1/#Morningreport @SinaiBmoreIMRes
featured a young patient presenting with abdominal pain X 2 weeks with a serum K=2.8.
There was also increased urinary frequency
some weakness and fatigue during the past 2 weeks
#DDX #MedTwitter #medstudents #FOAMed
2/The DDX for Hypokalemia requires consideration of a 3 pronged approach: 1)Decreased intake 2)Renal and GI losses and 3) IC shifts. Image
3/For the workup: Spot urine potassium and 24 hour urinary Potassium suggested urinary K wasting.
[UK] high (>40 mEq/L) =renal K loss
TTKG of 9 was concerning for renal potassium wasting
In hypokalemia (K⁺ <3.5 mEq/L), the TTKG > 7 suggests renal K wasting. Image
4/In this patient, there was also metabolic alkalosis and volume depletion with high urine Cl making a case for suspected Gitelman or Barrter syndrome.
We can tell the difference with a UCa. Low spot Ca:Cr ratio suggests a DX of Gitelman syndrome. Image
4/#Pearl
Manifestations of hypoK: vomiting, diarrhea, ileus, anorexia muscle weakness including respiratory muscles,
ECG changes: PACs, sinus bradycardia, ST depression, decrease in the amplitude of the T wave, and U waves in the lateral precordial leads. QT prolongation Image
5/#Pearl
Note: A normal individual can, in the presence of potassium depletion that is not due to urinary losses, lower urinary potassium excretion below 25 to 30 mEq per day on a 24-hour urine
6/#Pearl: The most common causes of hypokalemia are either GI (vomting, diarrhea) or Urine wasting (eg. Diuretic) Image
7/#Pearl: assess potassium excretion: 24-hour urine collection or alternatively with potassium-to-creatinine ratio on a spot urine are alternatives.
-can check The TTKG: During hypokalemia (K⁺ <3.5 mEq/L), the TTKG should be <3; greater values suggest renal K wasting Image

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More from @SinaiBmoreIMRes

Aug 24, 2021
1/9 #Morningreport recently @SinaiBmoreIMRes
by M. Thomas featured a middle aged pt presenting with sudden collapse whilst getting ready in the morning.
No prodromal episodes
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed
2/9
For acute collapse, this would need to be defined along the spectrum of:
Pre-syncope-> Syncope-> Near SCD-> SCD.
3/9
A quick review of medications show multiple medications that can present with this condition:
Read 9 tweets
May 1, 2021
1/10 #Morningreport recently @SinaiBmoreIMRes
by N.Rapista recently featured an elderly pt with an episode of dysphagia x 1 week
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed Image
2/10 Further history:
Unable to swallow any solid food
• “held in the throat”
• coughing frequently
• Generalized malaise
• New left ptosis
3/10EXAM:
T: 36.4°C BP: 139/69 HR: 68 RR: 18 SpO2: 100% on room air
Gen: Awake, alert
HENT: Left ptosis
Neuro: A&Ox3, CN 2-12 grossly intact. Moves all extremities spontaneously, 5/5 all extremities but had some fatigue and dropped to 4/5 with resistance. Cerebeller Neg
Read 10 tweets

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