Wednesday, March 25, 2009

Today, Dr. Poi asked:

" So youjiang, why must we correct sodium levels at around 8-10mmol/L a day?"

So i replied:

"i dunno. like seriously i dunno."

I looked at the House Officer.

He looked at me. I knew we made a connection when he gave me the "oh shit look away i dont know either" look.

Ladies and gents, the correct answer is:


this is classically observed in alcoholics

alcoholics often have hyponatremia

overvigorous correction results in CPM

note: damage to myelin sheath happening in pons and beyond = ODS osmotic demyelination syndrome

Cranial nerve lesions with quadraparesis

(acute paralysis, dysarthria, dysphagia)

KIV locked in syndrome (ventral pontine syndrome)

Monday, March 23, 2009

urine dipstick: nitroprusside coated, changes color with acetoacetate

Capillary blood for betahydroxybutyric acid

chorea = caudate
athetosis = putamen
hemiballismus = basal ganglia

Sunday, March 22, 2009

Polymyalgia rheumatica
- it means pain and stiffness in many muscles (neck shoulders hips especially)
- due to an inflammatory condition of the muscles
- onset can be both acute and insiduous
- WBC attacking joint lining
Typical history:
- usually in adults > 50 yo, women 2x > men
- acute/insiduous
- pain in their muscles on waking, so muhc so that activity is limited
- fatigue and LOA
- anemia
- general sense of being unwell
Look out for signs and symptoms of temporal arteritis: 50% have temporal arteritis
- fever headache
- jaw claudication
- tongue claudication
- reduced visual auity or acute visual loss
For polymyalgia rheumatica: no specific ones:
- ESR and CRP are raised
For temporal arteritis:
- FBC: raised platelets
- ESR and CRP are raised
Gold standard for diagnosing temporal arteritis is biopsy of temporal artery from multiple parts
Imaging studise: US shows halo sign, others include MRI and CT
Pain relief and prevention of weakening of muscles:
- Exercise
- Mild pain: aspirin, ibuprofen
- Severe pain: steroids (prednisolone)