Decode Medicine from Ward Rounds to ICU rounds
HYPOMAGNESEMIA Serum magnesium < 1.7 mg/dL/< 0.7 mmol/L/< 1.4 mEq/L Serum magnesium represents <1% of total body magnesium → normal serum levels do not exclude intracellular depletion. Severity Classification Severity Serum Mg Level Mild 1.6–1.8 mg/dL (0.66–0.74 mmol/L) Moderate 1.2–1.5 mg/dL (0.49–0.62 mmol/L) Severe <1.2 mg/dL (<0.49 mmol/L) Normal serum magnesium: 1.8–2.4 mg/dL (0.74–1.0 mmol/L) […]
Diabetic Ketoacidosis (DKA) It results from absolute or relative insulin deficiency combined with increased counter-regulatory hormones: Glucagon Catecholamines Cortisol Growth hormone DKA occurs most commonly in:Type 1 Diabetes Mellitus but can also occur in:Type 2 Diabetes Mellitus especially during severe stress or with SGLT2 inhibitor use. Diagnostic Criteria(2024) Parameter Typical DKA Finding (Diabetes)Blood glucose >200
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Pneumothorax Pneumothorax = Presence of air in the pleural space causing partial or complete collapse of the lung. Normal pleural pressure is negative relative to atmosphere. When air enters pleural space: Negative pressure is lost Lung recoils inward Chest wall expands outward Ventilation decreases Severe cases → hemodynamic compromise Classification Type Mechanism Primary Spontaneous Pneumothorax
Upper Gastrointestinal Bleeding (UGIB) Definition Upper GI bleeding refers to hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, duodenum). Anatomical Classification Site Examples Esophagus Varices, Mallory–Weiss tear, esophagitis Stomach Peptic ulcer, erosive gastritis, malignancy Duodenum Peptic ulcer, Dieulafoy lesion Etiology 1. Non-Variceal UGIB (≈ 80–85%) Peptic Ulcer Disease (most common) Duodenal ulcer >
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Refeeding Syndrome Refeeding syndrome is a potentially fatal metabolic complication that occurs after rapid reintroduction of nutrition (especially carbohydrates) in malnourished or starved patients, characterized by acute shifts of phosphate, potassium, magnesium, fluids, and vitamins (notably thiamine) due to insulin surge. Core hallmark: Hypophosphatemia after refeeding. diagnosis of exclusion Pathophysiology 1️⃣ Starvation State ↓ Insulin,
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Pleural Effusion Normal Pleural Space Contains 5–15 mL fluid Produced mainly by parietal pleura Absorbed via pleural lymphatics Functions as a lubricant allowing lung movement Pleural effusion develops when:Fluid formation > Fluid removal Etiology Transudative Pleural Effusion Cause Mechanism Heart failure(~80% of transudates) Increased hydrostatic pressure Cirrhosis (hepatic hydrothorax)(~13% of transudates) Ascitic fluid migration Nephrotic
Hypokalemia Hypokalemia = Serum potassium (K⁺) <3.5 mEq/L,it is is less dangerous than hyperkalemia. Severity Serum K⁺ Mild 3.0–3.5 mEq/L Moderate 2.5–2.9 mEq/L Severe <2.5 mEq/L 98% intracellular and Only 2% extracellular,Therefore serum potassium may not accurately reflect total body stores. Potassium Homeostasis Mechanism Site/Stimulus Action on Potassium Na⁺/K⁺-ATPase Pump Stimulated by insulin, β₂-agonists, thyroid
Ascites Normal peritoneal cavity contains <50 mL fluid which is usually not visible on routine abdominal ultrasound. Clinically detectable ascites usually requires >1.5 L fluid. Most common cause worldwide: Liver cirrhosis (~80–85% cases). Epidemiology Among patients with cirrhosis: Ascites is the most common complication. Approximately 50% develop ascites within 10 years of diagnosis. Development of
ATRIAL FIBRILLATION Atrial fibrillation is a supraventricular tachyarrhythmia characterized by: Irregularly irregular rhythm(One exception to these criteria is that if AF is combined with heart block, then the ventricular response may be regular.) No distinct P waves(If it is unclear whether there are P waves or fibrillation waves, consider obtaining a Lewis Lead ECG) Fibrillatory
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Hepatorenal Syndrome (HRS) Definition Hepatorenal syndrome (HRS) is a functional, potentially reversible acute kidney injury (AKI) occurring in patients with advanced cirrhosis and portal hypertension(Ascites), in the absence of intrinsic renal disease or structural kidney damage. Epidemiology Occurs in advanced decompensated cirrhosis (often Child-Pugh C) Triggers: Refractory ascites Spontaneous bacterial peritonitis (SBP) Large-volume paracentesis without
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