Author jacobi Posted on August 6, 2019August 6, 2019Categories EducationTags ,

Approach to Hyponatremia – Dr Anis

Dr. Anis, from the Nephrology department walk us through the physiology of water balance and the diagnostic approach to hyponatremia.   Educational Tidbits: General Approach to Hyponatremia Check serum osms Elevated serum osm: likely hyperglycemia or other osmotic agent Normal serum osm: psuedohyponatremia (hyperproteinemia or hyperlipidemia) Low urine osm: confirmed hypo-osmolar hyponatremia, proceed to b….2 Check urine osms Urine osms < 100: non ADH dependent Excess fluid intake (psychogenic polydipsia) Decreased solute intake (beer potomania and tea and toast) Urine … Continue reading “Approach to Hyponatremia – Dr Anis”

Author jacobi Posted on August 24, 2017August 25, 2017Categories Education, TidbitsTags , ,

Weekly Tidbits 8/26-27

Hepatorenal Syndrome ATACH-II trial: What is the optimal blood pressure control for ICH patients? Status Epilepticus Lung Cancer Immunology Therapy: Anti-PD-1 Antibodies Acetaminophen Hepatotoxicity Hepatorenal Syndrome Type 1 HRS is characterized by rapid and progressive renal impairment and is most commonly precipitated by spontaneous bacterial peritonitis (SBP).  Type 1 HRS occurs in approximately 25% of patients with SBP, despite rapid resolution of the infection with antibiotics.  Without treatment, the median survival of patients with type 1 HRS is < 2 … Continue reading “Weekly Tidbits 8/26-27”

Author jacobi Posted on August 10, 2017August 10, 2017Format AsideCategories Education, TidbitsTags , ,

Malaria Prophylaxis

  Falciparum Ovale Vivax Malarie Age of RBCs infected All Young Young Old Size of cell NL Big Big NL % of Parasitemia >5% <5% <5% <5% Liver stage no yes yes no Common prophylaxis drugs (eg, chloroquine, mefloquine and doxycycline) target blood stage of parasite (blood schizonticides). Malaria with liver stage (Ovale, Vivax) should treated with tissue schizoticides (eg, atovaquone/proguanil).   If one person travel to chloroquine-resistant P falciparum (Sub-Saharan Africa, Southern & Southeast Asia),  prophylaxis with Atorvaquone-proguanil, Doxycycline, … Continue reading “Malaria Prophylaxis”

Author jacobi Posted on August 3, 2017Format AsideCategories Tidbits, Weekend CoverageTags ,

Neurological emergency

Hydrocephalus: if you see hydrocephalus in a patient with consistent severe headaches, this could be a sign of impending herniation. Patient will need emergent relief of intracranial pressure.   Botulism: Rapidly progressive paralysis with blurry vision, sluggish pupils and diplopia. This condition is caused by an irreversible toxin and the antitoxin should be given as soon as possible, so needs high clinical suspicion. The diagnosis is by injecting patient’s serum in mice to see if it causes paralysis (takes a … Continue reading “Neurological emergency”

Author jacobi Posted on August 3, 2017August 9, 2017Categories Tidbits, Weekend CoverageTags , ,

hyponatremia

Pathophysiology: Hyponatremia means excess of body water compared to total body sodium and potassium.   Also likely to involve ADH (vasopressin), the hormone involved in water balance. Total osmolality: concentration of all solutes in a given weight of water (mOsm/kg) regardless of whether or not osmoles move across biological membranes Effective osmolality: number of osmoles that contribute to water movement between intracellular and extracellular compartments Most hyponatremia is from low effective osmolality (hypo-osmotic/hypotonic hyponatremia), but occasionally, hyponatremia occurs in isotonic … Continue reading “hyponatremia”

Author jacobi Posted on August 3, 2017August 3, 2017Format ImageCategories Tidbits, Weekend CoverageTags , , ,

weekly image 0803

  39M from DR, h/o AIDS (CD4 = 40, VL 250k) not on HAART, p/w AMS, also have decreased ambulation/appetite/speaking/ambulation for 2 wks Vitals:  98.3/55/18   BP: 100/60 What is the differential diagnosis ?   What to do for this patient ?               From NEJM  Teaching Topics | February 23, 2012   Q. What neoplastic processes are part of the differential diagnosis of a peripherally enhancing brain lesion? The differential diagnosis of a peripherally … Continue reading “weekly image 0803”

Author jacobi Posted on August 3, 2017Categories TidbitsTags , , ,

Syncope

1: Reflex syncope Neuro-cardiogenic (vaso-vagal), carotid sinus syndrome, situational (micturition) 2: Cardiogenic Arrhythmias – Tachyarrhythmia: WPW (especially with Afib), Brugada, Long QT syndrome, – Bradyarrhythmia: Second degree AV Block Mobitz II, Third degree AV block, Sick sinus syndrome – Structural heart disease (HOCM, LVOT obstruction, Aortic stenosis, Intracardiac tumor: Myxoma 3: Orthostatic

Author jacobi Posted on July 24, 2017July 24, 2017Format AsideCategories TidbitsTags , , , , ,

NOACs

Antidote:  Dabigatran = Idarucizumab (Praxabind)  Idarucizumab for Dabigatran Reversal  N Engl J Med 2015; 373:511-520 Factor Xa (Apixaban, Rivaroxaban) are POTENTIALLY reversible by Andexanet alfa (study was done in healthy human subjects, Andexanet reverses effect while infusion is running but rebounds on completion, further data will be available later)  ANNEXA-4 trial   N Engl J Med 2016;375:1131-41. Aripazine (PER977) is a medication currently on trial and can potentially reverse Factor Xa, dabigatran AND heparin, LMWH  Use of PER977 to Reverse the Anticoagulant Effect of Edoxaban  N Engl J … Continue reading “NOACs”