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Lithium Toxicity

Symptoms: (Neurological findings appear late in acute ingestion, but are common presenting complaints in chronic toxicity.) Nausea Vomiting Diarrhea QTc prolongation (rare) Lethargy Ataxia Confusion Tremors, fasciculations, or myoclonic jerks Seizures Encephalopathy Nephrogenic Diabetese Insipidus (in chronic toxicity) Testing: Lithium level Therapeutic  lithium level is 0.8 – 1.2 mEq/L  (mmol/L) 1.5-2.5 mEq/L (mmol/L) – mild symptoms, chronic toxicity, tremor, slurred

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Pediatric Seizure Recurrence

Recurrence rate after first unprovoked seizure 1: 6% recurrence within 48 hours ( 1 in 16 ) 15.8% recurrence within 14 days (1 in 6) 31.5% recurrence within 4 months ( 1 in 3 ) Age less than 3 yo at onset increases 14 days recurrence, OR 2.1 29% recurrence within 1 year 3 37% recurrence within 2 years 3 43% recurrence within

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Hypokalemia

Hypokalemia <3.5 mmol/L Severe < 2.5 mmol/L ECG changes ST depression U wave QT prolongation (>450 ms) PVCs AV block Bradycardia Vtach Vfib Treatment- Replacement Each 10 mEq raises K 0.1 mmol/L PO replacement preferred ECG changes require admission and IV + oral replacement. Magnesium replacement is also indicated. Many foods contain potassium. Replacement need not be tablets only. See list here. Symptoms

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Hyperkalemia

Hyperkalemia >6.0 mmol/L EKG changes (not necessarily in order, especially if chronic renal failure patient) Peaked T waves PR prolongation Short QT (<350 ms) Widened QRS Flat P waves Heart Block Sine wave V. Fib. Treatment: Stabilize, Shift, Excrete Stabilize: Calcium stabilizes myocardial membrane with onset in 15-30 minutes. Calcium gluconate IV 10 ml of 10% solution over 10 minutes may cause

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Ectopic Pregnancy

American College of Obstetrics and Gynecology Practice Bulletin – Tubal Ectopic Pregnancy, 2018 Location: >90% of ectopics are fallopian, 1% abdominal, 1% cervix, 1-3% ovarian, 1% c-section scar Heterotopic pregnancy risk 1/4000 – 1/30,000 in general population Heterotopic pregnancy risk in patients receiving in vitro fertilization, up to 1/100 Epidemiology: Incidence is estimated to be 1-2% (25 per 1000 pregnancies per

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DKA and HHS

Definitions: Diabetic ketoacidosis (DKA)1,2– uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketones Hyperosmolar hyperglycemic state (HHS)1,2– severe hyperglycemia, hyperosmolality, and dehydration in the absence of significant ketoacidosis Treatment: Fluid resuscitation:1,2 NS (0.9%NaCl) 15-20 ml/kg or 1-1.5 liters in first hour … THEN If corrected serum Na is low, cont. NS @ 250-500 ml/hr If corrected serum Na is high

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PECARN Pediatric Head CT Rule

The PECARN head injury rule was derived in a population of patients younger than 18 years old with blunt head injury. 42412 patients were included in the study population with a goal of identifying patients at very low risk of clinically important traumatic brain injury (ciTBI) by history and exam criteria, obviating the need for CT imaging.  Child <2 yo

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HIV PEP – Non-occupational

Preferred Regimen For Non-Occupational Post-Exposure Prophylaxis Raltegravir 400mg PO Twice Daily (Isentress®; RAL) Plus Truvada™,1 PO Once Daily [Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg]   Summary of CDC Guidelines: When care is sought ≤72 hours after a potential nonoccupational exposure that presents a substantial risk for HIV acquisition. Obtain screening labs. Test exposed patient AND source

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HIV PrEP – Pre-Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) has been recommended by the CDC since 2014 as one option for prevention of HIV transmission in adults at high risk. There is only one FDA approved drug for this indication.   Truvada 200mg/300mg, 1 tab PO daily [emtricitabine (FTC) 200 mg and tenofovir disoproxil fumarate (TDF) 300 mg] PrEP is recommended for the following populations: Sexually-active adult MSM (men

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HIV PEP – Occupational

HIV Occupational Post-Exposure Prophylaxis Regimen:   Raltegravir 400mg PO Twice Daily (Isentress®; RAL) Plus Truvada™,1 PO Once Daily [Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg] CDC Recommended approach: 1) Evaluate exposure: Exposures posing risk of infection transmission : Percutaneous injury Mucous membrane exposure Non-intact skin exposure Bites resulting in blood exposure to either person involved Substances posing risk of infection transmission:

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