By Cesar M Limjoco, M.D.
Chief Medical Officer
Volcanic Eruptions ?
A volcano can have an impending eruption or it can be actually erupting or has erupted. When magma is still underneath and has not broken through the earth’s crust, this is called an impending eruption. If it has broken through, the volcano has erupted.
In the same vein, diseases can be imminent or manifest. It cannot be both at the same point in time.
Impending conditions can be averted with appropriate interventions. The risk of mortality decreases with early intervention prior to acute onset.
Impending Acute Respiratory Failure?
When the patient’s gaseous exchange (O2 / CO2) has been compromised, physical manifestations and laboratory findings will confirm it. But, one does not have to wait for the patient to be in acute respiratory failure to intubate and ventilate. Intubation and ventilation is done either to pre-empt or treat acute respiratory failure.
Impending Acute Kidney Injury?
When creatinine rises due to hypovolemia (e.g., dehydration), it may or may not lead to AKI. Rising creatinine that resolves with fluid replacement within 6 hours is indicative of a false positive result due to concentrated plasma. Creatinine levels are normal but look inflated in the face of diminished fluid levels. Creatinine levels >0.3 or 1.5X baseline persisting more than 6 hours indicate AKI.
Local infections like Pneumonia, UTI, cellulitis, etc. may have features indicative of sepsis at the outset and placed on sepsis protocol. But after study, it may be determined that the total clinical picture was not consistent with sepsis.
And the list goes on. Impending MI, stroke, shock, etc. need to be distinguished from acute MI, stroke, shock, etc. The distinction lies in the manifested evidence. One may ask – how many features are needed as clinical evidence? The more features manifested, the stronger the case for the definitive diagnosis.