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Stuart and Mizuho continue their discussion about AMS, and discuss less common but interesting causes of AMS, including clinical findings, workup and management of these various diagnoses.
Just a clarification for anticholinergic toxicity. The BLIND as a BAT is due to cycloplegia (ciliary muscle paralysis with loss of accommodation) associated with mydriasis (NOT MIOSIS). So look for dilated pupils!
Yes you are correct - they get dilated pupils, we are setting about correcting that error! Thanks!
Love this! A few things I noticed...
Glucose - in the first part, it says to give an amp of d50 if < 80. Further down, it says < 70. I *think* (I could be wrong, I'm hearing impaired) in today's part it said <60. Which one is it?
The hypertensive encephalopathy was left off the written summary
Thanks for doing all this! It really is helpful!
Wait, what?Did I overhear someone talking about hanging a banana bag for an alcoholic? Why (pray tell) would one do that?
"Conclusions: in our ED, patients with acute ethanol intoxication do not have B12 or folate deficiencies ... Widespread administration of multivitamins is unwarranted by these findings"
Vitamin deficiencies in acutely intoxicated patients in the EDSiu Fai Li MDJulie Jacob MDJimmy Feng MDMiriam Kulkarni MD
The American Journal of Emergency MedicineSeptember 2008, Vol.26(7):792–795, doi:10.1016/j.ajem.2007.10.003
In regards to the PDF for cirrhosis it says dx: serum ammonia level.
In the curbsiders podcast this is what Dr. Scott Matherly (hepatologist) says:
Don’t measure Ammonia levels in cirrhotics. Drawing ammonia levels on cirrhotics leads to harm of patients; they end up being told to take huge amounts of Lactulose just because of the elevated ammonia level rather than because they are actually confused and encephalopathic (which is a clinical diagnosis), and which would warrant taking Lactulose.
With Hyponatremia it is not necessarily the level of Sodium.The speed of change and the depth of cange causes severe symptoms .
Love the straight forward and repetitive hyponatremia treatment segment. Definitely will not forget! thank you.
What you do matters.