Potassium is the principal cation of the intracellular fl uid
(ICF) where its concentration is between 120 and 150 mEq/L.
The extracellular fl uid (ECF) and plasma potassium concentration [K] is much lower––in the 3.5–5.0 mEq/L range.
The very large transcellular gradient is maintained by active
K transport via the Na-K-ATPase pumps present in all cell
membranes and the ionic permeability characteristics of
these membranes. The resulting greater than 40-fold transmembrane [K] gradient is the principal determinant of the
transcellular resting potential gradient, about 90 mV with
the cell interior negative . Normal cell function
requires maintenance of the ECF [K] within a relatively narrow
range. This is particularly important for excitable cells
such as myocytes and neurons. The pathophysiologic effects
of dyskalemia on these cells result in most of the clinical
manifestations.
Potassium is the principal cation of the intracellular fl uid
(ICF) where its concentration is between 120 and 150 mEq/L.
The extracellular fl uid (ECF) and plasma potassium concentration [K] is much lower––in the 3.5–5.0 mEq/L range.
The very large transcellular gradient is maintained by active
K transport via the Na-K-ATPase pumps present in all cell
membranes and the ionic permeability characteristics of
these membranes. The resulting greater than 40-fold transmembrane [K] gradient is the principal determinant of the
transcellular resting potential gradient, about 90 mV with
the cell interior negative . Normal cell function
requires maintenance of the ECF [K] within a relatively narrow
range. This is particularly important for excitable cells
such as myocytes and neurons. The pathophysiologic effects
of dyskalemia on these cells result in most of the clinical
manifestations.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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
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
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
3. PHYSIOLOGY
Potassium is a major intracellular cation
Total body K+ content in a normal adult -3000-
4000mEq
98% Intracellular , 2% in ECF
Normal homeostatic mechanisms maintain the
serum K level within a narrow range (3.5-5.0
mEq/L).
4. The primary mechanisms maintaining this balance
are the buffering of ECF potassium against a large
ICF potassium pool (via the Na-K pump)
Na-K ATPase pump actively transports Na+ out of
the cell and K+ into the cell in a 3:2 ratio
Renal excretion – Major route of excess K+
elimination
Approx 90% of K+ excretion occurs in the urine,
less than 10% excreted through sweat or stool.
5. Within the kidneys, K+ excretion occurs mostly in
the principal cells of the cortical collecting duct
(CCD).
Urinary K+ excretion depends on :
1. luminal Na+ delivery to the DCT and the CCD,
2.effect of Aldosterone and other adrenal
corticosteroids with mineralocorticoid activity.
6.
7.
8. HYPERKALEMIA
Defined as a plasma potassium level of >5.5
mEq/L
Causes of Hyperkalemia
I. Pseudohyperkalemia
Artifactual increase in K+- Venepuncture, clenching
Cellular efflux; thrombocytosis, erythrocytosis,
leukocytosis,
in vitro hemolysis
Hereditary defects in red cell membrane
9. II. Intra- to extracellular shift
Acidosis – Uptake of H+, efflux of K+
NAGMA
Hyperosmolality; hypertonic dextrose, mannitol,
- Solvent Drag effect
β2-Adrenergic antagonists (noncardioselective
agents)
Suppresses catecholamine stimulated renin release- in turn
aldosterone synthesis
Digoxin and related glycosides (yellow oleander,
10. Hyperkalemic periodic paralysis- Episodic attack of
muscle weakness asso with Hyper k+. Na Muscle
channelopathy
Lysine, arginine, and ε-aminocaproic acid
(structurally similar, positively charged)
Succinylcholine; depolarises Muscle cells, Efflux
of K+ through AChRs . Contraindicated in thermal
trauma, neuromuscular injury, disuse atrophy, mucositis, or
prolonged immobilization- upregulated AChRs
Rapid tumor lysis / Rhabdomyolysis
11. III. Inadequate excretion
A. Inhibition of the renin-angiotensin-
aldosterone axis;
(↑ risk of hyperkalemia when these drugs are
used in combination)
Angiotensin-converting enzyme (ACE) inhibitors
Renin inhibitors; aliskiren
(in combination with ACE inhibitors or angiotensin
receptor blockers [ARBs])
12. Angiotensin receptor blockers (ARBs)
Blockade of the mineralocorticoid receptor:
- spironolactone, eplerenone,
Blockade of the epithelial sodium channel
(ENaC): amiloride, triamterene, trimethoprim,
pentamidine, nafamostat
B. Decreased distal delivery
Congestive heart failure
Volume depletion
14. Chronic kidney disease, advanced age
Pseudohypoaldosteronism type II: defects in
WNK1 or WNK4 kinases, Kelch-like 3 (KLHL3), or
Cullin 3 (CUL3)
In The above said conditions –most Pt will be
volume expanded- secondary increse in circulating
ANP that inhibit both Renal renin release and
adrenal aldosterone release
15. D. Renal resistance to mineralocorticoid
Tubulointerstitial diseases:
SLE, amyloidosis, sickle cell anemia, obstructive
uropathy, post–acute tubular necrosis
Hereditary:
pseudohypoaldosteronism type I; defects in the
mineralocorticoid receptor or the epithelial sodium
channel (ENaC)
E. Advanced renal insufficiency
Chronic kidney disease
End-stage renal disease
Acute oliguric kidney injury
18. Clinical Features
Most of Hyperkalemic individuals are asymptomatic.
