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Internal Medicine

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78 papers 100 to 500 followers
https://www.readbyqxmd.com/read/28418572/the-single-high-sensitivity-serum-cardiac-troponin-level-a-significant-advance-for-chest-pain-pathways
#1
William G Kussmaul Iii
No abstract text is available yet for this article.
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/19414841/narrative-review-evolving-concepts-in-potassium-homeostasis-and-hypokalemia
#2
REVIEW
Megan Greenlee, Charles S Wingo, Alicia A McDonough, Jang-Hyun Youn, Bruce C Kone
Humans are intermittently exposed to large variations in potassium intake, which range from periods of fasting to ingestion of potassium-rich meals. These fluctuations would abruptly alter plasma potassium concentration if not for rapid mechanisms, primarily in skeletal muscle and the liver, that buffer the changes in plasma potassium concentration by means of transcellular potassium redistribution and feedback control of renal potassium excretion. However, buffers have capacity limits, and even robust feedback control mechanisms require that the perturbation occur before feedback can initiate corrective action...
May 5, 2009: Annals of Internal Medicine
https://www.readbyqxmd.com/read/21278718/pathophysiology-and-management-of-hypokalemia-a-clinical-perspective
#3
REVIEW
Robert J Unwin, Friedrich C Luft, David G Shirley
Potassium (K(+)) ions are the predominant intracellular cations. K(+) homeostasis depends on external balance (dietary intake [typically 100 mmol per day] versus excretion [95% via the kidney; 5% via the colon]) and internal balance (the distribution of K(+) between intracellular and extracellular fluid compartments). The uneven distribution of K(+) across cell membranes means that a mere 1% shift in its distribution can cause a 50% change in plasma K(+) concentration. Hormonal mechanisms (involving insulin, β-adrenergic agonists and aldosterone) modulate K(+) distribution by promoting rapid transfer of K(+) across the plasma membrane...
February 2011: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/22901631/a-physiologic-based-approach-to-the-treatment-of-a-patient-with-hypokalemia
#4
Abdo Asmar, Rajesh Mohandas, Charles S Wingo
Hypokalemia is common and can be associated with serious adverse consequences, including paralysis, ileus, cardiac arrhythmias, and death. As a result, the body maintains serum potassium concentration within very narrow limits by tightly regulated feedback and feed-forward systems. Whereas the consequences of symptomatic hypokalemia and severe potassium depletion are well appreciated, chronic mild hypokalemia can accelerate the progression of chronic kidney disease, exacerbate systemic hypertension, and increase mortality...
September 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28174217/diagnosis-and-treatment-of-hyponatremia-compilation-of-the-guidelines
#5
Ewout J Hoorn, Robert Zietse
Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status...
February 7, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/24169317/-the-treament-of-hyponatremia-secundary-to-the-syndrome-of-inappropriate-antidiuretic-hormone-secretion
#6
Isabelle Runkle, Carles Villabona, Andrés Navarro, Antonio Pose, Francesc Formiga, Alberto Tejedor, Esteban Poch
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most frequent cause of hyponatremia in a hospital setting. However, detailed protocols and algorithms for its management are lacking. Our objective was to develop 2 consensus algorithms for the therapy of hyponatremia due to SIADH in hospitalized patients. A multidisciplinary group made up of 2 endocrinologists, 2 nephrologists, 2 internists, and one hospital pharmacist held meetings over the period of a year. The group worked under the auspices of the European Hyponatremia Network and the corresponding Spanish medical societies...
December 7, 2013: Medicina Clínica
https://www.readbyqxmd.com/read/27305194/clinical-practice-upper-gastrointestinal-bleeding-due-to-a-peptic-ulcer
#7
REVIEW
Loren Laine
No abstract text is available yet for this article.
June 16, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27887750/chronic-kidney-disease
#8
REVIEW
Angela C Webster, Evi V Nagler, Rachael L Morton, Philip Masson
The definition and classification of chronic kidney disease (CKD) have evolved over time, but current international guidelines define this condition as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m(2), or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause. Diabetes and hypertension are the main causes of CKD in all high-income and middle-income countries, and also in many low-income countries. Incidence, prevalence, and progression of CKD also vary within countries by ethnicity and social determinants of health, possibly through epigenetic influence...
November 22, 2016: Lancet
https://www.readbyqxmd.com/read/27822135/chronic-kidney-disease-identification-and-management-in-primary-care
#9
REVIEW
Simon Ds Fraser, Tom Blakeman
Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD...
