Hyperkalemia

Normal : 3.5 – 5.5 mmol/L

>6.5mmol/L is an emergency and needs urgent treatment.

s/s – fast irregular pulse, palpitations, chest pain, weakness and light-headness,  parenthesis, areflexia, & paralysis

ECG – tall tented T waves >> small/ flat P waves; increased PR interval >> Widening of QRS (eventually may have sinusoidal pattern) and VF/VT

Causes

Pseudohyperkalemia/ artefactual results

  • Hemolysis (in laboratory tube) most common
  • Thrombocytosis
  • Leukocytosis
  • Venipuncture technique (ie, ischemic blood draw from prolonged tourniquet application)
  • contamination with potassium EDTA
  • delayed analysis

Redistribution

  • Acidosis
  • Insulin deficiency
  • Drugs: Beta-blocker, Digoxin (a/c overdose), Succinylcholine or Suxamethonium, Arginine hydrochloride
  • Hyperkalemic familial periodic paralysis
  • Burns

Excessive endogenous potassium load

  • Hemolysis
  • Rhabdomyolysis
  • Internal hemorrhage
  • Tumor lysis

Excessive exogenous potassium load

  • Parenteral administration/ Blood transfusion
  • High dose Penicillin (1.7 meq K+ per 1 Million Units)
  • Excess in diet
  • Potassium supplements
  • Salt substitutes

Diminished potassium excretion

  • Decreased glomerular filtration rate (eg, acute or end-stage chronic renal failure)
  • Decreased mineralocorticoid activity
  • Defect in tubular secretion (eg, renal tubular acidosis II and IV)
  • Drugs (eg, NSAIDs, ACE-i, heparin, cyclosporine, potassium-sparing diuretics)

Laboratory error

Management Protocol

See the link below:

http://www.fpnotebook.com/mobile/renal/potassium/hyprklmmngmnt.htm

What blood group you are ?

Does anybody aware of the fact that your blood group itself is a minor risk factor for certain type of diseases?

Here it comes –

  1. Individuals with blood groups A, B, or AB were 5% to 23% more likely to develop coronary heart disease compared with subjects with O blood type, and the associations were not altered by multivariate adjustment of other risk or dietary factors. (The analysis, led by Dr Meian He (Harvard School of Public Health, Boston, MA), included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow-up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.)
  2. Rotavirus (that causes diarrhea) has certain strains which are more likely to infect people with blood type A.
  3. People with type B blood have a 72 percent increased risk of pancreatic cancer, and the risk is also elevated for AB blood types (51 percent) and those with blood type A (32 percent) compared to people with blood type O, according to a study published in the Journal of the National Cancer Institute.
  4. For the women with blood type A and AB seeking fertility treatments—research shows they have more eggs in their ovaries than women with type O blood, who are more likely to have difficulty with fertility treatments.
  5. People with type A blood appeared to have higher incidences of breast cancer and lung cancer, blood types B and O were more likely to suffer from gastrointestinal cancer, and people with type B and A blood had higher incidents of oral cancer. In general, those with blood type A seemed to have an increases probability of getting cancer, and those with blood type O had a significantly lower risk.
  6. Patients with blood Group A have a higher chance to develop gastric cancer while those with Group O can easily get Peptic ulcer disease especially duodenal ulcer.

Well, I am group A and all those researches are saying I am more likely to get coronary heart disease, diarrhea and some GI tract cancers than any other blood types! And as you all know, doctors, especially junior doctors, are prone to get gastritis and heart problems  because of the nature of the work, stress and duty hours. It shocked me. Since this is  a non-modifiable risk factor, all I can do is to reduce the other risk factors such as smoking, heavy drinking, unhealthy eating habit and sedentary life style and finally, of course, to pray.
What about you?

 

Source:

http://health.yahoo.net/experts/dayinhealth/what-your-blood-type-reveals-about-your-health

http://www.ncbi.nlm.nih.gov/pubmed/20937632

Hematuria

Generally, hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart.

may be gross/Macroscopic or Microscopic; may be symptomatic or asymptomatic, transient or persistent, may be painful or painless and either isolated or associated with proteinuria and other urinary abnormalities.

can be of glomerular or nonglomerular origin; nephrological/medical or urological or surgical:

  • Glomerular hematuria

    • Thin basement membrane disease (benign familial hematuria)
    • Alport syndrome
    • IgA nephropathy (Berger’s dz)
    • Hemolytic-uremic syndrome (HUS)
    • Postinfectious glomerulonephritis
    • Membranoproliferative glomerulonephritis
    • Lupus nephritis
    • Anaphylactoid purpura (Henoch-Schönlein purpura)
    • PNH
    • Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension)
  • Nonglomerular hematuria

    • Fever
    • Strenuous exercise – March hematuria
    • Mechanical trauma (masturbation)
    • Menstruation
    • Foreign bodies
    • Urinary tract infection
    • Hypercalciuria/urolithiasis
    • Sickle cell disease/trait
    • Coagulopathy
    • Tumors (BPH, Ca Prostate, TCC)
    • Drugs/toxins (NSAIDs, anticoagulants, captopril, cephalosporins, ciprofloxacin, furosemide, cyclophosphamide, ritonavir, indinavir)
    • Anatomic abnormalities (hydronephrosis, polycystic kidney disease, vascular malformations)
    • Hyperuricosuria

Workup
1. Blood : CBC, BUN & Creatinine, Coagulation studies, Sickle, Ca++, PSA, serology

2. Urine : Urianalysis, microscopy (Dysmorphic RBC -> Glomerular), Culture & Sensitivity

3. Imaging: Ultrasound, X-ray, CT/ spiral CT, IVU, Voiding cystourethrogram (MCUG), radionucleotide studies

Relative indications for renal biopsy:

  • Significant proteinuria
  • Abnormal renal function
  • Recurrent persistent hematuria.
  • Serologic abnormalities (abnormal complement, ANA, or dsDNA levels).
  • Recurrent gross hematuria.
  • A family history of end-stage renal disease

Other causes of Red Urine

Drugs : Hydroxocobalamin (for cyanide poisoning),  warfarin, phenazopyridine, rifampin, ibuprofen, and deferoxamine

Foods : Carrots, Beets, blackberries

Factitious disorder/ Malingering

Contamination of menstrual blood

 

Ref: Medscape