56 Establishing A Bedside Diagnosis Of Hypovolemiakdiwavvou
This document summarizes a literature review on physical exam findings that can help diagnose hypovolemia. The review found that a large increase in pulse (over 30 beats per minute) when moving from lying to standing, or severe dizziness preventing standing, best indicate hypovolemia related to blood loss. However, these findings may be absent with moderate blood loss. Few physical exam findings reliably diagnose hypovolemia due to diarrhea, vomiting or low fluid intake. Prolonged capillary refill time and poor skin turgor did not prove useful. The authors recommend lab tests if hypovolemia is suspected.
This document summarizes three medications used to treat hyperaldosteronism: Canrenone, Spironolactone, and Eplerenone.
Canrenone and Spironolactone are aldosterone antagonists with diuretic effects that act to counteract aldosterone and promote excretion of sodium. Eplerenone selectively blocks aldosterone receptors in the kidneys and cardiovascular system.
The document provides information on indications, contraindications, side effects and dosing for each medication. It also notes that periodic monitoring of potassium levels is needed when using these aldosterone antagonists due to the risk of hyperkalemia.
The respiratory rate and pattern are determined by the respiratory control center in the brainstem. It receives feedback from peripheral chemoreceptors in the carotid bodies and central chemoreceptors in the brainstem to regulate ventilation and maintain normal blood gases. The respiratory rate, tidal volume, and use of accessory muscles are observed during a physical exam to detect any abnormalities. Changes in rate or tidal volume have different effects on gas exchange depending on whether the dead space or alveolar volume is altered.
The document summarizes essential thrombocytosis, a rare chronic blood disorder characterized by overproduction of platelets. It is one of four myeloproliferative disorders. The summary describes the epidemiology, pathophysiology involving abnormal megakaryocytes and platelet function, clinical features such as bleeding, thrombosis, and splenomegaly. Diagnostic criteria include persistent thrombocytosis over 600x109/L and exclusion of other causes, with some cases associated with a JAK2 kinase mutation. Treatment aims to reduce platelet count and risk of thrombosis.
Standing electrolyte replacement protocols are available for use in adult patients admitted to Orlando Regional Healthcare hospitals. These include protocols for calcium chloride or calcium gluconate, magnesium sulfate, potassium chloride, and potassium phosphate replacement. The protocols provide guidance on administration methods, dosage, rates of infusion, and monitoring based on current serum electrolyte levels. All electrolyte replacements must be administered via infusion pump with appropriate dilution and monitoring by medical staff.
Here are the key points about ionized calcium levels:
- Ionized calcium is the biologically active form of calcium and provides a more accurate assessment of calcium status compared to total calcium levels.
- Low ionized calcium levels are common in critically ill patients and those with conditions affecting calcium homeostasis like renal failure.
- Ionized calcium levels below 2.8 mg/dL increase the risk of cardiac arrest, so calcium replacement therapy is generally started once levels fall below this threshold.
- Measurement of ionized calcium is particularly important for monitoring unconscious or anesthetized patients where changes in calcium levels may not produce early warning signs.
- Ionized calcium can also be useful for evaluating conditions like neonatal hypocal
1. The Frederickson classification system outlines 5 types of hyperlipidemia based on elevated lipid levels and underlying genetic defects.
2. Type I is characterized by increased chylomicrons due to LPL deficiency. Type IIa is caused by LDL receptor deficiency leading to high LDL. Type IIb involves high LDL and VLDL due to LDL receptor and ApoB defects. Type III stems from ApoE defects causing elevated cholesterol and triglycerides. Type IV results from increased VLDL production and decreased elimination. Type V involves increased VLDL and chylomicron production coupled with low LPL.
56 Establishing A Bedside Diagnosis Of Hypovolemiakdiwavvou
This document summarizes a literature review on physical exam findings that can help diagnose hypovolemia. The review found that a large increase in pulse (over 30 beats per minute) when moving from lying to standing, or severe dizziness preventing standing, best indicate hypovolemia related to blood loss. However, these findings may be absent with moderate blood loss. Few physical exam findings reliably diagnose hypovolemia due to diarrhea, vomiting or low fluid intake. Prolonged capillary refill time and poor skin turgor did not prove useful. The authors recommend lab tests if hypovolemia is suspected.
