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Evaluation:  verify with repeat measurement that there is a true decrease in the serum calcium concentration (total serum calcium corrected for albumin or ionized calcium)  Note alkalosis augments calcium binding to albumin and increases severity of symptoms...

Evaluation:  verify with repeat measurement that there is a true increase in the serum calcium concentration (total calcium corrected for albumin or ionized calcium)  Compare with previous values if available Clinical evaluation, including duration of hyper...

Evaluation:  Serum phosphorus levels should be interpreted with concomitant evaluations of PTH, serum total and ionized calcium, urine phosphate and calcium and Vitamin D Medical history, physical examination and lab tests to determine etiology of hypophosph...

Definition Serum Phosphate >4.5mg/dL. Etiology/Risk Factors Increased intake (external/internal): Excessive vitamin D (increases GI absorption of PO4) or vitamin A. Phosphate-containing enema, particularly in patients with kidney insufficiency. P...

Before You Begin: Gather Data What lab tests do you need? ABG vs. VBG VBG can provide reliable estimation for pH (0.02-0.04 lower than ABG) and HCO3 (1-2 mEq higher than ABG). pCO2 on VBG is higher than arterial PaO2 by 4-9mmHg. ABG is necessary to accura...

Definition Renal tubular acidosis refers to an impaired acid-base metabolism by the kidney in the setting of normal glomerular filtration. These conditions are characterized by a non-elevated anion gap (hyperchloremic) metabolic acidosis. Kidney disease must...

Admit to Telemetry Tele-nurse may reach out to you for > 6 PVCs/min, atrial fibrillation, ventricular fibrillation, > 3 beats of VT. Admit as “observation status” if the patient will likely be discharged within 24 hours. Activity Bed rest until rul...

Definition A condition in which the heart is not able to pump enough blood to meet the body’s metabolic needs or does so in the face of elevated filling pressure due to abnormalities of ejection or abnormalities of filling. Classification In patients presen...

  Overview Diagnosis requires 2 major, 1 major with 3 minor, or 5 minor criteria from the modified Duke Criteria listed below: MAJOR CLINICAL CRITERIA: Persistently positive blood cultures with typical IE organisms. Bacteremia is continuous and high grade....

Rates Normal: 60-100 bpm Tachycardia: > 100 bpm Bradycardia: < 60 bpm Readings Count the number of large squares present within one R-R interval. Divide 300 by this number to calculate heart rate. OR Count the number of complexes on the rhythm strip ...

Syncope Rapid onset of transient loss of consciousness Inability to maintain postural tone It may be associated with a fall Resolves spontaneously and quickly without intervention Presyncope (Near-Syncope) Weakness, Dizziness, lightheadedness, or "grayin...

  Diagnosis DKA vs HHS:  DKA sugar ranges from 250 to 500 mg/dL HHS typically has sugars > 600 mg/dL Serum osmolality > 320 in HHS Neurologic symptoms such as stupor and coma are primarily seen in HHS, but can sometimes be seen in severe DKA. Little to ...

Definitions Type 1 DM: autoimmune. Patients require exogenous insulin to prevent DKA. Type 2 DM: insulin resistance and a relative insulin deficiency. Treatment may be with diet, exercise, oral meds, injectable meds, and/or insulin. With severe insulin d...

Etiology The site of bleeding is only suggested by the patient’s presentation and physical examination. Stool can turn black (melena) with as little as 50-100 cc of upper GI bleeding Pre-endoscopic clinical risk stratification Clinical judgment always come...

Definition Accumulation of peritoneal fluid Symptoms Abdominal Distention and discomfort Anorexia Nausea Early satiety Heartburn (Gastroesophageal Reflux) Flank Pain Respiratory distress Signs Umbilicus may evert Bulging flanks with the patient lyi...

Definition SBP is a bacterial infection of the ascitic fluid. Diagnosis: PMN count >= 250 cells/mm3 OR ascitic fluid WBC >= 500 cells/mm3 with a positive fluid culture. Diagnostic clinical signs: New onset fever, confusion or abdominal pain, hepatic enceph...

Definition indicates inflammation of the pancreas. Acute pancreatitis: results from the leakage of pancreatic enzymes into pancreatic tissue, leading to autodigestion. Chronic pancreatitis: causes are varied and lead to destruction of the pancreatic tissue....

 3 Histological Stages Simple steatosis (usually reversible w/ abstinence in 4-6 wks) Steatohepatitis (steatosis + neutrophil infiltration + Mallory-Denk bodies) Steato-fibrosis (extreme is cirrhosis) MELD SCORE [calculate with mdcalc] Model for End-Stage...

Nausea Nausea is the unpleasant sensation of about to vomit.  This can occur alone or with vomiting.  Many differentials are associated with nausea depending on patient's symptoms.   Always check patients electrolytes if they have been having severe vomiting...

Check if patient has Bowel Obstruction before giving anything PO Stool Softeners - Colace 100-250mg po qd or bid  Osmotic Laxatives   MiraLAX 17gm daily Lactulose 30ml q4hr until bowel movement Milk of Magnesia 30ml to 60ml qd Suppository - Dulcolax 10mg...