Endocrine / Metabolic Archives - Page 3 of 4 - The Emergency Medical Minute

Endocrine / Metabolic

Podcast # 371: EKG changes of Hyperkalemia

Author:  Jared Scott, MD Educational Pearls: EKG changes do not necessarily correlate to degree of hyperkalemia Traditional progression through peaked T-waves, flattened p-waves, QRS widening, and then sine-waves before asystole References Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18:721–729.

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Podcast # 346: Pediatric DKA

Author: Chris Holmes, MD Educational Pearls: There is a risk of cerebral edema in pediatrics with DKA if over resuscitated. Recent study comparing normal saline vs. ½ normal saline showed no difference in rates of cerebral edema regardless of rate of infusion. Recommend sticking with a fluid resuscitation protocol you are familiar with (i.e., 2…

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Podcast #310: Bicarb in DKA

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology – acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete, but will have a falsely normal/elevated serum potassium. 3 risk of giving bicarb in DKA – alkalosis will drive potassium intracellularly but can overshoot (hypokalemia) and  increase risk of arrhythmias;…

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Podcast #292: Hypercalcemia

Author: John Winkler, M.D.  Educational Pearls Normally, the parathyroid is the master regulator of serum Ca levels. It secretes PTH, which stimulates calcium uptake from the bone and gut. Causes of hypercalcemia include: parathyroid tumor, lytic bone lesions (multiple myeloma), breast cancer, renal injury, and some lung cancers. Hypercalcemia can lead to poor bone quality…

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Podcast #290: The Biochemistry of DKA

Author: Dave Rosenberg, M.D. Educational Pearls DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time. In DKA, glucose cannot be taken into the cells. This signals the body to create and use acidic ketones for energy. This leads to acidosis. To compensate for increased acid, H…

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Podcast #186: IV Contrast

Run Time: 2 minutes Author: Aaron Lessen M.D. Educational Pearls: Regularly a patient’s creatinine level is an important factor in determining whether a patient will receive IV contrast with a CT because it is thought that contrast can harm the kidneys and could worsen underlying kidney disease. A recent retrospective study compared the rates of…

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Podcast #181: Electrolyte Emergency

Run Time: 5 minutes Author: Peter Bakes, MD Educational Pearls: Calcium is ubiquitous ion in the body necessary for bone, muscle, and nerve function Hypocalcemia is associated with tetany (elicit Chvostek’s sign and Trousseau’s sign) and irritability Hypocalcemia can progress to seizures and prolonged QT which can cause cardiac arrest Hypocalcemia can be caused by…

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Podcast #178: Lupus Myocarditis

Run Time:  3 minutes Author: Gretchen Hinson M.D. Educational Pearls: Case presentation: a 44 year-old male after a syncope was found to have a heart rate of 261 wide complex tachycardia and a SBP in the 80s for EMS in the field. The patient was given adenosine on arrival to the ED, but with no…

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Podcast #167: Adrenal Glands

Run Time: 3 minutes Author: Jared Scott M.D. Educational Pearls: Adrenal glands sit on top of kidneys, and are approximately the size of a walnut. Each of the different layers of the adrenal glands make hormones and those hormones become more desirable with each layer – salt hormones→ sugar hormones→ sex hormones. Top layer: the…

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Podcast #141: Heat Stroke

Run Time: 4 minutes Author: Nicholas Hatch M.D. Educational Pearls: It is possible to acclimatize to heat, however it takes approximately 2-3 weeks. Never give tylenol for a heat related illness and heat related hyperthermia, it is not helpful. Heat rash: most common in kids. Lotion should not be used because it blocks the ducts…

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