Contributor: Taylor Lynch, MD Educational Pearls: When a patient who missed dialysis presents to the emergency department, our clinical concern is who needs to be admitted to the hospital for emergent dialysis and who can wait for their next regularly scheduled session. Dialysis sessions typically occur on Monday, Wednesday, and Friday, or Tuesday, Thursday, and…
Read MoreContributor: Meghan Hurley, MD Educational Pearls: What is hypokalemia? Hypokalemia is when the measured blood level of potassium falls below 3.5 mEq/L (normal 3.5 – 5.2 mEq/L). Can generally be considered in mild (3.0 – 3.5 mEq/L); moderate (2.5 – 2.9 mEq/L); and severe (<2.5 mEq/L) categories with differing treatment goals based on levels. Should…
Read MoreContributor: Meghan Hurley, MD Educational Pearls: What is hyperkalemia? Hyperkalemia is when the measured blood level of potassium reaches above 5.2 – 5.5 mEq/L (normal 3.5 – 5.2 mEq/L). What are common causes of hyperkalemia? Chronic or acute kidney disease. Medications that impact the Renin-Angiotensin-Aldosterone-System (RAAS). Hypoaldosteronism and primary adrenal insufficiency (Addison’s Disease). What are…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment. UTI signs and symptoms Burning sensation…
Read MoreContributor: Taylor Lynch, MD Educational Pearls: Dilutional Hyponatremia: Occurs when there is an excess of free water relative to sodium in the body. Causes a falsely low sodium concentration without a true change in total body sodium. Commonly seen in DKA: Hyperglycemia raises plasma osmolality. Water shifts from the intracellular to extracellular space. This dilutes…
Read MoreContributor: Travis Barlock MD Educational Pearls: There are three indications for IV albumin in the ED Spontaneous bacterial peritonitis (SBP) Patients with SBP develop renal failure from volume depletion Albumin repletes volume stores and reduces renal impairment Albumin binds inflammatory cytokines and expands plasma volume Reduced all-cause mortality if IV albumin is given with antibiotics…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Patients in renal failure may have elevated serum potassium levels which can result in EKG changes. EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Patients with acute renal failure often need medical management for hyperkalemia Those with severe electrolyte derangements or absent renal function may need emergent dialysis as well Dialysis catheters are 12 or 14 french catheters placed in the right internal jugular or left subclavian Placement is very similar to a…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia can cause EKG changes such as a widened QRS The fastest electrolyte results can be obtained off a VBG with electrolytes or point-of-care labs Hyperkalemia may be reported as “hemolyzed” which indicated lysis of red blood cells and artificial elevation of the potassium level. However, always keep in…
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