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Internal Medicine
Internal medicine is a medical specialty in which physicians apply scientific
knowledge and clinical expertise to diagnose and treat adults with a very broad
range of health concerns and diseases. Physicians who specialize in internal
medicine are called internists or general internists.
Differences Between Internal Medicine and General/Family Practice
While they are both primary care doctors and the terms are often used
interchangeably internists are not the same as general practitioners and
family physicians. One of the key differences is that internists see only adults,
and family practitioners see both children and adults.
General Internists
General internists are uniquely qualified to practice primary care and follow
patients through their adult lives. Some internists work as hospitalists,
delivering primary care in hospital settings; others provide only out-patient
care. General internists may also practice in rehabilitation centers and long-
term care facilities.
Internal medicine doctors are trained to provide:
Precise diagnoses of and prompt treatment for a broad range of
symptoms and diseases
Expertise in conditions that affect any of the body's systems
Guidance, counseling, and preventive interventions for improved overall
health
Life-long comprehensive care and palliative care
Care for mental health disorders, such as depression and anxiety caused
by abnormal activities in the brain, a chronic disease, or hormonal
imbalances
General Family Practitioners
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Unlike internists, general family practitioners do not solely concentrate on
adults and may practice pediatrics, obstetrics, and do minor surgery.
Family physicians can treat a full range of medical issues and provide acute,
chronic, and wellness services for patients.
Family physician training involves:
Adult critical care (1 month)
Care for children in the hospital or emergency settings (nearly 2 months)
Geriatric care (1 month)
Gynecology (1 month)
In-patient hospital experience (6 months minimum)
Musculoskeletal medicine (2 months)
Newborn encounters
Obstetrics (2 months)
Surgery (1 month)
Family medicine training also includes behavioral health, common skin
diseases, population health, and health system management, wellness, and
disease prevention.
Specialized Training
Internists are medical doctors who specialize in preventing, diagnosing, and
treating a wide variety of diseases and other health issues that affect adults.
They are experts in health promotion, disease prevention, and the care of
problems both simple and complex, acute and chronic.
Internal medicine training includes general medical education, as well as time
spent rotating among a variety of subspecialty clinics, both in-patient and out-
patient.
Internal Medicine Subspecialties
Internal medicine trainees gain experience working in areas that include:
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Endocrinology
Rheumatology
Infectious diseases
Pulmonary diseases
Cardiovascular diseases
Critical care medicine
Hematology
Oncology
Gastroenterology
Nephrology
Neurology
Psychiatry
Dermatology
Ophthalmology
Gynecology
Otorhinolaryngology
Non-surgical orthopedics
Palliative medicine
Sleep medicine
Geriatrics
Rehabilitation medicine
Internal medicine trainees spend at least one year caring for hospitalized
patients, with at least three months in intensive/critical care settings. They
undergo hospital-based training for at least one year, with additional exposure
to in-patient subspecialties such as cardiology, hematology-oncology, or
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gastroenterology.
Many internal medicine doctors have a particular subspecialty. To gain
expertise for those subspecialties, students complete an additional one to
three years of fellowship training after a required three-year internal medicine
residency.
Recognized internal medicine subspecialties include:
Allergy and Immunology (immune system)
Cardiovascular Disease (heart and vascular system)
Advanced Heart Failure and Transplant Cardiology
Interventional Cardiology (heart health)
Critical Care Medicine (patients with organ system failures)
Clinical Cardiac Electrophysiology (heart rhythm)
Endocrinology, Diabetes, and Metabolism (diabetes and other glandular
and metabolic disorders)
Gastroenterology (gastrointestinal system, liver, and gallbladder)
Transplant Hepatology (liver)
Hematology (blood)
Infectious Disease (bacterial, viral, fungal, and parasitic infections)
Nephrology (kidneys)
Oncology (cancer)
Pulmonary Disease (lungs and respiratory system)
Rheumatology (joints and musculoskeletal system)
Internal Medicine/Body Connection
Internal medicine is the study, diagnosis, and treatment of conditions that
affect the internal organs conditions such as heart disease, hypertension,
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diabetes, obesity, and lung disease. Internal medicine specialists often care for
people with complex, chronic, and multisystem disorders.
