PPI Triple Treatment: 3 drugs, 10-14 days PPI BID + clarithromycin 500 mg BID and amoxicillin 1000 mg BID or metronidazole 500 mg BID Bismuth-based treatment: 4 drugs, 14 days PPI BID+ metronidazole 250 mg TID and tetracycline 500 mg four times a day and bismuth 2 tabs four times a day Salvage Therapy: levofloxacin-based treatment for 10 […]
Guideline Materials and Tips
Liver Disease
Child-Pugh Scores for Cirrhosis Variable 1 Point 2 Points 2 Points encephalopathy absent mild-moderate severe to coma ascites absent slight moderate bilirubin <2 2-3 >3 albumin >3.5 2.8-3.5 <2.8 prothrombin time 1-4 4-6 >6 Class A = 5 points, class B=7-9 points, class C=10 or more points Ascites: Reduce dietary sodium, restrict fluid to 1.5 […]
Hepatitis
Hepatitis A – viral – spread person to person via feces. Pre-exposure prophylaxis Vaccines are available. Children are routinely vaccinated between their first and second birthdays. People who should consider vaccine – are traveling to countries where hepatitis A is common, are a man who has sex with other men use illegal drugs, have a […]
Spontaneous Bacterial Peritonitis
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 […]