This document summarizes three medications used to treat hyperaldosteronism: Canrenone, Spironolactone, and Eplerenone.
Canrenone and Spironolactone are aldosterone antagonists with diuretic effects that act to counteract aldosterone and promote excretion of sodium. Eplerenone selectively blocks aldosterone receptors in the kidneys and cardiovascular system.
The document provides information on indications, contraindications, side effects and dosing for each medication. It also notes that periodic monitoring of potassium levels is needed when using these aldosterone antagonists due to the risk of hyperkalemia.
The respiratory rate and pattern are determined by the respiratory control center in the brainstem. It receives feedback from peripheral chemoreceptors in the carotid bodies and central chemoreceptors in the brainstem to regulate ventilation and maintain normal blood gases. The respiratory rate, tidal volume, and use of accessory muscles are observed during a physical exam to detect any abnormalities. Changes in rate or tidal volume have different effects on gas exchange depending on whether the dead space or alveolar volume is altered.
The document summarizes essential thrombocytosis, a rare chronic blood disorder characterized by overproduction of platelets. It is one of four myeloproliferative disorders. The summary describes the epidemiology, pathophysiology involving abnormal megakaryocytes and platelet function, clinical features such as bleeding, thrombosis, and splenomegaly. Diagnostic criteria include persistent thrombocytosis over 600x109/L and exclusion of other causes, with some cases associated with a JAK2 kinase mutation. Treatment aims to reduce platelet count and risk of thrombosis.
Standing electrolyte replacement protocols are available for use in adult patients admitted to Orlando Regional Healthcare hospitals. These include protocols for calcium chloride or calcium gluconate, magnesium sulfate, potassium chloride, and potassium phosphate replacement. The protocols provide guidance on administration methods, dosage, rates of infusion, and monitoring based on current serum electrolyte levels. All electrolyte replacements must be administered via infusion pump with appropriate dilution and monitoring by medical staff.
Here are the key points about ionized calcium levels:
- Ionized calcium is the biologically active form of calcium and provides a more accurate assessment of calcium status compared to total calcium levels.
- Low ionized calcium levels are common in critically ill patients and those with conditions affecting calcium homeostasis like renal failure.
- Ionized calcium levels below 2.8 mg/dL increase the risk of cardiac arrest, so calcium replacement therapy is generally started once levels fall below this threshold.
- Measurement of ionized calcium is particularly important for monitoring unconscious or anesthetized patients where changes in calcium levels may not produce early warning signs.
- Ionized calcium can also be useful for evaluating conditions like neonatal hypocal
1. The Frederickson classification system outlines 5 types of hyperlipidemia based on elevated lipid levels and underlying genetic defects.
2. Type I is characterized by increased chylomicrons due to LPL deficiency. Type IIa is caused by LDL receptor deficiency leading to high LDL. Type IIb involves high LDL and VLDL due to LDL receptor and ApoB defects. Type III stems from ApoE defects causing elevated cholesterol and triglycerides. Type IV results from increased VLDL production and decreased elimination. Type V involves increased VLDL and chylomicron production coupled with low LPL.
Dyslipidemia refers to abnormalities in serum lipid levels, including high or low levels of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol. These abnormalities can be inherited, acquired, or secondary to other primary conditions. Dyslipidemias are classified based on the pattern of lipoproteins in electrophoresis or ultracentrifugation testing.
