By Paul D., M.D. Chan
This helpful instruction manual has been necessary to hundreds of thousands of scholars, citizens, and physicians. This publication experiences clinical therapeutics and administration for all clinical difficulties. remedy and laboratory checks for every disorder are indexed in a well-organized demeanour.
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Extra resources for Medicine, 2005 Edition
Regular insulin 10 units IV push with 1 ampule of 50% glucose IV push. -Kayexalate 30-45 gm premixed in sorbitol solution PO/NG/PR now and q3-4h prn. -Furosemide 40-80 mg IV, repeat prn. -Consider emergent dialysis if cardiac complications or renal failure. Extras: ECG. UA, urine specific gravity, urine sodium, pH, 24h urine potassium, creatinine. Vital Signs: Vitals, urine output q4h. 5°C. Activity: Bed rest; up in chair as tolerated. Special Medications: Acute Therapy: -KCL 20-40 mEq in 100 cc saline infused IVPB over 2 hours; or add 40-80 mEq to 1 liter of IV fluid and infuse over 4-8 hours.
Hyperkalemia is treated with sodium polystyrene sulfonate (Kayexalate), 15-30 gm PO/NG/PR q4-6h. -Hyperphosphatemia is controlled with calcium acetate (PhosLo), 2-3 tabs with meals. 2 and the bicarbonate level >20 mEq/L. 1-2 amps (50-100 mEq) IV push, followed by infusion of 2-3 amps in 1000 mL of D5W at 150 mL/hr. -Adjust all medications to creatinine clearance, and remove potassium phosphate and magnesium from IV. Avoid NSAIDs and nephrotoxic drugs. Extras: CXR, ECG, renal ultrasound, nephrology and dietetics consults.
10 mL/d Vitamin K (in solution, SQ, IM) . . . . . . . . . . . . . . . . . . . . . 10 mg/week Vitamin B12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000 mcg/week Se l e n i u m ( a fte r 2 0 d a ys of continuous T P N ) . . . . . . . . . . . . . . . . 80 mcg/d Intralipid 20%, 500 mL/d IVPB; infuse in parallel with standard solution at 1 mL/min for 15 min; if no adverse reactions, increase to 100 mL/hr once daily or 20 mg/hr continuously.