K, Ca, Mg, PO4 - quick and dirty guide

Via teaching session by Laura!

Munchausen's and Facitious disorders

Hi all. We had a case on Munchausen's syndrome. Here is an overview of factitious disorders. As we've experienced it is challenging to treat.

https://my.clevelandclinic.org/health/diseases_conditions/hic_An_Overview_of_Factitious_Disorders

All about gout

Gout - crystalline arthropathy. 
2 main types to know about:
1. Uric acid gout - looks like needles on micro, negatively birefringent crystals
2. CPPD - rhomboid crystals, positively birefringent

Risk Factors:

• High purine diet (e.g. red meats)
• Alcohol
• Dehydration
• Diuretics
• Male sex
• Age
• Post-menopause (pre-menopausal gout is rare - estrogen is protective)

Acute Tx:

• NSAIDs: 50 mg indomethacin bid OR Naproxen 500 mg bid
• Colchicine: Interesting drug, inhibits microtubules? no role for it in non-acute gout, also used in pericarditis. Tx for gout is 0.6 mg po bid
• Prednisone 15-20 mg po daily

The above is for 5 days to 2 weeks
Good to know: Renal dosing of acute gout meds is tough. Prednisone is ok to give in renal impairment.

Chronic Tx: Aim is to reduce uric acid level

• Allopurinol: Xa oxidase inhibitor. Don't start until flare is settled. If person has non-gout symptoms related to high uric acid, like kidney stones or uric acid deposits (tophi), there is a role for allopurinol 
• Good to know: high incidence of hypersensitivity reactions to allopurinol. If this fails, try febuxistat (but not covered by ODB)

SGLT 2 Inhibitors

Today at grand rounds we learned about SGLT 2 inhibitors.

Remember that their mechanism of action is renal glucose excretion. They come with a risk of euglycemic diabetic ketoacidosis.

SADMANS - hold these drugs in acute illness!

Sulfonylureas

ACE inhibitor

Diuretics 

Metformin

ARB

NSAIDS

SGLT2 inhibitors

Remember the website guidelines.diabetes.ca. Here is the link for the 2015 guideline updates: http://guidelines.diabetes.ca/Browse/Chapter13_2015

Localizing strokes

Localizing strokes using clinical symptoms is an important skill. This article from the Cleveland clinic is readable and quite quick to get through. It's a great overview!

CLEVELAND CLINC: Localizing Strokes

Hyperkalemia

In morning report, we talked about an approach to managing hyperkalemia.

To refresh your memory, here is a youtube video that goes over the treatment approach.

This is a nice link to show some of the ECG changes.

Finally, here is a link to the Merck Manual for hyperkalema:

Hyperkalemia overview

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