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38 Cards in this Set

  • Front
  • Back
Replacement IV Fluids
1. Fever (150 ml/day per 1 degree over 37 C)
2. Tachypnea
3. 3rd Spacing
4. Burns
IV Fluids
Normal = 154 mmol/L (286 osm/L)

1/2 Normal = 77 mmol/L (143 osm/L)

D5W (278 osm/L)
IVF Infusion Rate
4-2-1 Rule

1st 0-10 kg: 4 cc/kg/hr
Next 10-20 kg: 2 cc/kg/hr
Subsequently 1 cc/kg/hr
Maintenance / Replacement IVF
Pre-OP: D5 1/2 NS + 20 mEq KCl at 110 cc/hr

Gastroenteritis: NS + 20 mEq KCl at 175 cc/hr
Calcium
Total Ca: 8.7 - 9.5 mg/dL

iCa (46%) = 1.09-1.29 (corrected to pH 7.4)

Protein Bound (40%)

Organic Anion Bound (phosphate, citrate) = 14%
Mg
1.3 - 1.9 mEq/L (Critical < 1 or > 4)
Phos
2.2 - 4.7 mg/dL (critical < 1)
Cl
98-108
CO2
20-29
BUN
7-23
Hemoglobin
Males: 12.3 - 16.3 g/dL
Females: 11.5 - 14.6 g/dL
HCT
Male: 37.4% to 47%

Female: 34% to 42.1%
Platelets
143-398
WBC Count
3.28-9.29 x 10^3/μL
Hyperkalemia
1. EKG (flat P, peaked T)
2. Calcium Gluconate 1-2 amps
3. Insulin 10 U + Glucose
- Bicarb 1 amp
- Albuterol 10-20 mg inhaled or 0.5 mg IV
4. Kayexalate 30-45 g PO/PR
5. Diuretics
Hypokalemia
- 1 mEq increases K+ by 0.1

KCl Replacement:

Desired [K] - Measured [K] / Cr x 100
Hypomagnesemia
1 g MgSO4 increases by 0.1

If Cr x 2 -- > 50% MgSO4 dose

Goal 1.5 - 2 (> 2 if cardiac patient)
K+
3.6-5.4
Non-ICU CAP Treatment
Standard Empiric:
1. Ceftriaxone 1g IVPB STAT then qd
2. Azithromycin 500mg IVPB STAT then qd

Alternative Empiric (failed outpatient Rx, suspected resistant orgs, beta-lactam allergy):
1. levofloxacin 750mg qd x 5 days
Complicated Female UTI
1. ampicillin 1-2g IV q6hrs x 7-14d + gentamicin 3-5 mg/kg/day x 7-14d

2. Ceftriaxone 1g IV qd x 7-14d

3. Zosyn 3.375 g IV q6-8hrs x 7-14d
Short Acting Insulin
Regular insulin (novolin/humulin)

Onset 0.5-1 hr
Peak 2-4 hrs
Duration 4-8 hrs
Long-Acting Insulin
1. Detemir (Levemir)
- Onset 1 hr, duration 12-24 hrs

2. Glargine (Lantus)
- Onset 1 hr, duration > 24 hrs
VTE Prophylaxis
Standard:
1. Enoxaparin 40mg SC daily

BMI > 30 or high VTE risk:
1. Enoxaparin 40mg SC bid

GFR < 30
1. Enoxaparin 30mg SC qd

*Caution if GFR < 15
Stress Ulcer Prophylaxis
Mechanical ventilation, home PPI/H2 blocker Rx, coagulopathy + 1 risk factor, or at least 3 risk factors

1. Pantoprazole 40 mg PO/IV qd

or

2. Famotidine 20 mg PO/IV bid
Inpatient Diverticulitis Treatment
- Unable to tolerate PO
- Requiring narcotic analgesia
- Complicated diverticulitis

- Make NPO
- NGT if obstruction / ileus
- Flagyl + cipro/ceftriaxone
Hypernatremia Management
1. Treat Underlying Cause
- Stop GI losses
- Control pyrexia
- Normalize glucose
- d/c diuretics, lactulose, Li
- Treat hyperCa, hypoK

2. Correction of HyperNa
- Rapid correction (1 mmol/L per hour) if developed over period of hours
- Slow correction (0.5 mmol/L per hour) w/ goal decrease in serum Na of 10 mmol/L per day --- > 145 mmol/L
- Pure water, D5W, one-quarter normal saline, half normal saline (decr infusion rate req'd for lower tonicity of fluid)

3. Anticonvulsant Rx, airway management if seizures
TBW
TBW = ECF (40%) + ICF (60%)

Nonelderly men = 0.6 x body wt
Nonelderly women = 0.5 x body wt

Elderly men = 0.5
Elderly women = 0.45
DM Diagnosis
1. HbA1c >/= 6.5
2. Random glucose > 200
3. Fasting glucose > 125
4. 2 hr OGTT > 200

After diagnosis: lipid panel, BP, lytes, urinalysis, EKG
Rapid Acting Insulin
Lispro (Humalog), Aspart (Novolog)

- Onset 10-15 min
- Peak -2 hrs
- Duration 3-5 hrs
Intermediate Acting Insulin
NPH

- Onset 1-3 hrs
- Peak 4-10 hrs
- Duration 10-18 hrs
Goal LDL
0-1 Risk Factors: < 160
Risk factors = smoking, HTN, HDL<40, fam hx early CAD

Moderate Risk (> 1 risk factors): < 130

High Risk (CAD or CAD equivalent): < 100
Metabolic Syndrome
1. Abdominal Obesity (> 35-40 in)
2. Hypertriglyceridemia (> 150)
3. HDL < 40 in men < 50 in women
4. HTN
5. Fasting glucose > 110
Fibrates
Gemfibrozil, fenofibrate

Decrease VLDL synthesis (decr TG by 50%)
Niacin
- Most effected Rx to raise HDL (25-35%)
- Decr LDL, TG (10-30%)

Rx of choice for combined hyperlipidemia or low HDL

ASA to minimize flushing
HgbA1c
~ 30 mg/dL glucose per 1% HgbA1c

5% = 100 mg/dL
7% = 150 mg/dL
9% = 200 mg/dL
12% = 300 mg/dL
Celsius
98.6 = 37
99.5 = 37.5
100.4 = 38
101.3 = 38.5
102.2 = 39
Acute Interstitial Nephritis
- Rash
- Pruritis
- Eosinophilia
- Fever
- Urine sediment w/ pyuria, leukocyte casts, microscopic hematuria, proteinuria
Nephrotoxic Agents
- Contrast
- IV aminoglycosides
- Cisplatin