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JUST THE FACTS IN EMERGENCY MEDICINE - PART 2

Trên điện tâm đồ, bạn có thể thấy phân đoạn ST chán nản, mở rộng sóng T, rút ngắn khoảng QT, và các khối máu cơ tim. Mức trên 20 meq / L có thể gây ngừng tim. • Một ghi nhớ để hỗ trợ thu hồi các nguyên nhân phổ biến là Pam P. Schmidt: | 40 SECTION 2 RESUSCITATIVE PROBLEMS AND TECHNIQUES sion and abdominal groans abdominal pain constipation polyuria polydipsia . DIAGNOSIS AND DIFFERENTIAL On the ECG you may see depressed ST segments widened T waves shortened QT intervals and heart blocks. Levels above 20 meq L can cause cardiac arrest. A mnemonic to aid recall of the common causes is Pam P. Schmidt parathyroid hormone Addison s disease multiple myeloma Paget s disease sarcoidosis cancer hyperthyroidism milk-alkali syndrome immobilization excess vitamin D and thiazides. EMERGENCY DEPARTMENT CARE And disposition Emergency treatment is important in the following conditions a calcium level above 12 mg dL a symptomatic patient a patient who cannot tolerate PO fluids or a patient with abnormal renal function. Correct dehydration with normal saline 5 to 10 L may be required. Consider invasive monitoring. Administer furosemide 40 mg but do not exacerbate dehydration if present. Correct the concurrent hypokalemia or hypomagnesemia. Do not use thiazide diuretics they worsen hypercalcemia . If above treatments are not effective administer calcitonin 0.5 to 4 IU kg IV over 24 h or IM divided every 6 h along with hydrocortisone 25 to 100 mg IV every 6 h. HYPOMAGNESEMIA CLINICAL FINDINGS Mg2 K and PO4 I move together intra- and extracellularly. Hypomagnesemia can present with CNS symptoms depression vertigo ataxia seizures increased DTR tetany or cardiac symptoms arrhythmias prolonged QT and PR worsening of digitalis effects . Also seen are anemia hypotension hypothermia and dysphagia. DIAGNOSIS AND DIFFERENTIAL The diagnosis should not be based on Mg2 levels since total depletion can occur before any sig nificant laboratory changes appear. It must therefore be suspected clinically. In the United States the most common cause is alcoholism followed by poor nutrition cirrhosis pancreatitis correction of diabetic ketoacidosis DKA or excessive gastrointestinal losses. EMERGENCY DEPARTMENT CARE AND DISPOSITION First