DOC I HAVE HYPERCALCEMIA
Hypercalcemia is defined as high calcium(above 10.4 md per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypercalcemia occurs with high calcium due to:
1.High parathyroid hormones due to parathyoid adenomas
2.Vitamin D excess
3.Various malignancies including myeloma and leukemia.
4.breast tumors and metastases
5.sarcoidosis
Symptoms of Hypercalcemia:
1.weakness
2.lethargy
3.intractable nausea and vomiting
4.dehydration
5.constipation
6.coma
7.cardiac arrthymia
8.calcification of joint or skin
Diagnosis:
1.Plasma calcium and phosphate levels
2.Blood sodium bicarbonate and gases
3.Blood albumin and proteins
4.Joint Xrays in cases of joint calcification
Complications:
1.Calcification of gouty trophi
2.renal stones
3.Cacific tendonitis
4.Myositis ossificans
5.chondrocalcinosis
6.phosphate arthropathy
Treatment:
Acute hypercalcemia is a medical emergency because of its effect on the heart rhythm.
1.Immediate treatment of intravenous isotonic saline and
2.a powerful diuretic such as frusemide to induce excess calcium to pass out through the urine
3.Phosphate intravenously or orally can also be effective to reduce the calcium from the blood although it may cause diarrhea
4.Corticosteroids are also effective in reducing calcium blood levels.
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Tuesday, June 28, 2011
A Simple guide to Scarlet Fever
A Simple guide to Scarlet Fever
-----------------------------------------------
What is Scarlet Fever?
------------------------------------
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
How is Scarlet Fever transmitted?
-----------------------------------------------
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
What are the Signs and Symptoms of Scarlet Fever ?
------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever and rash
2.ESR raised very high somtimes > 80
3.moderate leucytosis
4.Throat swab for culture and sensitivity
What are the complications of Scarlet Fever?
----------------------------------------------------------------
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
What is the Treatment of Scarlet Fever?
------------------------------------------------------------
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
What is the Prevention for Scarlet Fever?
---------------------------------------------------
Avoiding infected patients
Recently there are new cases of Scarlet Fever in Hong Kong.
What is the Prognosis of Scarlet Fever?
-------------------------------------------------
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
-----------------------------------------------
What is Scarlet Fever?
------------------------------------
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
How is Scarlet Fever transmitted?
-----------------------------------------------
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
What are the Signs and Symptoms of Scarlet Fever ?
------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever and rash
2.ESR raised very high somtimes > 80
3.moderate leucytosis
4.Throat swab for culture and sensitivity
What are the complications of Scarlet Fever?
----------------------------------------------------------------
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
What is the Treatment of Scarlet Fever?
------------------------------------------------------------
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
What is the Prevention for Scarlet Fever?
---------------------------------------------------
Avoiding infected patients
Recently there are new cases of Scarlet Fever in Hong Kong.
What is the Prognosis of Scarlet Fever?
-------------------------------------------------
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Sunday, June 26, 2011
A Family Doctor's Tale - HYPERNATREMIA
DOC I HAVE HYPERNATREMIA
Hypernatremia is defined as high Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinent of intracellular volume of cells and intracellular 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 Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hypernatremia occurs with high sodium due to:
1.dehydration from insufficient water intake or excess water loss
2.impaired renal function cause retention of sodium
3.cardiac disease can cause retention of salt
4.excess intake of salt
Symptoms of Hypernatremia:
1.edema
2.peripheral muscles tetany
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.More intake of water may reduce concentration of sodium
2.diuretic to induce excess sodium to pass out through the urine
3.Infusion of sodium bicarbonate to induce alkalosis
4.Infusion of calcium bicarbonate to induce alkalosis
4.administer Sodium binding resins by mouth
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
7.hemodialysis
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Hypernatremia is defined as high Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinent of intracellular volume of cells and intracellular 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 Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hypernatremia occurs with high sodium due to:
1.dehydration from insufficient water intake or excess water loss
2.impaired renal function cause retention of sodium
3.cardiac disease can cause retention of salt
4.excess intake of salt
Symptoms of Hypernatremia:
1.edema
2.peripheral muscles tetany
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.More intake of water may reduce concentration of sodium
2.diuretic to induce excess sodium to pass out through the urine
3.Infusion of sodium bicarbonate to induce alkalosis
4.Infusion of calcium bicarbonate to induce alkalosis
4.administer Sodium binding resins by mouth
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
7.hemodialysis
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Friday, June 24, 2011
A Family Doctor's Tale - HYPONATREMIA
DOC I HAVE HYPONATREMIA
Hyponatremia is defined as low Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinant of intracellular volume of cells and intracellular 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 Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hyponatremia occurs with loss of salt through:
1.gastrointestinal -vomiting and diarrhea
2.urinary loss especially following use of Sodium wasting diuretics
3.sweating
4.fistula
5.diabetes mellitus.
Symptoms of hyponatremia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.reduced urination
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.oral Sodium chloride (or salt) is given in most cases with improvement of blood Sodium level
2.Intravenous Sodium chloride dextrose solutionis given in emergency cases.
3.Bicarbonate or lactate infusion may help correct acid base disorders depending on underlying cause.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Hyponatremia is defined as low Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinant of intracellular volume of cells and intracellular 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 Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hyponatremia occurs with loss of salt through:
1.gastrointestinal -vomiting and diarrhea
2.urinary loss especially following use of Sodium wasting diuretics
3.sweating
4.fistula
5.diabetes mellitus.
Symptoms of hyponatremia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.reduced urination
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.oral Sodium chloride (or salt) is given in most cases with improvement of blood Sodium level
2.Intravenous Sodium chloride dextrose solutionis given in emergency cases.
3.Bicarbonate or lactate infusion may help correct acid base disorders depending on underlying cause.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
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