Q: Why are Smurf’s Blue?
A: Methaemoglobin (MetHb) of course!
– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+
– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)
– Often due to chemical ingestion, but may also be genetic
– Treated with Methyl Blue & supportive measures
Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.
However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature
We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK
Trust Guidance varies slightly from BNF for those patients over 100kg
| Dalteparin Cr Clearance >29ml/min | Dalteparin Cr Clearance 20-29ml/min | ||
|---|---|---|---|
| Weight (kg) | Dose | Weight (kg) | Dose |
| <45kg | 7,500 units OD | <63kg | 5,000 units am 2,500 units pm |
| 45-56kg | 10,000 units OD | 63-80kg | 5,000 units BD |
| 57-68kg | 12,500 units OD | 81-98kg | 7,500 units am 5,000 units pm |
| 69-82kg | 15,000 units OD | 99-116kg | 7,500 units BD |
| 83-100kg | 18,000 units OD | 117-134kg | 10,000 units am 7,500 units pm |
| 101-115kg | 10,000 units BD | 135-152kg | 10,000 units BD |
| 116-140kg | 12,500 units BD | ||
| >140kg | 15,000 units BD | ||
| Weight (kg) | Dose |
|---|---|
| <50kg | 10,000 units OD |
| 50-69kg | 12,500 units OD |
| 70-79kg | 15,000 units OD |
| 80-89kg | 18,000 units OD |
| 90-109kg | 20,000 units OD |
| 110-124kg | 22,500 units OD |
| 125-139kg | 12,500 units BD |
| 140-154kg | 15,000 units am 12,500 units pm |
| 155-169kg | 15,000 units BD |
Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19
Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE
What is retrobulbar haemorrhage?Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
