Internal Medicine Tips

#cardiology

SGLT2 inhibitors lower blood glucose by increasing urinary glucose excretion, which leads to a state of relative carbohydrate deficiency. This triggers a drop in insulin levels and an increase in glucagon secretion. The low insulin-to-glucagon ratio promotes lipolysis and hepatic ketone production. As a result, patients can develop DKA even though their blood glucose isn't significantly elevated (euglycemic DKA). #pearl

🌟Safe Antihypertensives in Pregnancy: Mothers Love Having Normal BP • M → Methyldopa • L → Labetalol • H → Hydralazine • N → Nifedipine

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Hypokalemia with Acidosis 1- Diahrrea 2- DKA 3- RTA #pearls

Celecoxib : CELE = selective COX = COX-2 IB = InhiBitor Rivaroxaban (-xaban) : xa = factor Xa ban = inhibited #mnemonics

In any patient on Furosemide (Lasix) who has low urine output, do not rush to increase the dose immediately. First, check the serum albumin level because one of the most common causes of diuretic resistance is Hypoalbuminemia. Albumin acts as the carrier that transports furosemide from the bloodstream to the loop of Henle, where the drug exerts its effect. Without adequate albumin, giving more Lasix may have little benefit because the drug cannot effectively reach its site of action. This is especially important in patients with liver disease, particularly those with Liver Cirrhosis, where hypoalbuminemia is very common. #git

Tuberculosis (TB) in chest x-ray #chest

The term Liver Transplantation score usually refers to scoring systems used to assess severity of liver disease and prioritize patients for transplant. The most important are: 1. MELD Score (Model for End-Stage Liver Disease) Used for adult liver transplant priority. 2. Child-Pugh Score Used to assess chronic liver disease prognosis. 3. King’s College Criteria Used for acute liver failure to determine urgent transplant need (especially paracetamol toxicity. #git

🔵 PPI prophylaxis in long-term anti-platelet 🩺 NICE Guidance Summary: Use of PPIs with Aspirin 75 mg (single anti-platelet) for Secondary Prevention 🔍 Clinical Context Low-dose aspirin (75 mg daily) is widely used for secondary prevention of cardiovascular disease (CVD) (e.g., post-MI, stroke, or established atherosclerotic disease). However, it increases the risk of gastrointestinal (GI) bleeding, particularly in high-risk groups. ✅ Indications for Adding a PPI (Proton Pump Inhibitor) According to NICE, a PPI should be co-prescribed with aspirin only if the patient is at increased risk of GI adverse effects. 📌 Offer a PPI if ANY of the following risk factors are present: • Age ≥ 65 years • History of peptic ulcer disease or GI bleeding • Concomitant use of medications that increase GI risk, such as: NSAIDs Oral anticoagulants (e.g., warfarin, DOACs) Corticosteroids SSRIs • Severe comorbidities, such as: Advanced liver disease Chronic kidney disease • Helicobacter pylori infection (especially if untreated or history of ulcer) ❌ Not Routinely Indicated PPI is NOT routinely required in all patients on aspirin 75 mg alone if they are low GI risk. ⚠️ Additional Considerations Use the lowest effective PPI dose and review periodically. Consider H. pylori testing and eradication in those with prior ulcer disease. Balance GI protection vs long-term PPI risks (e.g., fractures, C. difficile, hypomagnesemia). 🧠 Practical Takeaway 👉 Aspirin 75 mg alone does NOT automatically require a PPI 👉 Add a PPI only if GI risk factors are present 🇬🇧 UK Practice Note Many NHS trusts embed this into local prescribing systems, often flagging ≥65 years as a trigger for automatic PPI co-prescription with antiplatelets. 🔄 Quick Decision Rule Aspirin 75 mg + No GI risk factors → No PPI needed Aspirin 75 mg + ≥1 GI risk factor → Start PPI #pharma #cardiology #neurology

🌟Most patients with liver disease (especially cirrhosis) develop bilateral pleural effusion. Main mechanism: Hypoalbuminemia → ↓ plasma oncotic pressure Leads to fluid shift from intravascular space → pleural cavity ⸻ ✅Management : 1. Avoid excessive crystalloids Large volumes of crystalloids can worsen third spacing and effusion. Try to minimize their use whenever possible. 2. If crystalloids are necessary Prefer Ringer’s lactate over normal saline (to avoid hyperchloremic acidosis and sodium overload) 3. Prefer colloids when indicated Better for intravascular volume expansion in hypoalbuminemic patients: Albumin Plasma Blood products (if indicated) ⸻ Diuretics Use loop diuretics (e.g., furosemide): Adequate dosing is important for effective fluid removal Often combined with spironolactone in cirrhotic patients #git #chest

🔷️Asterixis = flapping tremor of hands (negative myoclonus). #git

🟢 Pre-renal Causes of AKI Pre-renal AKI = ↓ renal perfusion without intrinsic kidney damage (initially reversible if corrected early) ⸻ 🔻 1. Hypovolemia (↓ effective circulating volume) Hemorrhage Dehydration (vomiting, diarrhea, poor intake) Excess diuretics Burns / third spacing (pancreatitis, peritonitis) ⸻ 🔻 2. ↓ Cardiac Output Heart failure (especially acute decompensation) Cardiogenic shock Massive myocardial infarction Arrhythmias ⸻ 🔻 3. Renal Vasoconstriction Drugs: NSAIDs → inhibit prostaglandins → afferent constriction ACE inhibitors / ARBs → efferent dilation → ↓ GFR Hepatorenal syndrome #nephrology #cardiology