Based on their subspecialties, internists may work with doctors in other
medical specialties or consult on patients referred by another specialist.
Treating a Broad Range of Internal Medicine Conditions
Internal medicine doctors diagnose, manage, and treat a wide range of
conditions. These include cancer, infections, and conditions affecting the heart,
blood, kidneys, joints, and the digestive, respiratory, and vascular systems.
Examples of conditions treated by internists include:
Abnormal liver biochemical and function tests
Abnormal uterine bleeding
Acid peptic disease associated with upper gastrointestinal bleeding
Acquired thrombotic thrombocytopenic purpura (TTP)
Acquired von Willebrand syndrome
Acute aortic dissection
Acute aortic regurgitation
Acute bacterial meningitis
Acute bronchitis
Acute calculous cholecystitis
Acute cholangitis
Acute colonic diverticulitis
Acute decompensated heart failure
Acute diverticulitis
Acute exacerbations of asthma
Acute ischemic stroke
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Acute liver failure
Acute lower extremity ischemia
Acute mesenteric arterial occlusion
Acute migraine
Acute myocardial infarction
Acute pancreatitis
Acute pericarditis
Acute pharyngitis
Acute pulmonary embolism
Acute respiratory distress syndrome
Acute sinusitis and rhinosinusitis
Acute variceal hemorrhage
Acute viral gastroenteritis
Adrenal insufficiency
Airway foreign bodies
Allergic rhinitis
Anal fissure
Angioedema
Aseptic meningitis
Aspiration pneumonia
Atrial fibrillation
Bacterial brain abscess
Balanitis and balanoposthitis in children and adolescents
Bell's palsy
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Bleeding peptic ulcers
Cancer pain
Cardiac arrest
Cardiogenic shock complicating acute myocardial infarction
Cellulitis and skin abscesses
Chronic complications and age-related comorbidities in people with
hemophilia
Chronic limb-threatening ischemia
Clostridial myonecrosis (“gas gangrene”)
Clostridioides difficile (“C. Diff”) infection (formerly Clostridium difficile)
Cognitive impairment and dementia
Colonic ischemia
Constrictive pericarditis
Convulsive status epilepticus in adults
Corneal abrasions and corneal foreign bodies
Cushing's syndrome
Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults
Disseminated intravascular coagulation
Dysphagia in adults
Electrocardiographic abnormalities suggesting myocardial ischemia and
infarction
Emergency contraception
Epilepsy and electroencephalogram (EEG)
Esophageal disease
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Exacerbations of chronic obstructive pulmonary disease (COPD)
Exercise-associated hyponatremia
External otitis
Failed fibrinolysis (thrombolysis) or threatened reocclusion in acute ST-
elevation myocardial infarction
Fasting ketosis and alcoholic ketoacidosis
Gastrointestinal infections
Giant-cell arteritis
Gout flares
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)
Hepatic encephalopathy
Hereditary thrombotic thrombocytopenic purpura (TTP)
Hyperkalemia
Hypotonic hyponatremia
Infections of cerebrospinal-fluid shunts and other devices
Ingested foreign bodies and food impactions in adults
Intestinal ischemia
Intracranial epidural abscess
Invasive group A streptococcal infection and toxic shock syndrome
Lactic acidosis
Lower gastrointestinal bleeding
Lyme disease
Malignancy-related superior vena cava syndrome
Massive hemoptysis
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Mechanical colorectal obstruction
Mechanical small-bowel obstruction
Mesenteric venous thrombosis
Metabolic acidosis
Metabolic acidosis in chronic kidney disease
Metabolic alkalosis
Mineral and bone metabolism
Mitral-valve prolapse and flail mitral leaflet
Moderate to severe hypertensive retinopathy and hypertensive
encephalopathy
Myopericardial disease
Narrow QRS complex tachycardias
Necrotizing soft-tissue infections
Neoplastic epidural spinal-cord compression
Neuromuscular disease
Neuropathies
New-onset atrial fibrillation
Non-HIV viral infections
Non-sustained ventricular tachycardia
Nonocclusive mesenteric ischemia
Open-angle glaucoma
Osmotic demyelination syndrome (ODS) and overly rapid correction of
