This document summarizes a presentation on fluid and electrolyte disorders given by Dr. Joel Topf. It discusses cases of hypokalemia, hypomagnesemia, and hypophosphatemia seen in patients with alcoholism, starvation, and vomiting. Specific causes of electrolyte abnormalities are explored, including decreased intake through alcohol abuse or starvation, and renal losses induced by vomiting. Treatment strategies are also covered, such as intravenous potassium and magnesium administration.
Interactions between Vitamins, Minerals and HormonesSakshi Singla
Various Antagonistic and Synergistic Interactions between various Vitamins, Minerals and Hormones in our body and how these interactions determine the level of Hormones, Vitamins and Minerals in our body.
Interactions between Vitamins, Minerals and HormonesSakshi Singla
Various Antagonistic and Synergistic Interactions between various Vitamins, Minerals and Hormones in our body and how these interactions determine the level of Hormones, Vitamins and Minerals in our body.
Calcium(ca) mineral bch 628(advanced nutritional biochemistry)ArreyettaBawakAugust
Calcium micronutrient, its importance to the human system, its sources, recommended dietary allowance, metabolism, functions and symptoms of deficiency.
The effects of a deficiency of one vitamin would not ordinarily be expected to be highly dependent on the presence or absence of another vitamin in the diet, since the symptoms of deficiency of each vitamin are usually quite distinct. Nevertheless, antagonistic or synergistic interactions between vitamins may occur to a greater or less extent. While several mechanisms can be proposed whereby vitamins can be synergistic, it is more difficult to conceive of one which could explain vitamin antagonism.
Internal Medicine Board Review - Hematology Flashcards - by KnowmedgeKnowmedge
Internal Medicine Board Review Flashcards - This eBook contains 50 Hematology Flashcards. The Flashcards are review questions and can be used to study for medical board exams including the USMLE Step Exams and the ABIM Internal Medicine Exam. More questions can be found at www.knowmedge.com
Internal Medicine Board Review - Nephrology Flashcards - by KnowmedgeKnowmedge
Internal Medicine Board Review Flashcards - This eBook contains 50 Nephrology / Urology Flashcards. The Flashcards are review questions and can be used to study for medical board exams including the USMLE Step Exams and the ABIM Internal Medicine Exam. More questions can be found at www.knowmedge.com
Calcium(ca) mineral bch 628(advanced nutritional biochemistry)ArreyettaBawakAugust
Calcium micronutrient, its importance to the human system, its sources, recommended dietary allowance, metabolism, functions and symptoms of deficiency.
The effects of a deficiency of one vitamin would not ordinarily be expected to be highly dependent on the presence or absence of another vitamin in the diet, since the symptoms of deficiency of each vitamin are usually quite distinct. Nevertheless, antagonistic or synergistic interactions between vitamins may occur to a greater or less extent. While several mechanisms can be proposed whereby vitamins can be synergistic, it is more difficult to conceive of one which could explain vitamin antagonism.
Internal Medicine Board Review - Hematology Flashcards - by KnowmedgeKnowmedge
Internal Medicine Board Review Flashcards - This eBook contains 50 Hematology Flashcards. The Flashcards are review questions and can be used to study for medical board exams including the USMLE Step Exams and the ABIM Internal Medicine Exam. More questions can be found at www.knowmedge.com
Internal Medicine Board Review - Nephrology Flashcards - by KnowmedgeKnowmedge
Internal Medicine Board Review Flashcards - This eBook contains 50 Nephrology / Urology Flashcards. The Flashcards are review questions and can be used to study for medical board exams including the USMLE Step Exams and the ABIM Internal Medicine Exam. More questions can be found at www.knowmedge.com
Grand Rounds which summarizes the data pointing to fructose and sugar intake as the chief cause of hypertension and the use of allopurinal to treat pediatric hypertension.
This demonstrates lead time bias. I do not know if lead time bias is responsible for the prolonged survival with early referral to nephrology I just know that it needs to be accounted for and most literature ignores this source of error.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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14. Decreased intake
945 outpatients with eating
disorders Serum Potassium
anorexia, bulemia, or both
2%
ALL of the hypokalemic 3%
patients were abusing
cathartics or inducing
vomiting
NONE of the hypokalemia
was due to restricted
caloric intake alone
95%
The restricted calorie
subgroup was the most
nutritionally deprived of >3.5 3.0-3.5 <3.0
all the subgroups.
Greenfeld, D., Et Al. Am. J. Psychiatry 152, 60-63 (1995).
