A basic biochemical laboratory panel (including serum sodium, potassium, glucose, chloride, bicarbonate, BUN and creatinine) is the core of screening in patients with hypokalemia. Urine electrolytes (potassium and chloride) in spot urine are useful in differentiating renal from non-renal causes of hypokalemia. An arterial blood gas (ABG) analysis should be performed to detect metabolic acidosis or alkalosis when the underlying cause is not apparent from the history. As the difference between arterial and vein blood samples, regarding the potassium levels, is clinically not significant, measurement of potassium in vein blood sample is not contraindicated in the emergency department. Further urinalysis and urine pH measurement should follow to assess for the presence of renal tubular acidosis. Serum magnesium, calcium and/or phosphorus levels are important to exclude associated electrolyte abnormalities, especially if alcoholism is suspected. Urinary calcium excretion is very critical to exclude Bartter syndrome. We should also measure serum digoxin level if the patient is on digitalis. In cases of high clinical index of suspicion for a disorder, a drug screen in urine and/or serum for diuretics, amphetamines and other sympathomimetic stimulants should be conducted. Assessment of TSH levels is required in cases of tachycardia or clinical suspicion of hypokalemic periodic paralysis (25).
Address for correspondence: Dr. Harsh Golwala, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Williams Pavillion 1130, P.O. Box 26901, Oklahoma City, Oklahoma 73190, Oklahoma City, USA. E-mail: harsh-golwala@ouhsc.edu
Golwala Clinical Medicine Pdf
No evidence of fibrosis or traction bronchiectesis on CT scan; no clinical features Negative blood test for alfa-1 antitrypsin level; upper lobe involvement in our patient in contrast to lower lobe predominance in alfa-1-antitrypsin deficiency
Findings In this meta-analysis of 4 randomized clinical trials that included 1874 patients with nonischemic cardiomyopathy, use of primary prevention implantable cardioverter defibrillators reduced all-cause mortality by 25%.
Study Selection Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. The search yielded 10 studies, of which only 1 met the inclusion criteria. A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies. 2ff7e9595c
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