hyponatremia
Osteonecrosis (avascular necrosis of bone)
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Ovarian and fallopian-tube torsion
Pelvic inflammatory disease
Perianal and perirectal abscess
Peripheral nerve and muscle disease
Pneumothorax
Pregnancy complications
Prerenal disease and acute tubular necrosis in acute kidney injury
Pulmonary infections
Retinal detachment
Rhabdomyolysis
Right-sided native-valve infective endocarditis
Second- and third-degree atrioventricular blocks
Secondary spontaneous pneumothorax
Segmental colitis associated with diverticulosis
Severe Crohn’s disease
Severe hypovolemia or hypovolemic shock
Severe ulcerative colitis
Sickle cell disease
Simple and mixed acid-base disorders
Sinus bradycardia
Spinal epidural abscess
Spontaneous bacterial peritonitis
Staphylococcal toxic shock syndrome
Stevens-Johnson syndrome and toxic epidermal necrolysis
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Streptococcal pharyngitis
Subacute kidney injury
Supraventricular arrhythmias after myocardial infarction
Suspected acute coronary syndrome (myocardial infarction, unstable
angina)
Suspected nephrolithiasis
Suspected nonvertebral osteomyelitis
Sustained monomorphic ventricular tachycardia in patients with
structural heart disease
Symptomatic aortic stenosis
Syncope
Thoracic aortic aneurysm
Thyroid storm
Transient ischemic attack (TIA)
Tubo-ovarian abscess
Tumor lysis syndrome
Unexplained thrombocytopenia
Unstable angina and non-ST elevation myocardial infarction
Upper gastrointestinal bleeding
Urinary tract obstruction and hydronephrosis
Ventricular arrhythmias
Ventricular arrhythmias during acute myocardial infarctio
Vertigo
Viral encephalitis
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Wide QRS complex tachycardias
Internal Medicine Tests, Procedures, and Surgeries
Internal medicine specialists perform or order tests, procedures, and surgeries
based on patients’ condition, overall health, and wellness goals.
“I believe that to a degree we have become too reliant on diagnostic testing,”
says Aldo Arpaia, MD, a Castle Connolly Top Doctor in Staten Island, New York.
An internist with a subspecialty in emergency medicine, Dr. Arpaia is affiliated
with Staten Island University Hospital. “That’s not to say there aren’t prudent
and timely diagnostic tools at the internist’s disposal that have value and can
improve the quality of care.”
These include the OralID® cancer-screening device and non-invasive coronary
artery calcium scanning. “Coronary artery calcium score testing helps us
determine the atherosclerotic load in asymptomatic patients at increased risk
for heart disease,” says Dr. Arpaia. “Calcium scoring can help us to identify and
treat at-risk patients more aggressively.”
According to Dr. Arpaia, in training his house staff the basic tenet has become
known as “the Arpaia rule of nines: 90% of your answer comes from a detailed
history, 9% from the physical exam and 0.9% from testing.”
And with the rise in the incidence of head and neck cancers, internists are on
the front lines of oropharyngeal cancer screening. The Centers for Disease
Control Prevention (CDC) recommends that all adults 18 and older get screened
annually.
Internists as well as nurses and other providers are trained to perform
many types of medical procedures, the use of which can vary greatly by
specialty, diagnosis, and treatment. Providers need experience and skill and
in many cases, additional training and medical credentials to perform these
procedures, as well as to minimize patient discomfort, optimize outcomes, and
reduce side effects.
Internal medicine specialists commonly perform procedures that include:
Venipuncture (“blood draw”) to test blood
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Arterial puncture to analyze blood gases
Endotracheal intubation
Flexible sigmoidoscopy
Intravenous (IV) line insertion
Nasogastric (NG) tube placement
Urinary catheters placement
Some internists have been trained in more complex and/or invasive diagnostic
and therapeutic procedures, such as thoracentesis, lumbar puncture, and
paracentesis.
