TDM

Chemotx-induced Nausea and Vomiting

Ondansetron

Dexamethasone

Prochlorperazine

Metoclopramide

ACS- UA/NSTEMI

DAT

NTG

BB/CCB

Heparin (UFH, LMWH, fondaparinux)

ACS- STEMI

DAT

ACE-I

Nitrates

BB

Heparin

Edema

Na+/fluid restriction

Elevate legs

Compression stockings

Spironolactone - if liver failure

Furosemide- if Renal failure (ClCr <50ml)

HCT - if no failures.

If hypokalaemia, use spironolactone. If hyperkalaemia, prefer HCT

Identify overdiuresis by monitoring for:

  • weakness

  • hypotension

  • azotemia, hypokalaemia or metabolic acidosis


Dehydration in children

Deficit = 100mL/kg for 10% dehydration. eg for a 15kg baby = 15 x 100 = 1500mL.

Replace 50% in first 8h ie 750mL over 8hrs = 94mL/h

Maintainance = 100mL/Kg/day for first 10kg, then 50mL/kg/day for each subsequent kg.

eg 15kg would be 1000mL/day + 2500mL/day = 1250mL/day = 50mL/hr

Therefore, Total replacement = 94 + 50 = 144m/h for first 8 hrs.

Na+ loss would be approx 10mmol/kg/day

K+ loss would be approx 10mmol/kg/day: Max replacement is 4mmol/kg/day

Solution of choice: NaCl 0.45% + D5W


Ca

  1. Correct for albumin

  2. Repeat the following day to exclude lab errors

  3. Do PTH & Phosp

  4. Asx hyperca = HPTH

Na

SODIUM DISORDER (ie abn Na level)

  1. Do Sosm, Uosm, UNa

HYPERNA

  1. 99% are Unwatered vegetables (dried out elderly): elderly nursing home patients who are bed bound, neglected

    1. Serum osm high, urine osm high,

    2. Rx

      1. Correct volume FIRST with 2L Bolus NS (Dont worry about central pontine myelinolysis- its for hyponatraemia)

      2. Then correct free water with either PEG/PO Tap or D5W at calculated rate

  2. Endocrine eg PP, Central DI, Nephro DI. Very rare

HYPONA

  1. Measure Sosm.

    1. If high -> fats + prot. Dont worry about it

    2. Normal: Osmotically active compound eg blood glucose, BUN, etoh, toluene etc

    3. Low Sosm: Hypoptonic hyponatraemia

      1. Hypervolaemic from hx (CCF, Cirhosis, peripheral edema, crackles, BNP elevation)? diuresis

      2. Hypovolaemic (fever, tachpnea, diuretics etc)? give vol

      3. Euvolaemic if not above: RATS

        1. RTA (renal tubular acidosis) = CKD/AKI

        2. Addisson's dx = Cortisol

        3. Thyroid low = TSH

        4. SIADH- diagnosis of exclusion of above. Uosm low

Rx

  1. If acute & severe: ie obtunded, initially Na was normal, seizing, coma, : 3% saline- central pontine myelinolysis

  2. Severe & Chronic: Normal saline. Calculate to change Na by 0.25mEq/hr. (do BMP every 4 hrs to ensure sodium changes by 1mEq). If it increases by > 1 every 4 hrs reduce rate and maybe give free water. Tip: best use computer to calculate rate, but can know normal saline contains Na at 152mEq/L?

  3. Mild-to mod: as chronic & severe

Potassium

HypoK

K change of 0.1

3.0 - 4.0 10mEq

2.5 - 3.0 15mEq

2.0-2.5 20mEq


IV rate. <10mEq/hr (burns) eg so give 40mEq KCl q4H x 3 per day (=120) AND

PO: 40mEq PO qAC x 3 (=120)- Elixir /pill

Do BMP at 2:00 hrs

Mg 1g IV

HyperK