Your Daily Meds - 23 November, 2023
Good morning and welcome to your Wednesday dose of Your Daily Meds.
Bonus Review: How much insulin and glucose would you administer when treating significant hyperkalaemia?
Answer: Give 50mL of 50% IV Dextrose with 10 units of intravenous insulin (we use actrapid).
This should be enough to reduce the potassium concentration by 1-2 mmol/L within about 30 mins, lasts for 2-3 hours and can be repeated.
Note: This does nothing to remove potassium from the body, it just shifts the potassium intracellularly.
A Question:
Kawasaki disease is a vasculitis that affects the coronary vessels and presents as an acute systemic disorder, usually in young children. Which of the following is not included in the diagnostic criteria for Kawasaki disease?
Bilateral conjunctivitis
Strawberry tongue
Erythema of palms and soles
Polymorphous rash
New onset hypertension
Have a think.
Scroll for the chat.
A Query:
Which of the following gives rise to the hypogonadism of Klinefelter’s syndrome?
Impaired Leydig cell function
Impaired hypothalamus function
Impaired Sertoli cell function
Impaired pituitary gland function
Impaired adrenal gland function
Have a think.
Scroll for the chat.
Nasty-itis:
Kawasaki disease is a vasculitis that mostly affects the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years, and also occurs rarely in adults. The cause of Kawasaki disease is unknown but is thought to be the result of an abnormal immune response to an infectious trigger.
The diagnosis of Kawasaki disease requires the presence of fever lasting at least five days, with no other explanation, and at least four of the following five criteria:
Bilateral conjunctival inflammation
Oral mucous membrane changes, including injured or fissured lips, inflamed pharynx or strawberry tongue
Peripheral extremity changes, including erythema of palms, soles, oedema of the hands or feet (acute phase), and periungual desquamation (convalescent phase)
Polymorphous rash
Cervical lymphadenopathy
Cardiovascular complications of Kawasaki disease include coronary arteritis, leading to myocardial infarction, transient coronary dilatation, myocarditis, pericarditis, peripheral vascular insufficiency and gangrene. Treatment is with aspirin (5 mg/kg daily for 14 days) and intravenous gammaglobulin (400 mg/kg daily for 4 days).
So, new onset hypertension is not included in the diagnostic criteria for Kawasaki disease.
Leydiggity:
Klinefelter’s syndrome is usually associated with the 47XXY karyotype and affects approximately 1 in 1000 males. The main abnormality is dysgenesis of the seminiferous tubules, which may be evident from infancy and progresses with age. By the time of adolescence, fibrosis and hyalinisation are present in the seminiferous tubules and there is impaired Leydig cell function. This impairment results in the hypogonadism responsible for the common clinical features of Klinefelter’s syndrome of gynaecomastia and failure to progress normally through puberty.
See the diagram below for an outline of the male reproductive hormone axis:
Bonus: What makes lymph flow?
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.