Categories and other types of tests and procedures an internist might perform
include:
Allergy: Skin testing, rhinoscopy
Cardiology: Cardiac stress testing, echocardiograms, coronary
catheterization, angioplasty, stent insertion, pacemakers,
electrophysiology testing and ablation, implantable defibrillators,
cardioversion, placement of intra-aortic and intra-ventricular devices
Endocrinology: Thyroid biopsy, dynamic hormone testing, bone density
testing
Gastroenterology: Upper and lower endoscopy, esophageal manometry,
endoscopic retrograde cholangiopancreatography (ERCP), stent
insertion, endoscopic ultrasound, liver biopsy
Hematology/oncology: Bone marrow biopsy, stem cell transplant, lymph
node biopsy, plasmapheresis
Pulmonary: Intubation and ventilator management, bronchoscopy, chest
tube thoracostomy, tracheostomy placement
Renal: Kidney biopsy, dialysis
Rheumatology: Joint aspiration and therapeutic injection
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Internal medicine and many other medical specialties use ultrasound,
computed tomography (CT), and magnetic resonance imaging (MRI) to guide
invasive procedures. Flexible fiberoptic instruments may be used to access
hard-to-reach areas of the body.
Major Professional Societies for Internal Medicine
Major professional societies for internists include:
Alliance for Academic Internal Medicine
American Association of the Study of Liver Diseases
American College of Cardiology
American College of Gastroenterology
American College of Physicians (ACP)
American Diabetes Association
American Geriatrics Society
American Heart Association
American Medical Association
American Society of Gastrointestinal Endoscopy
American Society of Hematology
American Thoracic Society
Endocrine Society
Infectious Diseases Society of America
Breaking News and Information on Internal Medicine
There are new advances in internal medicine all of the time. This includes new
medications and types of surgery that improve how internists can help their
patients. Because of this, it’s important to stay up to date on the latest news.
Here are a few reliable websites where you can stay current on the latest news
and information within internal medicine:
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Annals of Internal Medicine
ACP Internist
ACP Gastroenterology Monthly
ACP Diabetes Monthly
ACP Hospitalist
American Journal of Medicine
American Journal of Physical Medicine and Rehabilitation
Archives of Physical Medicine and Rehabilitation
BMC Medicine
British Journal of Medical Practitioners
Cleveland Clinic Journal of Medicine
Clinical Medicine & Research
Journal of Clinical Epidemiology
Journal of Internal Medicine
New England Journal of Medicine
Q&A with Aldo Arpaia, MD
Aldo Arpaia, MD, is a Castle Connolly Top Doctor in Staten Island, New York. An
internal medicine doctor who subspecializes in emergency medicine, Dr. Arpaia
is affiliated with Staten Island University Hospital.
NICE TO MEET YOU
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Dr. Aldo A. Arpaia
STATEN ISLAND, NY
Internal Medicine
VIEW PROFILE
Q: How do you encourage people to make lifestyle adjustments that will
improve their present and future health?
A: I believe it starts with getting patients to understand and buy in to important
lifestyle changes and trying to reinforce that at every visit.
As for things people can do to improve their present and future health, diet,
exercise, and statin therapy where indicated can help slow the progression of
coronary artery disease. An active lifestyle does indeed improve outcomes, as
does refraining from tobacco and excessive alcohol use. Patients under 45
should consider being vaccinated against human papillomavirus (HPV).
Q: Who should be on a person’s health team besides an internist?
A: It’s important that patients have on their health teams specialists
appropriate to their specific health needs. Women, for example, should have a
gynecologist, while someone with diabetes should have an endocrinologist.
REFERENCES
American College of Physicians
https://www.acponline.org/about-acp/about-internal-medicine
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"ACP: Who We Are". American College of Physicians.
https://www.acponline.org/about-acp/who-we-are
American College of Internal Medicine News Room
https://www.acponline.org/acp-newsroom/what-is-a-doctor-of-internal-
medicine-or-internist-0
Comprehensive Primary Care
https://comprehensiveprimarycare.com/everything-you-need-to-know-about-
internal-medicine/
General and Acute Care Medicine. The Royal Australasian College of Physicians.
https://www.racp.edu.au/trainees/advanced-training/advanced-training-
programs/general-and-acute-care-medicine
Poole, Philippa. "Restoring the Balance - The Importance of General Medicine
in the New Zealand Health System".
