Start urate-lowering therapy after flares are controlled in patients with tophi, frequent flares, or CKD; provide flare prophylaxis during ULT initiation.
• Acute Kidney Injury — KDIGO Staging, Prerenal vs Intrinsic vs Postrenal, and Nephrotoxins

  AKI is an abrupt decline in kidney function. Identify prerenal, intrinsic, and postrenal causes using history, exam, labs, and ultrasound; stage using KDIGO criteria; stop nephrotoxins; optimize hemodynamics; and involve nephrology for refractory complications or RRT indications.
• Acute Pyelonephritis — Risk Stratification, Imaging Indications, and Antibiotic Therapy

  Fever, flank pain, and CVA tenderness with pyuria/bacteriuria. Outpatient therapy for uncomplicated cases; admit if severe, pregnant, septic, or unable to tolerate PO. Obtain imaging if obstruction suspected or no improvement by 48–72 hours.
• Adult Asthma Exacerbation — SABA, Systemic Steroids, Magnesium, and Disposition

  Treat acute asthma with repeated inhaled short-acting beta-agonists (± ipratropium for severe), early systemic corticosteroids, and adjunct IV magnesium for severe exacerbations; provide oxygen to maintain SpO₂ 93–95%. Consider epinephrine and noninvasive ventilation/intubation if impending failure.
• Alcohol Withdrawal - Inpatient Benzodiazepine and Phenobarbital Algorithm

  Use symptom triggered benzodiazepines when possible; give thiamine before glucose, consider phenobarbital adjunct or loading in severe cases, and escalate monitoring for refractory agitation.

C

• Chronic Hyponatremia - Safe Correction Limits and Desmopressin Clamp

  Limit daily sodium rise to avoid osmotic demyelination; use desmopressin clamp with hypertonic saline in high risk or overcorrection scenarios and monitor closely.
• Clostridioides difficile Infection - Severity Assessment and Treatment

  Classify severity and treat with oral vancomycin or fidaxomicin; add IV metronidazole for fulminant disease, ensure infection control, and consider fecal microbiota therapy for multiply recurrent cases.
• Clostridioides difficile Infection — Severity Stratification, Fidaxomicin/Vancomycin, and FMT

  Suspect CDI with new-onset diarrhea after antibiotics or hospitalization. Use toxin immunoassay and NAAT algorithm. Treat initial episodes with fidaxomicin (preferred) or vancomycin; use vancomycin taper or fidaxomicin for recurrences; consider FMT after multiple recurrences.
• Community-Acquired Cellulitis — MRSA Considerations, Lymphatic Care, and Source Control

  Erythema, warmth, and tenderness of skin/subcutaneous tissue. Differentiate purulent vs nonpurulent cellulitis; drain abscesses and choose antibiotics considering MRSA risk. Address risk factors (tinea pedis, edema, venous stasis) to prevent recurrence.

D

• Deep Vein Thrombosis — Wells Score, Compression Ultrasound, and Anticoagulation

  Evaluate suspected DVT using Wells score and D-dimer in low probability cases. Confirm with compression ultrasonography. Start anticoagulation with DOACs or LMWH/warfarin; determine duration based on provoked vs unprovoked events and bleeding risk.
• Diabetic Foot Osteomyelitis — Probe-to-Bone, MRI, Debridement, and Targeted Antibiotics

  Suspect osteomyelitis in chronic or deep diabetic foot ulcers, especially with positive probe-to-bone test. Confirm with MRI and bone culture when feasible. Combine surgical debridement/revascularization with prolonged targeted antibiotics and offloading for limb salvage.

H

• Heparin-Induced Thrombocytopenia — 4T Score, PF4 Testing, and Non-Heparin Anticoagulation

  Suspect HIT with platelet fall 5–10 days after heparin exposure or sooner with prior exposure. Stop all heparin immediately, estimate probability with the 4T score, send PF4 ELISA and functional assay, and start a non-heparin anticoagulant while awaiting results in intermediate/high probability.
• Hypernatremia — Volume Repletion, Free Water Deficit, and Correction Limits

  Hypernatremia reflects hypertonicity, usually from water deficit. Restore intravascular volume with isotonic fluids first, then replace free water based on deficit and ongoing losses, limiting correction to ≤10–12 mEq/L/day (≤8 in high-risk) to avoid cerebral edema.
• Hyperosmolar Hyperglycemic State — Cautious Fluids, Insulin, and Electrolyte Strategy

  HHS features profound hyperglycemia, hyperosmolality, and minimal ketosis. Begin cautious isotonic fluids, correct potassium, then start insulin at lower rates than DKA; avoid rapid osmotic shifts. Search for precipitants (infection, MI, stroke, medications).