If present - symptoms are nonspecific and
predominantly related to muscular or cardiac functions.
The most common - weakness and fatigue.
Occasionally, frank muscle paralysis or shortness of
breath.
Patients also may complain of palpitations or chest pain.
Arrythmias occur- Sinus Brady, Sinus arrest, VT, VF, Asystole
Patients may report nausea, vomiting, and paresthesias
19.
20.
21. ECG Changes
ECG findings generally correlate with the
potassium level,
Potentially life-threatening arrhythmias - occur
without warning at almost any level of
hyperkalemia.
In patients with organic heart disease and an
abnormal baseline ECG, bradycardia may be the
only new ECG abnormality.
22. K+ 5.5-6.5 mEq/L - Early changes include tall,
peaked T waves with a narrow base, best seen in
precordial leads;
shortened QT interval; and
ST-segment depression.
K+ level of 6.5-8.0 mEq/L,
in addition to peaked T waves,
Widening of the QRS
Prolonged PR interval
Decreased or disappearing P wave
Amplified R wave
24. K+ level higher than 8.0 mEq/L,
The ECG shows absence of P wave,
progressive QRS widening, and
intraventricular/fascicular/bundle-branch blocks.
The progressively widened QRS eventually merges
with the T wave, forming a sine wave pattern.
Ventricular fibrillation or asystole follows.
29. Tests In Evaluation of Hyperkalemia
RFT
Serum Electrolytes- including Mg, Ca
Urine potassium, sodium, and osmolality
Complete blood count (CBC)
Metabolic profile
ECG
30. Trans-tubular potassium gradient (TTKG)
TTKG is an index reflecting the conservation of
potassium in the cortical collecting ducts (CCD) of
the kidneys.
It is useful in diagnosing the causes of
hyperkalemia or hypokalemia.
TTKG estimates the ratio of potassium in the lumen
of the CCD to that in the peritubular capillaries.
TTKG= Urine K/ Serum K x serum Osm/Urine
osm
31.
32. TREATMENT
3 main approaches to the treatment of
hyperkalemia :
●Antagonizing the membrane effects of potassium
with calcium
●Driving extracellular potassium into the cells
●Removing excess potassium from the body
33. ECG manifestations of hyperkalemia- a medical
emergency and treated urgently.
Patients with significant hyperkalemia (K+≥6.5 mM) in
the absence of ECG changes should also be
aggressively managed
Immediate antagonism of the cardiac
effects of hyperkalemia
IV calcium serves to protect the heart,
recommended dose is 10 mL of 10% calcium
gluconate, infused intravenously over 2–3 min with
cardiac monitoring.
34. Rapid reduction in plasma K+
concentration by redistribution into cells.
Insulin lowers plasma K+ concentration by shifting
K+ into cells - GI Bolus
β2-agonists, most commonly albuterol, are
effective but underused agents for the acute
management of hyperkalemia.
– Salbutamol Nebulisations
35. Removal of potassium.
use of cation exchange resins, Diuretics, and/or
Hemodialysis.
Cation Exchange Resins
sodium polystyrene sulfonate (SPS) exchanges Na+ for
K+in the gastrointestinal tract and increases the fecal
excretion of K+
Dose of SPS is 15–30 g of powder, almost always
given in a premade suspension with 33% sorbitol.
The effect of SPS on plasma K+ concentration is slow;
the full effect may take up to 24 h and usually requires
repeated doses every 4–6 h.
36. Therapy with intravenous saline may be beneficial
in hypovolemic patients with oliguria and decreased
distal delivery of Na+, with the associated
reductions in renal K+ excretion.
Loop and Thiazide diuretics can be used to
reduce plasma K+ concentration in volume-replete
or hypervolemic patients with sufficient renal
function
usually combined with iv saline or isotonic
bicarbonate to achieve or maintain euvolemia
37. Sodium Bicarbonate may be given for the
treatment of significant metabolic acidosis .
Reversible causes of impaired renal function asso
with hyperkalemia.
Includes hypovolemia, NSAIDs, urinary tract
obstruction, and inhibitors of the renin-angiotensin-
aldosterone system (RAAS), which can also directly
cause hyperkalemia
RX- Removal of offending agent & Hydration
38. Hemodialysis is the most effective and reliable
method to reduce plasma K+ .
The amount of K+ removed during hemodialysis
depends on
The relative distribution of K+ between ICF and
ECF
The type and surface area of the dialyzer used,
dialysate and blood flow rates,
dialysate flow rate, dialysis duration, and the
plasma-to- dialysate K+ gradient.