https://www.imsanz.org.au/documents/item/418
Internal Medicine. American Medical Association.
https://www.ama-assn.org/specialty/internal-medicine
Adult medical emergencies. UpToDate.
https://www.uptodate.com/contents/table-of-contents/emergency-medicine-
adult-and-pediatric/adult-medical-emergencies
DocDoc
https://www.docdoc.com.sg/info/specialty/internal-medicine-physicians/
Chapter 3: Procedures Commonly Performed by Internists. Access Medicine.
https://accessmedicine.mhmedical.com/content.aspx?bookid=1820§ionid=127
553672
Medical Student Career Path. American College of Physicians.
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https://www.acponline.org/about-acp/about-internal-medicine/career-
paths/medical-student-career-path/internal-medicine-vs-family-medicine
American Board of Internal Medicine.
https://www.abim.org/about/affiliated-organizations-links.aspx
Journals and Publications. American College of Physicians
https://www.acponline.org/clinical-information/journals-publications
MDLinx
https://www.mdlinx.com/internal-medicine/journals.cfm

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Internal Medicine Internal medicine is a medical specialty in which physicians apply scientific knowledge and clinical expertise to diagnose and treat adults with a very broad range of health concerns and diseases. Physicians who specialize in internal medicine are called internists or general internists. Differences Between Internal Medicine and General/Family Practice While they are both primary care doctors — and the terms are often used interchangeably — internists are not the same as general practitioners and family physicians. One of the key differences is that internists see only adults, and family practitioners see both children and adults. General Internists General internists are uniquely qualified to practice primary care and follow patients through their adult lives. Some internists work as hospitalists, delivering primary care in hospital settings; others provide only out-patient care. General internists may also practice in rehabilitation centers and longterm care facilities. Internal medicine doctors are trained to provide: • Precise diagnoses of and prompt treatment for a broad range of symptoms and diseases • Expertise in conditions that affect any of the body's systems • Guidance, counseling, and preventive interventions for improved overall health • Life-long comprehensive care and palliative care • Care for mental health disorders, such as depression and anxiety caused by abnormal activities in the brain, a chronic disease, or hormonal imbalances General Family Practitioners Unlike internists, general family practitioners do not solely concentrate on adults and may practice pediatrics, obstetrics, and do minor surgery. Family physicians can treat a full range of medical issues and provide acute, chronic, and wellness services for patients. Family physician training involves: • Adult critical care (1 month) • Care for children in the hospital or emergency settings (nearly 2 months) • Geriatric care (1 month) • Gynecology (1 month) • In-patient hospital experience (6 months minimum) • Musculoskeletal medicine (2 months) • Newborn encounters • Obstetrics (2 months) • Surgery (1 month) Family medicine training also includes behavioral health, common skin diseases, population health, and health system management, wellness, and disease prevention. Specialized Training Internists are medical doctors who specialize in preventing, diagnosing, and treating a wide variety of diseases and other health issues that affect adults. They are experts in health promotion, disease prevention, and the care of problems both simple and complex, acute and chronic. Internal medicine training includes general medical education, as well as time spent rotating among a variety of subspecialty clinics, both in-patient and outpatient. Internal Medicine Subspecialties Internal medicine trainees gain experience working in areas that include: • Endocrinology • Rheumatology • Infectious diseases • Pulmonary diseases • Cardiovascular diseases • Critical care medicine • Hematology • Oncology • Gastroenterology • Nephrology • Neurology • Psychiatry • Dermatology • Ophthalmology • Gynecology • Otorhinolaryngology • Non-surgical orthopedics • Palliative medicine • Sleep medicine • Geriatrics • Rehabilitation medicine Internal medicine trainees spend at least one year caring for hospitalized patients, with at least three months in intensive/critical care settings. They undergo hospital-based training for at least one year, with additional exposure to in-patient subspecialties such