Guess what!

Posted 17 December, 2009 - 02:10 by steve

Guess what first! I will tell you the story later.

Lactate 17.66 mmol/l [0.65 2.45]

Alkaline Phosphatase 150 IU/L [30 115 ]
Albumin 32 g/l [35 50]
Calcium 2.55 mmol/l [2.20 2.60]
Phosphate 3.56 mmol/l [0.80 1.45]
Corrected Calcium 2.77 mmol/l [2.20 2.60 ]
Total Protein 75 g/l [64 83]
Globulin 44 g/l [21 39]

C-Reactive Protein <10.0 mg/l [0 10.0]

TROPONIN I (Random) 0.04 ug/l [0 0.08]

Sodium 136 mmol/l [135 145]
Potassium 4.8 mmol/l [3.5- 5.0]
Chloride 100 mmol/l [98 107]
Urea 7.5 mmol/l [2.5 7]
Creatinine 155 umol/l [70 120]

ABG
pH 6.78 [7.35 -7.45]
pCO2 13.2 kPa [4.7- 6.0]
pO2 10.7 kPa [11 -14.5]
Base Excess -22.0 mmol/l [-3.0 3]
Hb Fract Sat 78.9 %
Hb Oxygen Sat 79.8 % [91.9 98.5]

Magnesium replacement

Posted 10 December, 2009 - 16:31 by steve

This regimen is what we use at work. I don't take any responsibility if something went wrong. It is only clinical judgement and local protocol.

For rapid replacement (ICU setting) , 5g of Mg in 250 ml of 0.9% NaCl in 2 hours (Cardiac monitor/Telemetry required)

For slow infusion (ward), 3 gm in 0.9% NaCl 250 ml in 6 hours.

 

 

Related article1

Related article2

 

Cause of weight loss

Posted 9 December, 2009 - 12:49 by steve

A 74 year old man was admitted with weight loss, nausea and vomiting, Rt hip pain.

Back ground history showed

  1. Recent multiple chest infections
  2. Under investigation for weight loss (18 kig in last 3 months)
  3. COPD on Inhalers for many years
  4. MI 1999
  5. planned for total hip replacement by ortho.

Social history:

  1. Retired factory worker (denied asbesto exposure)
  2. lives alone
  3. mobilizes with stick, limited by osteoarthritic hip pain
  4. Ex smokers (stopped 16 years ago, 25 pack years)
  5. Nil alcohol drink

 

On examination, he lookeed comfortable, but frail and very thin. abdomen.

CVS, Resp, abdo and neurological exams were nil significant.

No leg oedema.

Recent OGD and Colonoscopy showed NAD

FBC and U&E normal

CA 199 and CA 125 borderline high

T4 (15.5)normal and TSH (0.18) slightly low.

Gouty arthritis to Care pathway

Posted 7 December, 2009 - 19:18 by steve

This 79 yr old man admitted with feeling unwell and knee pains.A&E saw and got orthopedic doctor to have a look, suggesting that less likey septic arthritis. But joint aspiration done and awaiting MC&S.

Referred to medics. ( It was me)

Background history showed

  • COPD on LTOT under respiratory physician
  • CKD stage 4,
  • LVF under cardiologist
  • Gout

We got rhuematologist to see him.Hight Uric acid on repeat blood test. Colchisine started. Paracetamol and Codeine were regular analgesics.

Pain settling in next a couple of days. Joint aspiration came back as negative culture. we start Phyiso and Occupational input for discharge.

But during the last weekend, he got a sudden onset abdo pain and vomiting. I was asked to see.

Family was around. He looked miserable. Holding sick bowl in which foul smelling fluid.

Amphetamine overdose

Posted 6 December, 2009 - 11:49 by steve

This young chap in his early 20s came in with Amphetamine overdose. He also took unknown excess amount of C-codymol tablets.

He looked anxious. CK came back as 44,567.

We did supportive measures , including hydration.

Repeat blood next day showed CK 16,880. Phosphate low.

I will add updates

 

Quinolones and Epilepsy

Posted 6 December, 2009 - 11:42 by steve

Not particularly drug interaction, Quinolones reduce the seizure threaddshold. we came acoss pateints presenting with fit after Ciprofloxacin was started.

It is also reported that quinolones associated with tendon rupture. especially Archille's

 

Choking

Posted 2 September, 2009 - 14:34 by steve

It was 11:45 PM. I was called some one had been chesty and vomiting.

I arrived at 11.50 PM. At first glace, I thought she was lying on her left side and sleeping. But when I tried to wake her up, no response at all. The nurse was around.

I asked her if she is for resus. Answer was yes. The crush team arrived by mid night.

I ran through the note. 78f admitted with symptomatic anaemia, still under investigation. Past medical history shows hypothyroid and hypertenstion only.

Blood 2 units was given previously. No previously episodes of vomiting.

Only on that night, she was not well with chesty and vomiting.

We commenced CPR. It was PEA. ECG monitor showed VT. We followed Resus guide lines while establishing IV access and taking blood gas, U&E, FBC. BM was 7.

After 6 minutes, rhythm changed to VF which was shokable. After 3x shocks, rehythm changed to VT again.

We considered reversible causes 4H and 4T.

Courses

Posted 16 July, 2009 - 08:59 by steve

We are taking courses whenever we have a chance as a part of continuing medical education. At the same time, we need to feed our hobby, exploring and practising medicine.

You may already know this website.

http://www.mkupdate.co.uk/courses.php

There are loads of other websites for cousrsesIf you are interested, you may book in advance. 

 

 

 

Trop 1.5 in 2 hour time

Posted 3 June, 2009 - 16:08 by steve

Not exciting, but interesting to me

During last weekend oncall, 47M came in with 10 hr history of chest pain. Central chest pain, 8/10. radiated to lt shoulder.

PMHx: Nil significant, No DM, No HTN

FHx: 3 brother died of MI at the age of 47, 49, 52. Sister had heart attack, but she survived

SHx: never smoke, occasioanal drinker

Cholesterol: DK

O/e Still on pain 3-4/10 on GTN as A&E started

CVS: NAD

Resp: NAD

Abd: NAD

Legs: NAD

ECG: T flat in lateral leads, otherwise normal

CXR: NAD

Trop I on Adm (10hr) 0.05

Interestingly 12 hr Trop I came back as 1.5.

So he is for CCU and to continue with ACS protocol. He needs agniography / and angioplasty

 

2 Questions in my mind

1. Why Troponin I soared from 0.05 to 1.5 in 2 hr time, instead of gradually rose?

2. What would be the genetic association of the patient's condition?

Efalizumab Withdrawn From US Market

Posted 28 May, 2009 - 09:13 by steve

Efalizuman is a recombinant humanized monoclonal antibody that binds to CD11a. Because of its side effect, it is to be withdrawn from market in the USA. 

April 9, 2009 — Efalizumab (Raptiva, Genentech, Inc) is undergoing a voluntary, phased withdrawal in US markets because of a potential risk to patients of developing progressive multifocal leukoencephalopathy (PML). Source

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