- Acid - base
CO2 + H2O <->H2CO3<->HCO3- + H
CO2 > 45 Resp - Acidosis
CO2 < 45 Resp - Alkalosis
HCO3 < 24 Met - Acidosis
HCO3 > 24 Met - Alkalosis
1 Acidosis + Alkalosis ?
HCO3 / CO2 changed?
2. Anion Gap = Na - ( Cl + H CO3 )
-----------------------------------
Emergent Contraception
Ovral
(150 mg ?)
2 pills q12° x 2
Lo Ovral
Triphasil-Active
4 pills Bid
-----------------------------------
Herniation/Inc ICP
Cushings Triad ICP
Dec Hrt Rate
Dec Resp
Inc BP
If see w/ other neuro signs possible herniation.
-----------------------------------
Hyperbilli @ day #10
1° Galactosemia
Creiger-Nagle
Rotavirus
~Fructosemia
Biliary Atresia
Gilbert's
Dubbin-Johnson
2° Hypothyroidism
UTI
-----------------------------------
Low risk factors for SBI
WBC- 5-15
Bands < 5 thousand
Pyuria - Ø
Stooe - WBC < 25/hpf
Infection - No sign of focal Infection
BF - (+)
-----------------------------------
Crit & HC & Wt Perinatally
-HEMATOCRIT
AGE Crit Retic PO2 Poises
Antinatal 55 5 25 On
Perinatal 55 0 50 Off
Because Wt inc & no production -> Low Crit
-HC
Birth 37cm ^ by 1cm/Mo
3 mo 40 cm
12 mo 45 cm ^by 10 cm/yr
2 yr 50 cm
Adult 55 cm
-WT
^ by 1 Oz/Day for 1° 4 months
-----------------------------------
Long QT Syndrome (LQTS)
Etiology-
- Once considered rare
- now found to just be concealed by other diagnosis
- Causes
Drugs
- antianginals
- Antiarrhythmics
-Class Ia
- Class III
- Antibiotics ( Erythro, Pentamidine, Tmp/sulfa)
-Antifungals (Fluconazole, itraconizole, Ketoconazole)
- Antihistamines (Astermizole, Terfenadine)
- Antipsychotics (Haloperidol, Respiridone, Phenothiazines)
- Lipid lowering drugs (Probucol)
- Oral Hypoglycemic (glibeclamide, Gliburide)
- Organophosphates
- Promotil agent (Cissapride)
Electric disturbances
- Acute hypokalemia (Associated with Diuretics & hyperventilation)
- Chronic hypocalcemia
- Chronic Hypokalemia
- Chronic hypomag
Underlying Medical Disorders
- Arrhythmia ( Complete AV block, bradycardia, sick sinus)
- Cardiac ( Anthracycline tox, CHF, myocarditis, tumors
- Endocrine (hyperpararthyriod, Anorexia Nervosa, starvation, liquid protein diet)
PERTINENT FAMILY HISTORY
-Unexplained fatal accidents (ie single auto accidents)
- SIDS
- Familial epilepsy or fainting spells
SYNDROMES -
- Jewell & Lange-Nielsen
- rare 1to 6/miliion
- Autosomal Recessive
- Sensorial Hearing loss
- Romano Ward
- Not Rare just underdiagnosed
- Heterogeneous collection of 6 genotypes
- 1 in 10,000
- No Gender
- Accounts for 4,000 SIDS /yr
PRESENTATION
-Can strike quickly, 1/3 of previously healthy kids die suddenly
- 60 % have activity or emotion-related syndromes
- Syncope
- Sz
- Palpitations
if sx related to fight or flight LQTS should be concidered
Swimming seems to be a particular trigger
Often misdiagnosed as epilepsy
Cerebral Ischemia 2° to ventricular arrhythmia
-sequence- Dizziness, lightheadedness, blackout, LOC, then sz.
More than 1/3 are asymptotic
EVALUATION
EKG
Determine QTc ( QT/sq rt R-R)
inspect T waves
TREATMENT
10 yr mortality is 50 % w/therapy <5%
ß- blockers
Pacemakers/Defibrilators
Left cervicothoracic sympathetic ganglionectomy
Role of 1° care physician is to:
monitor compliance
watch for side effects
Depression
bronchospasm
Facilitate tx w/ breakthroughs
Some experts recommend tx every one with LQTS because 1/3 present DOA
Always treat if QT > .6
No competitive sports, and always with a buddy
Tx for electrolyte imbalance is Mg
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