Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
Potassium Chloride is an electrolyte, used to treat hypokalemia, yet considered as a High Alert Medication requiring great attention, upon ordering, preparing, dispensing and administration
in this presentation, I focused on the possible risks associated with KCl, also some reported incidents and international guidelines finally my institution\’s guidelines and ISMP\’s recommendations to prevent harm due to Potassium Chloride.
Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
Potassium Chloride is an electrolyte, used to treat hypokalemia, yet considered as a High Alert Medication requiring great attention, upon ordering, preparing, dispensing and administration
in this presentation, I focused on the possible risks associated with KCl, also some reported incidents and international guidelines finally my institution\’s guidelines and ISMP\’s recommendations to prevent harm due to Potassium Chloride.
The purpose of this presentation is to provide an overview of fluid and electrolyte maintenance related handicaps and physiological changes in early neonatal period and its management in brief.
The purpose of this presentation is to provide an overview of fluid and electrolyte maintenance related handicaps and physiological changes in early neonatal period and its management in brief.
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
Corporate Presentation of Kinetic Gears which was established in 1980 as SSI Unit, Kinetic Gears is an ISO 9001:2015 certified organisation since 1999 & at present it’s a family-owned business. The unit is an approved supplier in Automobile, Textiles, Coal, Steel, Power, Defense & Aviation Sector.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Corporate Presentation of Kinetic Gears which was established in 1980 as SSI Unit, Kinetic Gears is an ISO 9001:2015 certified organisation since 1999 & at present it’s a family-owned business. The unit is an approved supplier in Automobile, Textiles, Coal, Steel, Power, Defense & Aviation Sector.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
Laghu Udyog Bharati is one of India’s largest MSE Industry Networks in India, with branches in every state and members in every district of India, working towards the welfare of MSEs in India. We have grass-root level insights into the challenges faced by the MSEs as well as changing industry trends & practices on the ground.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Seizures in pyogenic meningitis………
Had seizure on 2nd
day . On Dilantin.
10 months female with meningitis.
Second L.P.( 3rd
day ) showed improvement
Refractory seizure on 6th
day
S.I.A.D.H.
5. Respiratory failure………………………………..
5 months male with R.A.D. was doing well
On extensive nebulization and supportive therapy.
Deteriorated on 4 the day , lethargic, look exhausted .
Respiratory rate is less now.
ABG day 2..pH 7.34.,pO2 80 on FiO2 of 50. CO2 30
ABG day 4..pH 7.23.,pO2 85 on FiO2 of 30. CO2 67
Electrolytes gave the answer…
6. Status on 4 th day
On mannitol
Blood sugar 377 mg %
Serum sodium 151. BUN 38
= 336
Seizures in falciparum malaria
Osmolality (mOsm/kg) = 2 [mEq/L Na+
] +
(mg/dL glucose) / 18 + (mg / dL BUN) /2.8
7. 14 months male with RTA
Hypo tonic no h/o seizures
ECG : suggestive of Hypokalemia with extra systoles
Plasma sodium = 140
Plasma potassium = 1.3
Chloride = 117
Bicarbonate = 10
Ca = 6.3
Arterial pH = 7.26
PCO 2
= 23
What effect would correction of acidosis
have on plasma K +
?
Would correction of Ca be part of
initial management . ?
8. Correction of acidosis will drive k +
into the cells
Further worsening hypokalemia.Acidosis is not sever
and can wait. Hypokalemia first.
Hypocalcaemia protects against hypokalemia
Thus treatment of hypokalemia should precede
Hypocalcaemia.
Correction of hypokalemia may precipitate
Tetany , this is a less serious than hypokalemia.
What effect would correction of acidosis
have on plasma K +
?
Would correction of Ca be part of
initial management ?
9. 1. Anions - Negatively charged ions, such as chloride .
2. Cations - Positively charged ions as sodium .
3. Colloid/Colloid solution - Liquid containing
suspended substances that do not settle out of the
liquid/solution
4. Crystalloid - a substance that in solution can pass
through a semi permeable membrane and be
crystallized.
5. Electrolytes - cations or anions which have the ability
to conduct electrical current in solutions.
10. Age
TBW as % of
body weight
ECF as % of
body weight
ICF as % body
weight
Premature 75-80
Newborn 70-75 50 35
1 Year Old 65 25 40-45
Adolescent
Male
60 20 40-45
Adolescent
Female
55 18 40
11. MAINTENANCE REQUIRMENT……
Up to 10 Kg 100 ml/Kg
10 to 20 Kg 1000 ml + 50 ml / Kg above 10.
20 Kg onwards 1500 ml + 25 ml / Kg above 20.
3 mEq Na and K per 100 ml of water
12. Usually estimated from body weight
insensible water loss averages 50 ml per 100
kcal consumed. Provision of 50 ml of water
per 100 kcal consumed allows the excretion
of isotonic urine. Thus, 100 ml of water is
required for each 100 kcal consumed.
Empirically, 1-3 mEq Na+ and K+ are
required for each 100 kcal . Five percent
dextrose is necessary to prevent protein and
lipid catabolism. Maintenance requirements
are best replaced with [5% dextrose, 0.2%
NaCl + 20 mEq KCl/liter].
Maintenance requirements
18. I .C .F B
L
O
O
D
K = 140
Osm = 280
Na = 140
Osm = 280
I .C .F In.
