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Hypernatremia (causes)
6 D's: diuresis, dehydration, diabetes insipidus, docs (iatrogenic), diarrhea, disease (kidney/sickle)
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Hyperkalemia
- K>5
- Causes: renal insuff, spironolactone, triamterene, ACEi, trimethoprim, NSAIDs, hypoaldo, type IV RTA, tumor lysis, cell death
- peaked T->wide QRS->PR prolongation->loss of P->sine wave->Vfib
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Duke criteria
- Endocarditis = 5
- major (2.5ea) - echo, new regurg murmur, 2 +culture endocarditis-causing organism
- minor (1ea) - embolic phenom, fever, osler node(SC nodule -immuno), <full echo criteria, culture for other org, predisposition
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Hyperkalemia tx
- calcium (stabilize membranes)
- kayexelate (sodium polystyrene sulfonate - not w/sorbitol!)
- bicarb/IVF
- insulin/D5
- B2 agonist (albuterol)
- loop/thiazide diuretics
- dialysis
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Effusion v. transduate (Light's criteria)
- exudate
- LDH eff/serum > 0.6
- protein eff/serum > 0.5
- serum-effusion alb gradient >1.2, chol eff>45, LDH eff >200
- complicated: glucose < 60, +gm stain, pH<7.2
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Wells
- 3 - PE likelier than other dx or s/s DVT
- 1.5 - tachy or prior PE/DVT
- 1.5 - immob >3d or surgery 4wks
- 1 - hemoptysis or malignancy
- <2 low, 2-6 intermediate, >6 high probability
- >4 "likely" -> justifies CTA
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transudate and exudate causes
- transudate - low oncotic, incr hydrostatic
- - CHF, constrictive pericarditis, cirrhosis, nephrotic, myxedema, PE
- exudate - cap perm
- - infection, malignancy, PE, collagen vascular dz, chylothorax, hemothorax,
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Charcot's triad
ascending cholangitis: fever, jaundice, RUQ pain
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Reynolds pentad
Charcot's (fever, RUQ pain, jaundice) + shock + AMS = obstructive ascending cholangitis
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conjugated/direct hyperbili
>1 when tbili <5, if tbili above 5, >20%
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