DOC I HAVE HYPERKALEMIA
Hyperkalemia is defined as high Potassium in the blood.
Normal blood potassium varies from 3.4 to 5.7 mmol per liter.
Extracellular potassium level represents only 2 per cent of the total body potassium.
Potassium is a major determinent of intracellular volume of cells and intracellur osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular potassium concentrations.
Plasma and extracellular potassium levels are influenced by many factors particularly acid based balance. Acidosis moves potassium out of cells while alkalosis shifts potassium into cells.
Hyperkalemia occurs with impaired renal function
Symptoms of Hyperkalemia:
1.cardiac arrhythmias
2.muscle weakness especially peripheral muscles
Diagnosis:
1.Plasma potassium levels
2.Electrocardogram shows peaked T waves, prolonged PR intervals,
complete heart block and atrial asystole
Treatment:
1.glucose with insulin infusion can drives potassium into cells lowering the plasma potassium( U insulin for every 2gms of glucose)
2.Infusion of sodium bicarbonate to induce alkalosis
3.Infusion of calcium bicarbonate to induce alkalosis
4.administer potassium binding resins by mouth
5.hemodialysis
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Friday, April 29, 2011
Wednesday, April 27, 2011
A Family Doctor's Tale -HYPOKALEMIA
DOC I HAVE HYPOKALEMIA
Hypokalemia is defined as low Potassium in the blood.
Normal blood potassium varies from 3.4 to 5.7 mmol per liter.
Extracellular potassium level represents only 2 per cent of the total body potassium.
Potassium is a major determinent of intracellular volume of cells and intracellur osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular potassium concentrations.
Plasma and extracellular potassium levels are influenced by many factors particularly acid based balance. Acidosis moves potassium out of cells while alkalosis shifts potassium into cells.
Hypokalemia occurs with gastrointestinal or urinary loss especially following use of potassium wasting diuretics or in diabetes mellitus.
Symptoms of hypokalemia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.polyuria
5.myocardial irritabilty is increased with hypokalemia and the use of digitalis becomes more dangerous.
Diagnosis:
1.Plasma potassium levels
2.Electrocardogram shows flattening of the T waves, U waves and sagging ST segment
Treatment:
1.oral potassium is given in most cases with improvement of blood potassium level
2.Intravenous potassium is given in emergency cases. The concentration of infused potassium should not exceed 40 mEQ per liter except in rare cases.
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Hypokalemia is defined as low Potassium in the blood.
Normal blood potassium varies from 3.4 to 5.7 mmol per liter.
Extracellular potassium level represents only 2 per cent of the total body potassium.
Potassium is a major determinent of intracellular volume of cells and intracellur osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular potassium concentrations.
Plasma and extracellular potassium levels are influenced by many factors particularly acid based balance. Acidosis moves potassium out of cells while alkalosis shifts potassium into cells.
Hypokalemia occurs with gastrointestinal or urinary loss especially following use of potassium wasting diuretics or in diabetes mellitus.
Symptoms of hypokalemia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.polyuria
5.myocardial irritabilty is increased with hypokalemia and the use of digitalis becomes more dangerous.
Diagnosis:
1.Plasma potassium levels
2.Electrocardogram shows flattening of the T waves, U waves and sagging ST segment
Treatment:
1.oral potassium is given in most cases with improvement of blood potassium level
2.Intravenous potassium is given in emergency cases. The concentration of infused potassium should not exceed 40 mEQ per liter except in rare cases.
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Monday, April 25, 2011
A Family Doctor's Tale - UNDESCENDED TESTES
DOC I HAVE UNDESCENDED TESTES
Undescended Testis is incomplete or improper descent of one or both testes through the canal which is the tunnel which leads the spermatic duct from the abdomen to the testis.
The causes of Undescended Testis are:
1.Normally the testes in the fetus are in the abdomen and make their way to the inguinal canal by the 23rd week of pregenancy and enter the scrotum by the 39th week of pregnancy.
2.Sometimes one or rarely both testes fail to enter the scrotum before birth.They may remain in the abdomen or may be not fully descended to the scrotum at birth.
3.The undescended testes can either be normal or dyplastic(cells may turn abnormal)
4.Intra-abdominal testes may be unable to produce sperm and also susceptible to malignant change.
5.Testis situated outside the usual course of descent is termed ectopic.
Diagnosis:
All male babies are examined at birth to determine whether their testes have descended into the scrotum normally.
Where the testes are not found in the scrotum an ultrasound scan of the pelvis can determine where the testes are located.
Where there is no testes to be found, a human chorionic gonadotrophin test help to rule out anorchia(complete absence of testes) and whether there is a need for counseling later on at puberty.
The complications for Undescended Testis are:
Untreated undescended testes may have increased risk for
1.infertility
2.testicular torsion
3.malignant change
The treatment of Undescended Testis is:
1.In the absence of both testes, there is nothing that can be done.
2.If there is one Undescended Testis, the testis can be brought down to their scrotum.
Similarly if both testes are undescended the testes can be brought down to the scrotum by surgery.
This surgery is preferably done between 2 to five years old.
3.If there is associated indirect inguinal hernia that should be repaired simultaneously.
4.In some cases descent of the testes may occur up to the 3rd month of age.So hypermobile testes found at birth are observed if they can descend by themselves by that age.
The Prognosis of Undescended Testis is:
Most cases of Undescended Testis usually will recover with proper surgical treatment.
If there is bilateral occurence of undescended testes and test shows that they are intra-abdominal, there is high risk of subfertility or sterilty.
Even a single viable testis can have good prognosis for fertility.
Very rarely there may be complications such as postoperative infections or recurrence.
