Metabolic syndrome

Background
  • Prothrombotic, proimflammatory state
  • May be associated with elevated CRP, IL-6, and tissue plasminogen activator, which may be associated with increased risk of cardiovascular disease and type 2 diabetes
    • Markers not shown to be of utility in the ED

Clinical Features

Although several diagnostic features exist, below is the most widely accepted: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)

  • Diagnostic Criteria - 3 or more of the following:
    • Waist circumference >/=102 cm in men or >/=88 cm in women
    • Plus 3 of the following:
    • Fasting blood glucose >/= to 100 mg/dL or requiring treatment for elevated blood glucose
    • HDL </=40 in men or </=50 in women
    • TGs >/=150 mg/dL
    • BP >/= 130/85 or requiring drug treatment for HTN

Differential Diagnosis

Evaluation
  • Not an ED diagnosis!
  • Evaluate for sequelae of associated diseases (e.g. cardiovascular disease, DM) as appropriate
  • Non-ED workup may include:
    • BMP
    • HbA1c
    • Lipid panel
    • TSH
    • +/- Polysomnography to evaluate for OSA

Management
  • Lifestyle modification
  • Metformin
  • BP control(e.g. ACEi or ARBs}
  • OSA treatment
  • Depending on the level of obesity, and severity of the condition bariatric surgery may be advantageous to the patient

Disposition
  • Discharge with outpatient follow-up


References
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