I

• Inpatient Delirium - Prevention and Management Bundle

  Prevent and treat delirium with multicomponent non pharmacologic measures, regular screening, and judicious medication use while correcting underlying precipitants.
• Inpatient Glycemic Control - Basal Bolus Insulin Protocol

  For non ICU adults, avoid sliding scale alone; use basal bolus correction with bedside glucose monitoring and a target range generally 140 to 180 mg per dL.
• Iron Deficiency Anemia - Intravenous Iron Selection and Dosing

  Choose intravenous iron when oral is ineffective or not tolerated; select preparation based on dose per visit and anaphylaxis risk, and calculate total iron deficit.
• Iron Deficiency Anemia — Evaluation, Oral/IV Iron Dosing, and Transfusion Strategy

  Microcytic anemia with low ferritin and high transferrin indicates iron deficiency. Identify source of blood loss (GI, gynecologic), dose oral iron using alternate-day schedules for better absorption, use IV iron when intolerance or malabsorption, and transfuse based on symptoms and thresholds.

L

• Lower Gastrointestinal Bleeding — Resuscitation, Colonoscopy Timing, and IR Options

  Hematochezia often from diverticulosis, angiodysplasia, or hemorrhoids. Resuscitate with restrictive transfusion, exclude brisk upper source when indicated, perform colonoscopy within 24 hours after prep; use CT angiography and IR embolization for ongoing massive bleeding.

M

• Myxedema Coma — IV Thyroxine, Hydrocortisone, and Gentle Rewarming

  Severe decompensated hypothyroidism with hypothermia, bradycardia, hypotension, and altered mental status. Give IV levothyroxine (± liothyronine), administer stress-dose steroids until adrenal insufficiency excluded, correct precipitating factors, and provide slow rewarming and ventilatory support.

P

• Periprocedural Anticoagulation - DOAC and Warfarin Interruption and Bridging

  Hold anticoagulants according to renal function and bleeding risk of the procedure; avoid routine bridging for atrial fibrillation and reserve for highest risk conditions.
• Positive Blood Cultures without Source - Inpatient Evaluation and Follow Up

  Confirm true bacteremia versus contamination, repeat cultures for Staphylococcus aureus and other pathogens, search for source, and arrange appropriate duration and follow up.

R

• Refeeding Syndrome - Prevention and Electrolyte Protocol

  Identify high risk malnourished patients, refeed slowly with careful electrolyte and thiamine replacement, and monitor closely during the first week.

S

• Severe Alcohol Withdrawal (Delirium Tremens) — Benzodiazepines, Phenobarbital Pathway, and Thiamine

  Autonomic hyperactivity, agitation, hallucinations, and seizures peak at 48–72 hours after cessation. Use symptom-triggered or front-loaded benzodiazepines; consider adjunct phenobarbital or dexmedetomidine/propofol in ICU. Give high-dose IV thiamine before glucose to prevent Wernicke's.
• Severe Hyponatremia — Symptom-Driven 3% Saline, DDAVP Clamp, and Safe Correction

  Manage severe or symptomatic hyponatremia with hypertonic saline boluses and a desmopressin ('DDAVP') clamp to prevent overly rapid correction. Identify etiology (hypovolemic, euvolemic/SIADH, hypervolemic) and treat the cause while monitoring sodium correction limits to prevent osmotic demyelination.

V

• VTE Prophylaxis for Medical Inpatients - Risk Stratification and Dosing

  Stratify venous thromboembolism risk with validated tools; give pharmacologic prophylaxis when VTE risk outweighs bleed risk and use mechanical prophylaxis when bleeding risk is high.