What Causes SBP Gram-Negative Bacteria (50%) E.coli (37%) Klebsiella other Gram-Positive Bacteria (50%) Strep pneumonia (10%) Other Strep Staphylococcus aureus Treatment of SBP SPB has a high mortality rate. Start treatment immediately. If ascitic fluid polymorphonuclear cell count is greater than 250, start antibiotics. (PMN= total number of white cells * % of neutrophils) Poorer prognosis if […]
Pancreatitis and Irritable Bowel Syndrome
Pancreatitis: The early stage has a systemic inflammatory response (SIRS) or organ damage. Late associated with local complications. Signs: Abdominal pain, nausea and vomiting, jaundice, fever Local complications: necrosis, hemorrhage, pseudocyst, abscess, infection Systemic complications: SIRs, acute respiratory distress, shock, organ failure Causes: Alcohol, gallstones, drugs (azathioprine, adenosine, diuretics, estrogens, exenatide, mesalamine, pentamidine, sitagliptin, tetracycline, […]
Fluids
IV Fluid Infused Volume Intervascular Volume Expansion Fluid Type Normal Saline* 1000 ml 250 ml crystalloid Lactated Ringers 1000 ml 250 ml crystalloid Normosol and Plasmalyte 1000 ml 250 ml crystalloid D5W 1000 ml 100 ml crystalloid Albumin 5% 500 ml 500 ml colloid Albumin 25% 100 ml 500 ml colloid Hydroxyethyl Starch 500 ml […]
Disorders of Sodium
Normal Sodium=136-145 Rapid changes in sodium can be life-threatening (demyelination seizures). Correct no more than 10-20 mEq in 24 hours. Hypernatremia: Determine fluid status and correct. If acute (occuring over 1-3 days), lower 1-2 mEq/L/h over 24 hours. If not acute, correct 0.5 mEq/L/hr over 48 hours. Hypernatremia: 3 % sodium: 100 cc bolus then […]
Disorders of Potassium
Potassium normal: 3.5-5.5 Hypokalemia: Mild: 3.0-3.5, moderate: 2.5-3.0, severe=<2.5 Common causes: thiazide and loop diuretics, kidney injury, GI loss, sweating, burns, Beta blockers, insulin, sodium bicarbonate Every 0.3 mEq decrease is a 100 mEq deficit Symptoms start at < 3.0 Correct Mg too. It’s used in potassium transport. Seen in EKG as U waves. Hyperkalemia: […]
Disorders of Calcium
Increased calcium is often caused by malignancy. Calcium regulation is carried by PTH (increases serum calcium, decreases serum phosphate, increases bone resorption) , calcitonin (decreases calcium, decreases bone resorption) and active vitamin D (increases calcium and phosphate, increases bone resorption). Increases bone resorption = pulls calcium out of the bone, into the blood. Hyperparathyroid conditions affect calcium levels […]
Disorders of Magnesium
Hypomagnesemia: Normal magnesium is 1.7-2.3 mg/dl. Usually associated with ulcerative colitis, diarrhea, pancreatitis, laxative abuse, inadequate intake, alcohol use, diuretic use, often occurs concurrently with hypocalcemia and hypokalemia. Symptoms include tetany, twitching, seizures, arrhythmias, hypertension, and sudden cardiac death. Treatment: Oral supplements Symptomatic patients treated with 1-4 mg by IV infusion (1 g/hour to avoid hypotension and […]
Disorders of Phosphate
Hypophosphatemia: Normal phosphate: 2.5-4.5 mg/dl Usually caused by diuretics, glucocorticoids, sodium bicardbonate, rapidly refeeding patients, respiratory alkalosis, treatment of diabetic ketoacidosis (phosphate shifts into intracellular space) Symptoms: hypoxia, confusion, delirium, seizures, coma, respiratory failure, difficulty breathing, heart failure, arrhythmias Treatment: Supplement IV fluid with 10-30 mmol/L of phosphate in patients at risk. Oral products (K-Phos) can […]
TPN: Total Parenteral Nutrition
They aren’t going to ask you to make a TPN, but here’s some of the most basic info. TPN Makeup Glucose should be 30-70% Fat should be 15-30% Protein: 1g/kg/day + stress (up to 2) Electrolytes I remember 50% glucose, 20% fat and 1g/kg of protein. Caloric requirements: The dirty way to calculate caloric needs: 30 […]
Basic Anemia
Macrocytic anemia: usually due to B12 and/or folic acid deficiency (increased MCV and MCH) Microcytic anemia: usually due to decreased iron Normocytic anemia: usually due to bleeding or chronic disease Normal MCV = 80-100 Normal MCH = 27-31