…sample : : Metabolic acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂ in suspected…

…Increased urinary albumin/creatinine ratio reflects altered endothelial and renal pathophysiology in insulin resistance. Metabolic Dysfunction Associated Fatty Liver Disease Insulin resistance increases free fatty…

…often used in clinical settings because it is considered a more accurate indicator of metabolic mass than body weight alone. BSA is utilized in various…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support…

…for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients in whom non invasive measurement…

…in choosing the level of care. The clinical state, the circulation, comorbidity and the precipitating cause carry at least as much weight as the laboratory…

…Nielsen syndrome Romano Ward syndrome Idiopathic congenital long QT syndrome (LQTS) Metabolic disorders Hypokalemia Hypomagnesemia Hypocalcemia Starvation Anorexia nervosa Liquid protein diets Hypothyroidism Bradyarrhythmia Sinus…

…used. Risk in these circumstances appears to track more closely with apoB. Discordantly high apoB is especially associated with metabolic syndrome and mildly elevated triglycerides…

…glucose metabolism, hypertension, atherogenic dyslipidaemia, endothelial biology and platelet related pathways. The source material also describes possible antiarrhythmic effects, associated with reductions in sudden cardiac…

…approximately 1 in 250–300 people and is the most common inherited metabolic disorder associated with premature cardiovascular disease. Prevalence is higher in populations with…

…a myocardial territory to augment blood flow during exercise or pharmacological vasodilation. Relative differences in regional tracer uptake during stress are compared with rest images…

Cardiology Endocrinology & metabolism Definition and pathophysiology Primary aldosteronism (PA), also termed primary hyperaldosteronism or Conn syndrome, comprises disorders in which aldosterone secretion is inappropriately increased…

…one fifth of the risk of all cause mortality in the cited international cohort evidence. Metabolic risk factors make a particularly large contribution to cardiovascular…

…metabolism Pharmacology & dosing Definition and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in…

…conventional risk factors, together with diabetes specific vascular and metabolic abnormalities. Diabetes is associated with inflammation, thrombosis and accelerated atherosclerosis. In CKD, additional mechanisms include…

…with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders…

…of aerobic metabolism, is transported from the tissues back to the lungs where it is exhaled. The final partial pressure of carbon dioxide in exhaled…

…In such instances, favorable neurological outcomes are possible even with prolonged periods of no blood flow, due to the reduced metabolic rate that accompanies declining…

…during which the patient is still carefully observed, follows after the exercise effort is terminated. Reliability as a function of workload In order for the…

…VT) and ventricular fibrillation (VF). Defibrillation is extremely effective during the first few minutes of these arrhythmias. This is evident from randomized trials and observational…

…hyperkalaemia and metabolic disturbance, hypothermia, tamponade, toxins, thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in cardiac…

…4]. The first hour, in order The measures should in practice overlap. Document the time of the suspicion of sepsis, the first dose of antibiotic…

…soon as it is safe to do so after the endoscopy. Fluid and monitoring Use a balanced crystalloid in the first instance. Give small boluses…

…in older protocols but is no longer routinely recommended — alkaline urine increases the precipitation of calcium phosphate. Contraindications Hypokalaemia — must be corrected first or in…

…Conversely, a rise in creatinine during effective decongestion and overall clinical improvement does not necessarily indicate an adverse outcome. Classification of CKD CKD severity is…

…the number one killer worldwide since the 1960s. In 1948 the NHLBI initiated the Framingham Heart Study, which demonstrated that high blood pressure and high…

…by exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular disease after accounting for age. Chronotropic response…

…in conditions like osteoarthritis and obstructive sleep apnea primarily reflect the extent of weight loss, the reductions in hard cardiovascular outcomes (MI, stroke) and metabolic…

…Obesity Insulin resistance or metabolic syndrome Elevated triglycerides Low or apparently well controlled LDL C with suspected residual atherogenic particle burden In patients with diabetes…

…CMD: resting vascular tone is generally normal, but the increase in coronary blood flow during stress is inadequate. Structural CMD: resting vascular tone is increased…

