Your Daily Meds - 22 November, 2022
Good morning and welcome to your Tuesday dose of Your Daily Meds.
Bonus Review: What is the normal osmolality of the Extracellular Fluid (ECF)?
Answer: It’s about 285-290 mOsmoles/kg.
Case:
In which of the following scenarios of delirium should benzodiazepine use be considered?
Post-operative delirium
Delirium secondary to fever
Delirium secondary to hypoxia
Delirium secondary to opioid withdrawal
Delirium secondary to alcohol withdrawal
Have a think.
Scroll for the chat.
Case:
A 3-year-old male is brought to the Emergency Department with a painful right leg. His mother reports that he fell over while playing and was surprised when he immediately started to cry in pain. On examination there is no deformity of the right lower limb although the ankle region is swollen and extremely tender. The clinician notes that the child has blue-grey sclera, poor dentition and many bruises over his lower limbs of differing ages. In which of the following is the defect or deficiency responsible for this boy’s condition most likely to be found?
Type 1 collagen
Fibroblast growth factor (FGF) receptor
Osteoid
Ascorbic acid
Copper metabolism
Have a think.
Scroll for the chat.
Booze and Benzos:
The management of delirium should be multifactorial and include identification and management of the precipitating factors, environmental management (such as well lit rooms and allowing family members to be present), and biological management with low-dose antipsychotics such as haloperidol, risperidone or quetiapine. Benzodiazepines should only be used in alcohol withdrawal delirium as it can worsen delirium due to other causes.
Floppy and Brittle:
Key to answering this question is recognising the likelihood diagnosis of osteogenesis imperfecta in a boy who fractures and bruises easily and who has poor dentition and notable blue sclera. Defects in the synthesis of type 1 collagen are responsible for the condition of osteogenesis imperfecta. The clinical findings result from a qualitative or quantitative reduction in type 1 collagen usually inherited in an autosomal dominant fashion.
Defects to the function of FGF receptors are implicated in achondroplasia, where an FGF receptor 3 mutation causes suppression of cartilage growth resulting in short proximal extremities, with a normal trunk and enlarged head.
A failure of osteoid to calcify in a growing person results in Rickets and is characterised by curved deformities in long bones, depressed ribs, pigeon chest, large forehead and kyphosis.
Ascorbic acid (Vitamin C) deficiency, or scurvy, is characterised by bony changes (especially around the sternum), haemarthroses, gum haemorrhage and easy bruise and petechiae formation.
Defects in copper metabolism is characteristic of Wilson disease, an autosomal recessive condition characterised by signs of hepatic insufficiency, cirrhosis and neurologic symptoms.
Bonus: How much insulin and glucose would you administer when treating significant hyperkalaemia?
Answer in tomorrow’s dose.
News: I made a little Ward Call Course for you all. It maps out an Evening Ward Call shift and covers a bunch of common tasks that you may need to do, like:
Deteriorating Patients
Heparin Infusions
Fluid Orders
Electrolyte Replacement
Difficult patients - Discharge Against Medical Advice, Ryan’s Rule
End of Life etc
You can find the course page here:
It’s free and always will be. Let me know what you think.
Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.
As always, please contact me with any questions, concerns, tips or suggestions. Have a great day!
Luke.