Dyslipidemia refers to abnormalities in serum lipid levels, including high or low levels of cholesterol, triglycerides, and lipoproteins. Dyslipidemias can be inherited, acquired, primary, or secondary. They are classified based on the pattern of lipoproteins seen on electrophoresis or ultracentrifugation. Causes include genetic factors, endocrine conditions, drugs, and lifestyle factors like smoking. Symptoms are often nonspecific but may include obesity.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, atrioventricular blocks, preexcitation syndromes, myocardial infarction in various territories, athlete's heart, electrolyte abnormalities, drug effects and various cardiac pathologies.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, atrioventricular blocks, preexcitation syndromes, myocardial infarction in various territories, athlete's heart, electrolyte abnormalities, drug effects and various cardiac pathologies.
The 11-step method provides a systematic approach to reading EKGs:
1. Gather data such as heart rate, intervals, and axis.
2. Diagnose rhythm, conduction blocks, enlargement, and infarction by applying specific criteria.
3. Potential diagnoses are identified through disturbances of rhythm, conduction, hypertrophy, and ischemia. The relationship between P waves and QRS complexes helps determine block types.
Hypertension, or high blood pressure, is a major risk factor for coronary artery disease and cerebrovascular accidents. The risk of these conditions increases as blood pressure rises. For those over age 60, pulse pressure is the best predictor of outcomes from hypertension. Essential or primary hypertension, which has no identifiable cause, accounts for 80% of hypertension cases. It is defined as a diastolic blood pressure of 90-104 mmHg. Isolated systolic hypertension, affecting those over age 75, occurs when systolic pressure is over 160 mmHg and diastolic is under 90 mmHg.
This document discusses vitamin A, including its sources, forms, and functions. It notes that vitamin A is found primarily in animal foods as retinol, retinal, and retinoic acid. These forms are essential for growth, tissue integrity, and vision. Deficiencies can occur rarely due to absorption or storage issues, though stores usually last over 2 years. Toxicity risks exist from excessive supplementation, with symptoms taking long to resolve as stores are depleted slowly. The document recommends vitamin A supplementation only for deficiencies, pregnancy, or lactation, as normal diets provide sufficient amounts.
The document discusses a clinical case of a 30-year-old woman experiencing intermittent right upper quadrant pain. Her lab tests and ultrasound were normal. The key signs and symptoms suggest a diagnosis of biliary dyskinesia. There is no standardized test for this condition, but HIDA scanning is commonly used to assess gallbladder ejection fraction, with values under 35-40% indicating dysfunction. However, the test protocol can vary between providers and affect results. The most reliable approach may be one where CCK is administered at 30 and 60 minutes to better evaluate gallbladder motility.
Diverticulitis is inflammation of diverticula in the colon. It can range from mild to severe, with complications including colonic perforation, abscesses, and peritonitis. Symptoms include abdominal pain, fever, and tenderness. Treatment involves antibiotics, clear liquid diets, and sometimes surgery for recurrent or complicated cases.
1. Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects 10-22% of the population. It is characterized by abdominal pain and changes in bowel habits without any underlying structural or biochemical abnormalities.
2. Management of IBS focuses on lifestyle modifications, diet changes, stress reduction techniques, and symptom-targeted medications. Dietary triggers like caffeine, alcohol, dairy, and fatty or gas-producing foods should be avoided. Bulk-forming fibers can help constipation, while antidiarrheals may relieve diarrhea.
3. Evaluation involves a careful history, physical exam, and initial labs as warranted. Colonoscopy is recommended if red flags are present. While there are no
Biliary colic is a painful condition caused by gallstones obstructing the cystic duct or ampulla of Vater. This leads to distention of the gallbladder or biliary tree. Pain is relieved when the gallstone passes through or moves locations. The main symptom is intermittent abdominal pain in the right upper quadrant that may radiate to the right shoulder. Diagnostic tests include ultrasound and bloodwork. Treatment options range from pain medications and watchful waiting to laparoscopic cholecystectomy to permanently remove the gallbladder in symptomatic patients.
Dyslipidemia refers to abnormalities in serum lipid levels, including high or low levels of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol. These abnormalities can be inherited, acquired, or secondary to other primary conditions. Dyslipidemias are classified based on the pattern of lipoproteins in electrophoresis or ultracentrifugation testing.