Cardiology Endocrinology & metabolism Definition and pathophysiology Obesity is a chronic, relapsing and biologically complex disease characterized by excessive accumulation of adipose tissue. It is an…

…Failure with improved Ejection Fraction" (HFimpEF) is now applied to patients with a baseline LVEF ≤40% who have experienced a ≥10 point increase in LVEF…

…blood flow despite changes in coronary perfusion pressure, typically within a range of 50 120 mmHg. This process is primarily mediated by local metabolic mechanisms…

Endokrinologi & metabolism Farmakologi & dosering Lathundar Two situations are often confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory…

…or unexpected values should be confirmed with a laboratory analysed plasma glucose when the situation allows. Glucose meters are less reliable in the hypoglycaemic range…

…Corticosteroid treatment This causes marked hyperglycaemia above all in the afternoon and evening. Increase the mealtime insulin at lunch and dinner in the first instance…

…is an essential first step. Recognised causes include: Diabetes and insulin resistance Thyroid disease Kidney disease Excessive alcohol consumption Diets high in carbohydrate or fat…

…Endocrinology & metabolism Definition and pathophysiology Secondary hypertension is elevated blood pressure attributable to a specific, identifiable underlying cause. It should be considered in every patient…

…hypertensive emergency. Acute left ventricular failure. Mechanism of action Enalaprilat is the active metabolite (ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers…

…in 20–30% of patients, while clinically evident restenosis, manifested by recurrent angina attributable to the treated segment, occurred in 10–15% during the first…

…needed The active metabolite accumulates in renal failure Oxycodone IV 2.5–5 mg Oxycodone PO 5–10 mg as needed The first choice among…

…mg once daily. Rationale: Patients in this age group have higher bleeding risk and increased exposure to the active metabolite of prasugrel. Patients weighing <…

…hepatic metabolism. Alcohol dehydrogenase converts ethanol to acetaldehyde, which is subsequently converted by aldehyde dehydrogenase to acetate. The remaining fraction is excreted unchanged in urine…

…and minimal hepatic first pass extraction. Following a single oral dose, plasma concentrations peak within 3 to 6 hours. The agent undergoes extensive hepatic metabolism…

…regulates substrates involved in lipid metabolism and inflammatory signalling. ACLY additionally influences fatty acid synthesis and may affect epigenetic regulation through changes in DNA acetylation…

…a rate reducing effect in selected circumstances. Ivabradine undergoes extensive first pass hepatic metabolism through CYP3A4. Dose adjustment is required in severe hepatic or renal…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…syndrome (DI LQTS) [1]. The condition arises in the setting of both modifiable and nonmodifiable risk factors. Modifiable risk factors include electrolyte abnormalities such as…

…leading to unconsciousness. The myocardium responds to hypoxia by downregulating metabolism and thus contractility (a consistent finding in acute coronary syndromes). Between 3 8 minutes…

…cannot occur. No changes on resting ECG. Increased myocardial workload (exercise) Oxygen supply increases in parallel with increased oxygen consumption during exercise. Thus, supply and…

…stunning . This is a protective mechanism since the cessation of contractions leads to a marked reduction in cell metabolism and thus prolongs survival. Myocardial stunning…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…option. Contraindications Ongoing clinically significant bleeding. Pregnancy in the first trimester and close to delivery (embryopathy and fetal bleeding respectively). Marked liver failure with coagulopathy…

Info This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…

Myocardial ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form…

…Palpitations. Headache Hypotension. Facial flushing. Sweating. Bronchospasm Dyspnea Nausea Metallic taste Tightness in throat Lightheadedness, dizziness, tingling in arms, numbness, blurred vision, burning sensation. Relevant…

…arrest (OHCA) who achieve ROSC in the emergency room (ER) are transferred to the intensive care unit (ICU), coronary care unit (CCU), or catheterization laboratory…

…should exhibit) due to rich collateral circulation in the ischemic area. Moreover, intensive collateral circulation may also prevent ischemia from occurring during exercise stress testing…

Cardiology This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…