2016: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/27522622/lactic-acidosis-an-update
#10
REVIEW
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27670788/acute-kidney-injury-2016-diagnosis-and-diagnostic-workup
#11
REVIEW
Marlies Ostermann, Michael Joannidis
Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.
September 27, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27583432/weight-loss-practical-tips
#12
(no author information available yet)
No abstract text is available yet for this article.
September 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/19318384/intensive-versus-conventional-glucose-control-in-critically-ill-patients
#13
RANDOMIZED CONTROLLED TRIAL
Simon Finfer, Dean R Chittock, Steve Yu-Shuo Su, Deborah Blair, Denise Foster, Vinay Dhingra, Rinaldo Bellomo, Deborah Cook, Peter Dodek, William R Henderson, Paul C Hébert, Stephane Heritier, Daren K Heyland, Colin McArthur, Ellen McDonald, Imogen Mitchell, John A Myburgh, Robyn Norton, Julie Potter, Bruce G Robinson, Juan J Ronco
BACKGROUND: The optimal target range for blood glucose in critically ill patients remains unclear. METHODS: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10...
March 26, 2009: New England Journal of Medicine
https://www.readbyqxmd.com/read/27566810/new-antiplatelet-drugs-and-new-oral-anticoagulants
#14
V Koenig-Oberhuber, M Filipovic
In our daily anaesthetic practice, we are confronted with an increasing number of patients treated with either antiplatelet or anticoagulant agents. During the last decade, changes have occurred that make the handling of antithrombotic medication a challenging part of anaesthetic perioperative management. In this review, the authors discuss the most important antiplatelet and anticoagulant drugs, the perioperative management, the handling of bleeding complications, and the interpretation of some laboratory analyses related to these agents...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27567896/severe-community-acquired-pneumonia-timely-management-measures-in-the-first-24-hours
#15
REVIEW
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27716262/new-aspects-in-the-management-of-pneumonia
#16
REVIEW
Elena Prina, Adrian Ceccato, Antoni Torres
Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27530907/what-doctors-say-and-what-patients-hear
#17
Andrew McDonald
No abstract text is available yet for this article.
August 16, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27478966/assessment-of-adequacy-of-volume-resuscitation
#18
John H Boyd, Demetrios Sirounis
PURPOSE OF REVIEW: It has recently become evident that administration of intravenous fluids following initial resuscitation has a greater probability of producing tissue edema and hypoxemia than of increasing oxygen delivery. Therefore, it is essential to have a rational approach to assess the adequacy of volume resuscitation. Here we review passive leg raising (PLR) and respiratory variation in hemodynamics to assess fluid responsiveness. RECENT FINDINGS: The use of ultrasound enhances the clinician's ability to detect and predict fluid responsiveness, whereas enthusiasm for this modality must be tempered by recent evidence that it is only reliable in apneic patients...
October 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27510349/managing-thyroid-disease-in-general-practice
#19
REVIEW
John P Walsh
Serum thyroid-stimulating hormone (TSH) testing is the best screening tool for thyroid dysfunction. When TSH levels are in the reference range, additional tests such as free thyroxine, free triiodothyronine or thyroid antibodies rarely add value, except in patients with pituitary disease, when TSH is unreliable. Overt hypothyroidism and subclinical hypothyroidism with TSH levels > 10 mU/L can be treated without further investigation. The health impact of subclinical hypothyroidism with mildly elevated levels of TSH (4-10 mU/L) remains uncertain, particularly in older people; treatment or observation are reasonable options...
August 15, 2016: Medical Journal of Australia
https://www.readbyqxmd.com/read/27291485/lactic-acidosis-current-treatments-and-future-directions
#20
Jeffrey A Kraut, Nicolaos E Madias
Mortality rates associated with severe lactic acidosis (blood pH<7.2) due to sepsis or low-flow states are high. Eliminating the triggering conditions remains the most effective therapy. Although recommended by some, administration of sodium bicarbonate does not improve cardiovascular function or reduce mortality. This failure has been attributed to both reduction in serum calcium concentration and generation of excess carbon dioxide with intracellular acidification. In animal studies, hyperventilation and infusion of calcium during sodium bicarbonate administration improves cardiovascular function, suggesting that this approach could allow expression of the positive aspects of sodium bicarbonate...
September 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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