S
F
K = 140
Osm = 280
Na = 140
Osm = 280
B
L
O
O
D
In.
S
F
E.C.F. E.C.F.I.C.F. I.C.F.
DEHYDRATION
19. I S O HYPERHYPO
120 140 160
240 280 320
W W
ICF ICF
ICF
20. Isonatremic dehydration….
Correction over 24 hours…
20 Kg child
10 % Dehy.
Na = 140
Maintenance Replacement Total
½ N.S.X X
2000 ml
10 % of 20 Kg
1500 ml 3500 ml
5 % dext.
H20
Na
3 mEq / 100 ml.
15 3 = 45
10 20 = 200 mEq
245 mEq / 3.5 Lt.Loss =
10mEq / Kg
21. Hyponatremic dehydration….
Slow correction , over 48 hours…
Not more than 10 mEq in 24 hours
20Kg child
10 % Dehy.
Na = 110
Maintenance Replacement Total
( As 5 % dextrose )
1 / 2 N.S.
XNa
3 mEq / 100 ml.
30 3 = 90
140-110 ½ wt.X
300 mEq
390 / 5 Lit.
2000 ml
10 % of 20 Kg1500 2
3000ml
5000 mlXH2O
22. HYPONATRMIC
EMERGENCIES
3% hyper tonic saline
5 ml/kg over 1 hour with the goal
sodium level of 125meq/ L , then correct
sodium further by calculating deficit
23. Maintenance Replacement Total
1/4 N.S.
Hypertonic dehydration….
Slow correction , over 48 hours
Not more than 10 mEq in 24 hours
20 Kg child
10 % Dehy.
Na = 165
400 m.l. of N.S.
= 61 mEq
Free water deficit = ( 4 X wt inKg ) X ( Serum Na – 145)
1500 2
3000ml
3 mEq / 100 ml.
30 3 = 90X
X Deficit = 2000
F.W.D. = 1600
Reminder as N.S.
5000 ml
151 mEq / 5 lit.
H20
Na
26. D 5 % with ½ Normal Saline = 77 mEq Na /
Lit.
Add 150ml of 3 % Normal Saline to a Liter of 5
% Dextrose
D 5 % with ¼ Normal Saline = 34 mEq Na /
Lit.
Add 70 ml of 3 % Normal Saline to a Liter of 5
% Dextrose
27. Isonatremic dehydration is best replaced with
5% dextrose, ½ NaCl + 20 mEq KCl/L over
24 hours. ( Deduct bolus therapy )
Hyponatremic dehydration is best replaced
with 5% dextrose ½ NaCl + 20 mEq KCl/L
over 48 hours. ( Deduct bolus therapy )
Hypernatremic dehydration is best replaced
with 5% dextrose with ¼ NaCl + 20 mEq
KCl/L over 48 hours. ( Deduct bolus therapy )
28. Fallacies of body fluid calculations
Lean body mass calculations
Variation in body secretion
Variation in renal handling
Effect of body temperature
Isohydric effect
Variation in surface area
29. HYPERNATREMIA IN ICU Urine output
Low High
Urine osmolality Urine osmolality
Low HighHigh
Hypo tonic fluid
loss
Insensible loss
G I Loss
Diuretics
D. Insipidus
Osmotic
diuresis
Central
Nephrogenic
36. Calcium chloride: 0.2 mL /kg/dose of 10% sol IV over 5
min; not to exceed 5 mL (stop infusion if bradycardia
develops)
Calcium gluconate: 100 mg/kg (1 mL/kg) of 10% sol IV over
5 min; not to exceed 10 mL (stop infusion if bradycardia
develops)
Soda bi carb …
2 ml / kg 25 % dextrose with .1 units /kg insulin .
over 30 minutes (1 U regular insulin/5 g glucose )
Beta agonists
Hyperkalemia
39. I . V . Kesol should be considered for
Significant arrhythmia
Sever muscle weakness
Severe hypokalemia (< 2.5.0 mEq. / L).
Digoxin toxicity
Hepatic encephalopathy
Maximum concentrations of KCl used in
peripheral veins generally should not exceed 4
meq. /100 cc, due to the damaging effects on
the veins , at a rate of 1 mEq/kg per hour.
40. Potassium should be administered slowly,
preferably Orally, at a dosage of 4 to 6
mEq/kg per day.
42. Hypotonic Hyponatremia (Na < 135 meq. /L)
Hypovolemia Euvolemia Hypervolemia
Urinary
sodium
More than 20
Urinary loss
Less than 20
G I Loss
Diuretics
SIADH
Adrenal
Drugs
HypoTH
More than 20
C.C.F.
Hepatic F.
Less than 20
Renal disease
Urinary
sodium
43. SIADH………………
Definition: AVP excess associated with hyponatremia
without edema or hypovolemia. The AVP excess is
inappropriate in the face of hypoosmolality.
Clinical manifestations are those of water
intoxication and depend on rate more than
magnitude of development of hyponatremia.
Commonest cause of euvolemic hyponatremia
44. HYPONATREMIA HYPO OSMOLAR
U. OSM. HIGHER THAN SERUM
CONTINUED URINARY Na LOSS
NORMAL RENAL FUNCTION & B.P.
NO OEDEMA
NO ENDOCRINE DISORDER
RESPONSE TO WATER REST.
SIADH………………