58yo male, with DMI controlled with insulin, has blood glucose measurements in the morning of 205-272 mg/dL for the past week. He reports that his evening blood glucose measurements before bed range from 103-127 mg/dL. What are two potential causes of these findings?
There are four main ways pH can change:
Remember, that the lungs can compensate considerable FASTER than the kidneys.
Respiratory Acidosis
Respiratory Alkalosis
If the condition is 100% acute respiratory, then the pH will change 0.08 for every 10 mmHg change in PaCO2
Metabolic Acidosis
Metabolic Alkalosis
In an oliguric patient, what is the first step in differentiating between prerenal and intrinsic renal causes?
The fractional excretion of sodium (FENa) can help differentiate prerenal from intrinsic renal causes in patient with oliguria. If the FENa is < 1%, it suggests prerenal and if it is > 2%, it suggests intrinsic renal causes. There are many limitations to using this calculation, but it is a good first step in determining the cause of a patient’s oliguria. Other laboratory studies, such as BUN/Cr, can be useful as well.
Other Known Aliases – none
Definition – an acquired, localized fibrotic disorder of the tunica albuginea where thick, fibrous plaques compress the corpora cavernosa
Clinical Significance – The pathogenesis of Peyronie’s disease is unknown and is postulated to be multifactorial. Patients experience pain, penile deformity, and sexual dysfunction
History – Named after François de la Peyronie (1678-1747), who was a French surgeon and received his medical training as a barber-surgeon in Montpellier in 1695. He continued his academic career teaching and practicing surgery and anatomy throughout France. In 1736, he was appointed first-surgeon to King Louis XV and was instrumental in organizing formal training in the surgical arts and was a major force in the creation of the 1743 law that banned barbers from practicing surgery. Also in 1743, he first described the eponymous disease in a book on ejaculation dysfunction where described “indurations of the cavernous bodies like rosary beads” leading to penile curvature. His last name, lapeyronie, means litter stone because his father was a stone cutter. Its a shame he didn’t pursue management of kidney stones as his claim to fame.
References
In an oliguric patient, what is the first step in differentiating between prerenal and intrinsic renal causes?
Other Known Aliases – none
Definition – spiral fracture of the proximal third of the fibula caused by pronation with external rotation
Clinical Significance – This injury is a sequelae of significant ankle trauma with disruption of the distal tibiofibular syndesmosis and can be unstable. It is also one of the criteria of the Ottawa Rules of the Ankle so you don’t miss these
History – Named after Jules Germain François Maisonneuve (1809-1897), a French surgeon who studied under Guillaume Dupuytren in the mid-1800s. He first reported this injury pattern in 1840 in the article entitled Recherches sur la fracture du Péroné. He was also the first surgeon to advocate the use of external fixation in the management of ankle fractures
References
What rheumatologic disease can be summed up the phrase “can’t see, can’t pee, can’t climb a tree”?
The triad of ocular symptoms (conjunctivitis, uveitis, episcleritis, keratitis), genitourinary symptoms (dysuria, urethritis, cervicitis) and musculoskeletal symptoms (arthritis, enthesitis, dactylitis) are diagnostic of reactive arthritis.