Friday, February 27, 2009
15. Serum K with dietary restriction
Intake does matter in
4.00
experimental settings
but clinical
Serum K (mEq/dL)
3.25
relevance is
questionable
2.50
A compilation of 7 1.75
separate metabolic
balance studies 1.00
reveals the 0 200 400 600 800
following graph K defecit (mEq)
Friday, February 27, 2009
16. Alcoholism
61 patients with weekly alcohol ingestion
greater than 600g/wk.
No cirrhosis of hepatitis, renal disease or,
acute medical condition.
Admitted for inpatient detoxification for 4
weeks
De Marchi, S. et al. N Engl J Med 1993;329:1927-1934
Friday, February 27, 2009
19. Vomiting induced hypokalemia
is not due to GI losses
potassium content
of stomach fluid
is 15 mEq/L
Friday, February 27, 2009
20. Vomiting induced hypokalemia
is not due to GI losses
potassium content
of stomach fluid
is 15 mEq/L
How much vomit
to get a 120 mEq
potassium deficit?
Friday, February 27, 2009
21. Vomiting induced hypokalemia
is not due to GI losses
potassium content
of stomach fluid
is 15 mEq/L
How much vomit
to get a 120 mEq
potassium deficit?
Friday, February 27, 2009
22. Distal convoluted
tubule
Glomerulus
Vomiting induced Proximal tubule
hypokalemia is Collecting
tubule
due to renal
losses
Loop of Henle
Friday, February 27, 2009
23. Vomiting induced
hypokalemia is
due to renal
losses
Friday, February 27, 2009
24. Vomiting induced
hypokalemia is
due to renal
losses
Friday, February 27, 2009
25. Vomiting induced
hypokalemia is
due to renal
losses
Friday, February 27, 2009
26. Vomiting induced
hypokalemia is
due to renal
losses
Friday, February 27, 2009
27. Vomiting induced hypokalemia
is due to renal losses
Vomiting causes
metabolic alkalosis
Increased serum
bicarbonate is
dumped into the
urine
urine potassium can
rise to 80-120 mEq/L
Friday, February 27, 2009
28. Hypokalemia: Treatment
Potassium is 2.8
How much poassium will you give:
100 x (4–k)
Friday, February 27, 2009
51. magnesium
2 grams of Magnesium Sulfate IVPB over an
hour or so
Friday, February 27, 2009
52. magnesium
2 grams of Magnesium Sulfate IVPB over an
hour or so
Friday, February 27, 2009
53. magnesium
doesn’t really work
the next day it’s still low
Most of the IV magnesium is immediately
dumped in the urine
you need to drip it in over as long as
possible
i like 6g (48.6 mEq) over 24 hours
Friday, February 27, 2009
54. day one labs
12
128 92 128
2.8 22 3.0
0.6
Friday, February 27, 2009
55. day two labs
12
128 92 128
2.8 22 3.0
0.6
8.8 10
132 100 94
1.2 2.2 3.2 24
0.6
Friday, February 27, 2009
68. Transcellular redistribution is movement of phosphorous into
cells. This is usually transient and, in the face of
normal total body phosphourous is harmless.
However, in the face of pre-existing phosphorous depletion,
this transcellular movement can provoke serious symptoms
including death. The most severe cases are
found with refeeding syndrome.
Weinsier and Krumdieck, 1981, Am J Clin Nutr, 34, 393-9
Friday, February 27, 2009
69. Starvation decreases total body phosphorous.
However, serum phos remains normal due
to movement of phosphorous out of cells.
With refeeding, insulin moves
phosphorous into cells, in order to
phosphorylate carbs as part of glycolysis.
This unmasks the previous
phosphorous depletion.
Friday, February 27, 2009
70. this is worse with fructose
conversion of fructose to fructose-P
is unregulated
causes rapid consumption of Phos and
ATP
the loss of ATP is thought to be the
cause of fructose toxicity
Friday, February 27, 2009
71. give phos
stop carbs
Friday, February 27, 2009
72. Stop the D5LR
Started 8 ounces of
milk four times a
day
Used a packet of
KPhos
Friday, February 27, 2009
73. IV sodium phosphorous
8mmol q6 hours
target 32 mmol in a day
careful in renal failure
Friday, February 27, 2009
74. day four and five labs
Day Na K P Mg
1 128 2.8 3.0
2 132 3.2 2.2 1.2
3 133 3.9 1.4 2.3
4 131 3.8 1.8 2.2
5 130 4.2 2.8 1.8
Friday, February 27, 2009
75. problem list
hyponatremia
Friday, February 27, 2009
76. Specific gravity on admission:
1.005
What’s the specific gravity in:
hypervolemic hyponatremia: heart
failure? Cirrhosis? Nephrotic
syndrome?
