Acid (Base) Trip
Formula used for calculating unmeasured anions in blood
Anion Gap- Na-(Cl+HCO3) </= 12
Rare finding in Graves' Disease charecterized by bilateral, elevated form nodules and plaques with yellow waxy skin on anterior aspect of distal LE
Pretibial Myedema (due to accumulation of polysaccharides)
Hyperparathyroidism, Addison's disease, MM, Paget's disease, Sarcoidosis, Cancer, Hyperthyroidism, Milk-alkali syndrome, Immobilization, D Vitamin, Thiazide Diuretics (PAM P SCHMIDT)
Low phosphate, magnesium, potassium and thiamine in setting of rapid nutrition reintroduction in patient with severe malnutrition
Refeeding Syndrome
3 Causes of persistent hypoglycemia
Insulinoma, medications/drugs/alcohol, neoplasm, hepatic disease, deficiency of counter regulatory hormones, critically ill, hypothermia, dumping syndrome
MUDPILES
Methanol, uremia, DKA, AKA, starvation ketosis, phenformin, paraldehyde, iron/INH, lactic acidosis, ethylene glycol, salicylates
Thyroid stimulating immunoglobulins mimic action of TSH
Graves' Disease
Treatment of Hypercalcemia
IV NS, 2-4L, Loop diuretics, Bisphosphonates, less of ten Calcitonin and Steroids
Treatment of choice in alcoholic with ataxia, confusion and ophthalmoplegia
Inhibits insulin secretion in setting of hypoglycemia
Octreotide
HARD-UP
Non anion gap met. acidosis- Hyperaldosteronism, acetazolamide, rental tubular acidosis, diarrhea, ureterosigmoidostomy, pancreatic fistula (cause loss of both bicarb AND Na)
Antipyretic that should NOT be given in setting of thyroid storm
Salicylates/ASA- decreases protein binding and subsequently increases free T3 and T4
Patient presents s/p thyroidectomy, paresthesia's in fingers and generalized weakness likely has these two electrolyte problems
Hypocalcemia, hyperphosphatemia
3 Symptoms of Korsakoff Syndrome
Amnesia, confabulation, impaired cognition
IV Dextrose dosing for a) neonates b)infants-8 years c) Child 8 > years
A) 5 ml/kg of D10
B) 2 ml/Kg of D25
C) 1 ml/kg D50
Formula to calculate "unmeasured low molecular weight solutes" in the blood
Osmolal Gap- 2Na+ Glu/18+ BUN/2.8 + EtOH/4.6. Primary determinants of Serum Osm Na, Cl, glucose, BUN (normal is 280-295)
Lab findings in hypothyroidism
Low T4, elevated TSH (usually), hyperlipidemia, hyponatremia, anemia
Parathyroid hormones regulates these three processes to increases total serum Ca+++
osteockast stimulation (bone resorption), renal resorption, GI absorption
Patient currently being treated for TB presents with hyperpigmented skin, scaling of skin and blisters on arms, chelosis and glossitis, feelings of depression and confusion
Vitamin B6/Niacin Deficiency
Chronic alcoholics/ liver disease/ infants with low liver glycogen stores
hypoalbumenia (less measured anions),MM, hyperCa, HyperMg, lithium tox, Bromide intoxication
Elderly patient with slowed mentation, lethargy, droopy eyelids, new onset a fib in RvR not responding to usual treatment
Apathetic Thyrotoxicosis
Kidney
Treatment for an alcoholic that presents with abdominal pain, nausea, dry MM, confusion + glucose 240 + high AG
Glucose + saline (D5NS), thiamine, K+ repletion alcoholic ketoacidosis)
Hypokalemia, hypophosphatemia, sodium overload, cerebral edema in children, decreased Ox-hgb dissociation (curves shifts to the left), paradoxical CSF acidosis