Undescended Testis is incomplete or improper descent of one or both testes through the canal which is the tunnel which leads the spermatic duct from the abdomen to the testis.
The causes of Undescended Testis are:
1.Normally the testes in the fetus are in the abdomen and make their way to the inguinal canal by the 23rd week of pregenancy and enter the scrotum by the 39th week of pregnancy.
2.Sometimes one or rarely both testes fail to enter the scrotum before birth.They may remain in the abdomen or may be not fully descended to the scrotum at birth.
3.The undescended testes can either be normal or dyplastic(cells may turn abnormal)
4.Intra-abdominal testes may be unable to produce sperm and also susceptible to malignant change.
5.Testis situated outside the usual course of descent is termed ectopic.
Diagnosis:
All male babies are examined at birth to determine whether their testes have descended into the scrotum normally.
Where the testes are not found in the scrotum an ultrasound scan of the pelvis can determine where the testes are located.
Where there is no testes to be found, a human chorionic gonadotrophin test help to rule out anorchia(complete absence of testes) and whether there is a need for counseling later on at puberty.
The complications for Undescended Testis are:
Untreated undescended testes may have increased risk for
1.infertility
2.testicular torsion
3.malignant change
The treatment of Undescended Testis is:
1.In the absence of both testes, there is nothing that can be done.
2.If there is one Undescended Testis, the testis can be brought down to their scrotum.
Similarly if both testes are undescended the testes can be brought down to the scrotum by surgery.
This surgery is preferably done between 2 to five years old.
3.If there is associated indirect inguinal hernia that should be repaired simultaneously.
4.In some cases descent of the testes may occur up to the 3rd month of age.So hypermobile testes found at birth are observed if they can descend by themselves by that age.
The Prognosis of Undescended Testis is:
Most cases of Undescended Testis usually will recover with proper surgical treatment.
If there is bilateral occurence of undescended testes and test shows that they are intra-abdominal, there is high risk of subfertility or sterilty.
Even a single viable testis can have good prognosis for fertility.
Very rarely there may be complications such as postoperative infections or recurrence.
Saturday, April 23, 2011
A Family Doctor's Tale - PREMENSTRUAL TENSION
DOC I HAVE PREMENSTRUAL SYNDROME
Premenstrual syndrome is a condition occurring seven to ten days before menses more common in women over the age of 30.
Premenstrual Syndrome may manifested itself as a period of irritability, abdominal discomfort, headache and other various symptoms for the patient presenting just before the menses.
The cause of Premenstrual Syndrome is still not known.
There are a few theories:
1.Fluctuation in estrogen and progesterone hormonal concentration may affect the body's function and emotions
2.The fluid retention action of estrogen may cause abdominal discomfort, irritability of the brain, and weight gain
3.changes in the other glands such as the adrenal gland may also be involved
4.Stress aggravates the symptoms of excessive hormones before the menses.
Symptoms of Premenstrual syndrome may consists of:
1.feeling of fullness in lower abdomen
2.Bloated abdomen and ankle edema(swelling due to fluid retention)
3.Weight gain during the second half of menstrual cycle due to fluid retention which is reversed after the onset of menses
4.Low back pain
5.headache and exacerbation of migraine,
6.painful breasts,
7.depression, anxiety, irritabilty
8.emotional instabilty and mood changes
9.interpersonal problems and social unhappiness
Treatment for premenstrual Syndrome are as follows:
Mild premenstrual Syndrome symptoms:
reassurance without other treatment
More severe Premenstrual syndrome symptoms:
1.ankle edema may require diuretics to pass out fluids or decreased salt intake
2.Tranquillizer or antidepressant for anxiety or depression
3.Analgesics or Muscle relaxant for headaches and back pain
4.breast support with properly fitting brassieres for painful breasts
Very severe symptoms:
a course of low combination female hormones may help
Family counseling may be indicated
Prognosis of Premenstrual syndrome:
It may improve spontaneously over years or it may recur on and off until menopause.
Premenstrual syndrome is a condition occurring seven to ten days before menses more common in women over the age of 30.
Premenstrual Syndrome may manifested itself as a period of irritability, abdominal discomfort, headache and other various symptoms for the patient presenting just before the menses.
The cause of Premenstrual Syndrome is still not known.
There are a few theories:
1.Fluctuation in estrogen and progesterone hormonal concentration may affect the body's function and emotions
2.The fluid retention action of estrogen may cause abdominal discomfort, irritability of the brain, and weight gain
3.changes in the other glands such as the adrenal gland may also be involved
4.Stress aggravates the symptoms of excessive hormones before the menses.
Symptoms of Premenstrual syndrome may consists of:
1.feeling of fullness in lower abdomen
2.Bloated abdomen and ankle edema(swelling due to fluid retention)
3.Weight gain during the second half of menstrual cycle due to fluid retention which is reversed after the onset of menses
4.Low back pain
5.headache and exacerbation of migraine,
6.painful breasts,
7.depression, anxiety, irritabilty
8.emotional instabilty and mood changes
9.interpersonal problems and social unhappiness
Treatment for premenstrual Syndrome are as follows:
Mild premenstrual Syndrome symptoms:
reassurance without other treatment
More severe Premenstrual syndrome symptoms:
1.ankle edema may require diuretics to pass out fluids or decreased salt intake
2.Tranquillizer or antidepressant for anxiety or depression
3.Analgesics or Muscle relaxant for headaches and back pain
4.breast support with properly fitting brassieres for painful breasts
Very severe symptoms:
a course of low combination female hormones may help
Family counseling may be indicated
Prognosis of Premenstrual syndrome:
It may improve spontaneously over years or it may recur on and off until menopause.
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