Category Archives: Morning Report

Morning Report

Acute Kidney Injury – 11/7/17

Leave a comment

Definition of AKI

1) Increase in Cr by greater or equal to 0.3 in 48 hours
2) Increase in Cr 1.5 x baseline within 7 days
3) UOP < 0.5 mL/kg/hr x 6 hours

Causes of elevated Cr without drop in GFR

Medications that block secretion – cimetidine, TMP, and HIV medications
Increased muscle mass

Causes of elevated BUN without drop in GFR

GIB
Albumin infusions
Steroid use
Tetracycline antibiotics

Urine sediment

Pre-renal azotemia = hyaline casts
ATN = muddy brown granular casts
AIN = sterile pyuria (+/- eosinophils)
GN = protein, dysmorphic RBCS, RBC casts

Indications for dialysis

A = acidosis
E = electrolyte abnormalities refractory to medical therapy
I = intoxicants
O = overload refractory to diuretics
U = uremia

Morning Report

Dementia – 10/31/17

Leave a comment

Normal aging = no change in independent functioning

Mild cognitive impairment = stage between normal aging and dementia

  • Subjective reports of cognitive decline
  • Objective findings of impairment of cognitive decline
  • Loss of independence in daily functioning
  • No significant impairment in occupational and social functioning

Dementia = deterioration of cognitive function severe enough to impair occupational and social functioning; biggest risk factor = age

Alzheimer’s disease

  • Most common type of dementia
  • Insidious development of recent memory loss
  • Word finding difficulties early
  • Visuospatial dysfunction (getting lost in familiar places)
  • Problems with executive function (problem solving ability)
  • No role for biomarker testing

Lewy Body dementia

  • Dementia precedes Parkinsonian symptoms
  • Visual hallucinations

Parkinsons dementia

  • Parkinsonian features before onset of dementia
  • Symptoms of Parkinsons include = bradykinesis + rigidity, pill-rolling tremor, postural/gait instability

Frontotemporal dementia

  • Can occur in younger people
  • Change in social behaviors
  • Loss of executive functioning and decision making
  • Has a genetic component 40% of the time so genetic counseling is beneficial

 

Morning Report

Varicella Zoster – 10/18/17

Leave a comment

Primary infection – chicken pox (lesion at varying stage on the trunk, face, and extremities)
Reactivation – shingles (painful, unilateral rash in a restricted dermatome)

Clinical manifestations – 1) Rash – most common location is thoracic and lumbar dermatomes
2) Acute neuritis – 75% of patients have pain/burning/throbbing prior to onset of rash

Complications in immunocompetent hosts – post-herpetic neuralgia (7.9%), ocular complications (1.6%),, meningitis (0.5%), oticus (0.2%)

Disseminated if > 3 contiguous dermatomes or 2 dermatomes on separate parts of the body

Diagnosis for encephalitis/meningitis – elevated WBC with lymphocytic predominance, elevated protein, positive VZV PCR or IgM

Treatment: IV acyclovir

Vaccines: Age > 60 give live vaccine unless immunosuppressed
VZIG – give to exposed pregnant or immunosuppressed patients