Hyperkalemia

Chief Compliant The patient is a 50 year old white male with hypertension who presents with an elevated serum potassium on routine screening. History of the Present Illness Serum potassium > 5.5 mMol L (repeat test to exclude lab error) muscle weakness, syncope, lightheadedness, palpitations, oliguria oral or intravenous potassium, salt substitutes, potassium sparing diuretics, angiotensin converting enzyme inhibitors nonsteroidal anti-inflammatory drugs, beta-blockers, heparin, digoxin,...

Oculovestibular Reflex Cold caloric maneuver

Irrigation of ear with cold water causes tonic deviation of eyes to irrigated ear if intact brain stem if the patient is conscious, nystagmus and vertigo will occur. Labs Glucose, electrolytes, calcium, BUN, creatinine, ABG. CT MRI, ammonia, alcohol, liver function tests, urine toxicology screen, B-12, folate levels. LP if no signs of elevated intracranial pressure and suspicion of meningitis. Differential Diagnosis of Delirium Electrolyte imbalance, hyperglycemia, hypoglycemia (insulin...

Hematemesis and Upper Gastrointestinal Bleeding

Chief Compliant The patient is a 50 year old white male with peptic ulcer disease who complains of emesis of blood for 4 hours. History of the Present Illness Duration and frequency of hematemesis (bright red blood, coffee ground material), volume of blood, hematocrit. Forceful retching prior to hematemesis (Mallory-Weiss tear). Abdominal pain, melena, hematochezia (bright red blood per rectum) history of peptic ulcer, esophagitis, prior bleeding episodes. Nose bleeds, syncope, lightheadedness,...