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Adrenaline Lab Tetrad

Pain, anxiety, trauma, pregnancy or any form of emotional or physiologic stress can cause any or all of the following lab abnormalities, probably from endogenous adrenaline release and/or hyperventilation

  1. Leukocytosis from demargination (often left shift but should not have toxic granulation or Dohle bodies and CRP should be normal)
  2. Hyperglycemia
  3. Hypokalemia from shift into cells similar to giving albuterol for hyperkalemia
  4. Low bicarb non-gap metabolic acidosis to compensate for respiratory alkalosis (hyperventilation).  This probably starts within minutes but is only remarkable if hyperventilation has been going on for more than half an hour (my estimate)
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