Euvolemic hyponatremia: SIADH?
Hypovolemic hyponatremia:
diuretics? GI losses?
Friday, February 27, 2009
80. What regulates specific gravity?
ADH
We start with an increase in the plasma osmolality
Friday, February 27, 2009
81. What regulates specific gravity?
ADH
This is detected increase in
We start with an by the brainthe plasma osmolality
Friday, February 27, 2009
82. What regulates specific gravity?
ADH
The is detected increase
Thisbrain releases the in
We start with an by ADHbrainthe plasma osmolality
Friday, February 27, 2009
83. What regulates specific gravity?
ADH
ADH acts releases the
The is detected kidney
Thisbrain on an increase in
We start withthe by ADHbrainthe plasma osmolality
Friday, February 27, 2009
84. What regulates specific gravity?
ADH
The retained water
goes here
not here
The kidney reacts by retaining water and producing a
small amount of kidney
The is detected concentrated
Thisbrain on an increase in urine.
ADH acts releases the
We start withthe by ADHbrainthe plasma osmolality
Friday, February 27, 2009
85. What regulates specific gravity?
ADH
What do all of the etiologies of
hyponatremia have in common?
Friday, February 27, 2009
86. What regulates specific gravity?
ADH
What do all of the etiologies of
hyponatremia have in common?
ADH
Friday, February 27, 2009
90. Our patient has a low specific gravity.
Friday, February 27, 2009
91. Our patient has a low specific gravity.
ADH independent hyponatremia
Friday, February 27, 2009
92. Our patient has a low specific gravity.
ADH independent hyponatremia
psychogenic polydipsia
Friday, February 27, 2009
93. Our patient has a low specific gravity.
ADH independent hyponatremia
psychogenic polydipsia
tea and toast or beer drinkers
potomania
Friday, February 27, 2009
96. The kidney is able to
concentrate urine to 1200
mOsm/L
The kidney is able to dilute
urine to 50 mOsm/L
If a patient has a daily
solute load of 600 mOsms.
What is:
The minimal amount of
urine he can produce
(maximum ADH)
The maximum amount of
urine he can make
(minimal ADH)
Friday, February 27, 2009
97. The kidney is able to
concentrate urine to 1200
mOsm/L
The kidney is able to dilute
urine to 50 mOsm/L
If a patient has a daily
solute load of 600 mOsms.
What is:
The minimal amount of
urine he can produce
(maximum ADH) 500 mL
The maximum amount of
urine he can make
(minimal ADH)
Friday, February 27, 2009
98. The kidney is able to
concentrate urine to 1200
mOsm/L
The kidney is able to dilute
urine to 50 mOsm/L
If a patient has a daily
solute load of 600 mOsms.
What is:
The minimal amount of
urine he can produce
(maximum ADH) 500 mL
The maximum amount of
urine he can make
(minimal ADH) 12,000 mL
Friday, February 27, 2009
99. 600 mOsms is the typical daily solute
load
so a patient requires a minimum of
500 mL of urine to remove the daily
solute load
A patient making less than that is
unable to clear the daily solute load
what is the definition of oliguria
Friday, February 27, 2009
100. What if the daily solute load is 100
mOsms?
What is the most urine they can make?
Friday, February 27, 2009
101. What if the daily solute load is 100
mOsms?
What is the most urine they can make?
2,000 mL
Friday, February 27, 2009
102. What if the daily solute load is 100
mOsms?
What is the most urine they can make?
2,000 mL
What happens if they are getting IV
fluids at 100 mL/hour?
Friday, February 27, 2009
103. An alcoholic gets much of
his daily calories from
alcohol.
Alcohol is metabolized to
CO2 and water
no solute for the kidney
to excrete
Low daily solute load
Friday, February 27, 2009
104. A tea and toast diet refers to
a carbohydrate rich diet free
of proteins
Friday, February 27, 2009
105. Both beer drinker’s and Tea and Toast
respond to increased protein intake
Usually get a brisk response to
crystalloids
Friday, February 27, 2009
Editor's Notes
likely the tissue destruction associate with starvation provides a steady supply of intracellular potassium