as cardiology, hematology-oncology, or gastroenterology. Many internal medicine doctors have a particular subspecialty. To gain expertise for those subspecialties, students complete an additional one to three years of fellowship training after a required three-year internal medicine residency. Recognized internal medicine subspecialties include: • Allergy and Immunology (immune system) • Cardiovascular Disease (heart and vascular system) • Advanced Heart Failure and Transplant Cardiology • Interventional Cardiology (heart health) • Critical Care Medicine (patients with organ system failures) • Clinical Cardiac Electrophysiology (heart rhythm) • Endocrinology, Diabetes, and Metabolism (diabetes and other glandular and metabolic disorders) • Gastroenterology (gastrointestinal system, liver, and gallbladder) • Transplant Hepatology (liver) • Hematology (blood) • Infectious Disease (bacterial, viral, fungal, and parasitic infections) • Nephrology (kidneys) • Oncology (cancer) • Pulmonary Disease (lungs and respiratory system) • Rheumatology (joints and musculoskeletal system) Internal Medicine/Body Connection Internal medicine is the study, diagnosis, and treatment of conditions that affect the internal organs — conditions such as heart disease, hypertension, diabetes, obesity, and lung disease. Internal medicine specialists often care for people with complex, chronic, and multisystem disorders. Based on their subspecialties, internists may work with doctors in other medical specialties or consult on patients referred by another specialist. Treating a Broad Range of Internal Medicine Conditions Internal medicine doctors diagnose, manage, and treat a wide range of conditions. These include cancer, infections, and conditions affecting the heart, blood, kidneys, joints, and the digestive, respiratory, and vascular systems. Examples of conditions treated by internists include: • Abnormal liver biochemical and function tests • Abnormal uterine bleeding • Acid peptic disease associated with upper gastrointestinal bleeding • Acquired thrombotic thrombocytopenic purpura (TTP) • Acquired von Willebrand syndrome • Acute aortic dissection • Acute aortic regurgitation • Acute bacterial meningitis • Acute bronchitis • Acute calculous cholecystitis • Acute cholangitis • Acute colonic diverticulitis • Acute decompensated heart failure • Acute diverticulitis • Acute exacerbations of asthma • Acute ischemic stroke • Acute liver failure • Acute lower extremity ischemia • Acute mesenteric arterial occlusion • Acute migraine • Acute myocardial infarction • Acute pancreatitis • Acute pericarditis • Acute pharyngitis • Acute pulmonary embolism • Acute respiratory distress syndrome • Acute sinusitis and rhinosinusitis • Acute variceal hemorrhage • Acute viral gastroenteritis • Adrenal insufficiency • Airway foreign bodies • Allergic rhinitis • Anal fissure • Angioedema • Aseptic meningitis • Aspiration pneumonia • Atrial fibrillation • Bacterial brain abscess • Balanitis and balanoposthitis in children and adolescents • Bell's palsy • Bleeding peptic ulcers • Cancer pain • Cardiac arrest • Cardiogenic shock complicating acute myocardial infarction • Cellulitis and skin abscesses • Chronic complications and age-related comorbidities in people with hemophilia • Chronic limb-threatening ischemia • Clostridial myonecrosis (“gas gangrene”) • Clostridioides difficile (“C. Diff”) infection (formerly Clostridium difficile) • Cognitive impairment and dementia • Colonic ischemia • Constrictive pericarditis • Convulsive status epilepticus in adults • Corneal abrasions and corneal foreign bodies • Cushing's syndrome • Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults • Disseminated intravascular coagulation • Dysphagia in adults • Electrocardiographic abnormalities suggesting myocardial ischemia and infarction • Emergency contraception • Epilepsy and electroencephalogram (EEG) • Esophageal disease • Exacerbations of chronic obstructive pulmonary disease (COPD) • Exercise-associated hyponatremia • External otitis • Failed fibrinolysis (thrombolysis) or threatened reocclusion in acute STelevation myocardial infarction • Fasting ketosis and alcoholic ketoacidosis • Gastrointestinal infections • Giant-cell arteritis • Gout flares • HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) • Hepatic encephalopathy • Hereditary thrombotic thrombocytopenic purpura (TTP) • Hyperkalemia • Hypotonic hyponatremia • Infections of cerebrospinal-fluid shunts and other devices • Ingested foreign bodies and food impactions in adults • Intestinal ischemia • Intracranial epidural abscess • Invasive group A streptococcal