Jan 2nd, 2020 - Diagnosis and management. If a patient receiving VPA is experiencing nausea, fatigue, or somnolence, it is important to check the patient’s ammonia level (normal range: 11 to 32 µmol/L) and VPA total levels (therapeutic range: 50 to 125 µg/mL).
Cynthia A. Smith, DNP, CNN-NP, FNP-BC, APRN, FNKF
Oct 15th, 2019 - Q)What exactly is the difference between the protein-to-creatinine ratio and the microalbumin in the lab report? How do they compare? For the non-nephrology provider, the options for evaluating urine protein or albumin can seem confusing. The first thing to understand is the importance of assessing for proteinuria, an established marker for chronic kidney disease (CKD).
Feb 28th, 2019 - Patient assessment The physical examination should involve localization and quantification of weakness, and assessment for fever, rash, atrophy/wasting/scooping of forearms, fasciculations, cranial nerve involvement, Raynaud’s phenomenon, nailfold capillary changes, arthritis, calcinosis, “mechanic’s hands,” signs of other autoimmune diseases, and lung crackles. Initial laboratory testing shoul.
Aug 29th, 2018 - Percutaneous coronary intervention can be performed with "ultra-low" contrast volume -- less than or equal to the patient's estimated creatinine clearance -- when the individual is at high risk of acute kidney injury. (Catheterization and Cardiovascular Interventions) European medical societies came out with their position on patent foramen ovale (PFO) management: "perform percutaneous closure ...
May 19th, 2018 - Conversely, entecavir, an older and less expensive drug than TAF, deserves priority in a patient with no prior exposure to a nucleoside, no HIV coinfection, or in an individual with a creatinine clearance below 15 mL/min after dose adjustment. TAF hasn’t been studied in patients with a creatinine clearance that low.
Apr 4th, 2018 - Patients had to have a cardiac ejection fraction greater than 40%. For inclusion, patients had to have estimated creatinine clearance greater than 40 mL/min, bilirubin less than two times the upper limit of normal, and ALT/AST less than 2.
Aug 24th, 2017 - Comment Amyopathic DM is a subset of DM that accounts for 10% to 20% of DM cases. 1,2 Sontheimer’s3 diagnostic criteria for ADM require histopathologic confirmation of the hallmark skin findings of classic DM and lack of muscle weakness or muscle enzyme (creatine kinase/aldolase) elevation for at least 2 years.
Michael Lawrenz Ferreras Co, MD, Anshuman Das, MD et. al.
Aug 1st, 2017 - A 22-year old man with no cardiac history presented to our emergency department after 5 days of dyspnea, cough, vomiting, and sharp intermittent epigastric pain. He used marijuana chronically and had inhaled it in unusually high amounts for several days before the onset of his symptoms.
Jul 31st, 2017 - Order Set Modifications After the P&T committee decision to emphasize UFH for VTE prophylaxis in October 2013, the relevant electronic order sets were altered to highlight the fact that UFH was the first choice for VTE prophylaxis. The order sets still allowed LMWH (enoxaparin) or alternative anticoagulants at the prescribers’ discretion but indicated they were a second choice.
Apr 4th, 2017 - Action Points Higher than creatinine clearance (CrCL)-based doses of allopurinol can effectively lower serum urate (SU) levels to treatment target in most people with gout, and the allopurinol dose escalation is well tolerated. Recognize that while the aim of achieving target SU is dissolution of monosodium urate crystals, suppression of gout flares, and regression of tophi, reluctance to incre...
Dec 8th, 2016 - BOSTON, MA — Among patients on long-term warfarin therapy seen in an anticoagulation clinic, those with CAD or moderate renal impairment when therapy was started were most likely to develop severe renal impairment—defined as creatinine clearance (CrCl) <30 mL/min—often within months, in a new study. This pattern would be similar in patients receiving novel oral anticoagulants (NOACs), althou...
Oct 1st, 2016 - This last point is critical because it can delay VHE identification and treatment or worse, result in misdiagnosis with accompanying continuation or escalation of VPA dosing as has initially occurred in Mr. D’s case.
Aug 13th, 2016 - DURBAN, SOUTH AFRICA – The optimal frequency of kidney safety monitoring in patients using oral daily tenofovir/emtricitabine for pre-exposure prophylaxis against HIV infection is every 6 months, but less frequent monitoring may be reasonable in most low-risk patients, Renee Heffron, PhD, said at the 21st International AIDS Conference. The occurrence and pattern of detection of a drop in creati.
Jul 19th, 2016 - Time to pregnancy (TTP) was longer in couples in which the men had high concentrations of acetaminophen in the urine than it was among couples in which the men had low concentrations of the commonly used pain reliever, according to a report published online July 13 in Human Reproduction. Exposure to acetaminophen may come from the environment, as well as in the form of a pill. Para-aminophenol ...
Mar 23rd, 2016 - Action Points Arhalofenate, an investigational uricosuric drug that also prevents the local release of inflammatory cytokines involved in gout attacks, was effective in preventing disease flares in this most common inflammatory arthritis. Note that changes in estimated creatinine clearance were similar between arhalofente and allopurinol (with or without colchicine), and no treatment-emergent r...
Feb 23rd, 2016 - TREATMENT Benzodiazepines, ECT Mr. R is admitted for stabilization of catatonic symptoms.
Aug 6th, 2015 - Action Points Note that this cohort study reveals factors that appear to influence hydroxychloroquine concentrations among individuals with lupus. Be aware that the study does not link hydroxychloroquine levels with disease activity. Factors significantly associated with low blood hydroxychloroquine (HCQ) concentrations are high body mass index (BMI), no concomitant treatment with corticosteroi...
Aug 3rd, 2015 - Caution must be used when prescribing direct oral anticoagulants to older patients, especially those in a frail condition, according to an opinion piece by Anne-Laure Sennesael and her associates. In the case study, an 86-year-old woman weighing 55 kg was admitted to an emergency department with persistent epistaxis.
Aug 1st, 2015 - TRIALS OF STENTING VS MEDICAL THERAPY ALONE Technical improvements have led to more widespread use of diagnostic and interventional endovascular tools for renal artery revascularization. Studies over the past 10 years examined the impact of stenting in patients with uncontrolled hypertension.
Jun 8th, 2015 - NATIONAL HARBOR, Maryland — The American Geriatrics Society (AGS) is updating its Beers Criteria, which help prevent adverse drug events in older adults. A preview was shared during a well-attended plenary symposium here at the AGS 2015 Annual Scientific Meeting, and the final version is scheduled to be published in July. The society is removing its recommendation to avoid nitrofurantoin in pat...