Dyslipidemia refers to abnormalities in serum lipid levels, including high or low levels of cholesterol, triglycerides, and lipoproteins. Dyslipidemias can be inherited, acquired, primary, or secondary. They are classified based on the pattern of lipoproteins seen on electrophoresis or ultracentrifugation. Causes include genetic factors, endocrine conditions, drugs, and lifestyle factors like smoking. Symptoms are often nonspecific but may include obesity.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, atrioventricular blocks, preexcitation syndromes, myocardial infarction in various territories, athlete's heart, electrolyte abnormalities, drug effects and various cardiac pathologies.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, atrioventricular blocks, preexcitation syndromes, myocardial infarction in various territories, athlete's heart, electrolyte abnormalities, drug effects and various cardiac pathologies.
The 11-step method provides a systematic approach to reading EKGs:
1. Gather data such as heart rate, intervals, and axis.
2. Diagnose rhythm, conduction blocks, enlargement, and infarction by applying specific criteria.
3. Potential diagnoses are identified through disturbances of rhythm, conduction, hypertrophy, and ischemia. The relationship between P waves and QRS complexes helps determine block types.
Hypertension, or high blood pressure, is a major risk factor for coronary artery disease and cerebrovascular accidents. The risk of these conditions increases as blood pressure rises. For those over age 60, pulse pressure is the best predictor of outcomes from hypertension. Essential or primary hypertension, which has no identifiable cause, accounts for 80% of hypertension cases. It is defined as a diastolic blood pressure of 90-104 mmHg. Isolated systolic hypertension, affecting those over age 75, occurs when systolic pressure is over 160 mmHg and diastolic is under 90 mmHg.
This document discusses vitamin A, including its sources, forms, and functions. It notes that vitamin A is found primarily in animal foods as retinol, retinal, and retinoic acid. These forms are essential for growth, tissue integrity, and vision. Deficiencies can occur rarely due to absorption or storage issues, though stores usually last over 2 years. Toxicity risks exist from excessive supplementation, with symptoms taking long to resolve as stores are depleted slowly. The document recommends vitamin A supplementation only for deficiencies, pregnancy, or lactation, as normal diets provide sufficient amounts.
The document discusses a clinical case of a 30-year-old woman experiencing intermittent right upper quadrant pain. Her lab tests and ultrasound were normal. The key signs and symptoms suggest a diagnosis of biliary dyskinesia. There is no standardized test for this condition, but HIDA scanning is commonly used to assess gallbladder ejection fraction, with values under 35-40% indicating dysfunction. However, the test protocol can vary between providers and affect results. The most reliable approach may be one where CCK is administered at 30 and 60 minutes to better evaluate gallbladder motility.
Diverticulitis is inflammation of diverticula in the colon. It can range from mild to severe, with complications including colonic perforation, abscesses, and peritonitis. Symptoms include abdominal pain, fever, and tenderness. Treatment involves antibiotics, clear liquid diets, and sometimes surgery for recurrent or complicated cases.
1. Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects 10-22% of the population. It is characterized by abdominal pain and changes in bowel habits without any underlying structural or biochemical abnormalities.
2. Management of IBS focuses on lifestyle modifications, diet changes, stress reduction techniques, and symptom-targeted medications. Dietary triggers like caffeine, alcohol, dairy, and fatty or gas-producing foods should be avoided. Bulk-forming fibers can help constipation, while antidiarrheals may relieve diarrhea.
3. Evaluation involves a careful history, physical exam, and initial labs as warranted. Colonoscopy is recommended if red flags are present. While there are no
Biliary colic is a painful condition caused by gallstones obstructing the cystic duct or ampulla of Vater. This leads to distention of the gallbladder or biliary tree. Pain is relieved when the gallstone passes through or moves locations. The main symptom is intermittent abdominal pain in the right upper quadrant that may radiate to the right shoulder. Diagnostic tests include ultrasound and bloodwork. Treatment options range from pain medications and watchful waiting to laparoscopic cholecystectomy to permanently remove the gallbladder in symptomatic patients.