Do Ammonia Levels Correlate with Hepatic Encephalopathy? - October ...
Explores the connection between ammonia levels and encephalopathy in patients
with advanced liver disease.

  • Advanced Search > > > > Previous | Do Ammonia Levels Correlate with Hepatic Encephalopathy? Hepatic encephalopathy in patients with chronic liver dysfunction is believed to be caused by a failure of the liver to clear toxic products from the stomach

  • Many physicians determine ammonia levels to diagnose hepatic encephalopathy and as a guide to treatment

  • However, studies have shown that the correlation between serum ammonia levels and severity of hepatic encephalopathy is inconsistent

  • A recent study suggested that the partial pressure of ammonia may correlate more closely with the severity of hepatic encephalopathy than the total plasma ammonia level

  • Ong and associates evaluated the correlation between plasma ammonia levels and the severity of hepatic encephalopathy

  • The arterial total ammonia level had the highest correlation, but it was not statistically significant

  • Other variables that had a correlation to the severity of hepatic encephalopathy included International Normalized Ratio (INR) values, serum creatinine levels, bilirubin levels, and lactulose use

  • A multivariable ordered logistic regression analysis revealed that only serum ammonia levels and INR values were independently associated with the severity of hepatic encephalopathy

    Hyperkalemia - January 15, 2006 -- American Family Physician
    Details the disorders and agents that can cause this condition, methods for
    diagnosis, and medications used in treatment.

  • Serum potassium levels can be lowered acutely by using intravenous insulin and glucose, nebulized beta2 agonists, or both

  • Sodium polystyrene therapy, sometimes with intravenous furosemide and saline, is then initiated to lower total body potassium levels

  • Nutritional and herbal supplements Herbs containing high potassium levels (e.g., Noni juice, alfalfa, dandelion, horsetail, nettle) Packed red blood cells Stored cells can partially hemolyze and release potassium when infused

  • Normal Potassium Physiology Two mechanisms normally regulate potassium levels in response to variation of potassium intake

  • Elevated insulin levels induce rapid transport of potassium from the extracellular space into cells via cellular sodium-potassium adenosine triphosphatase

  • Potassium released from platelets can lead to spuriously high levels of potassium in a blood sample allowed to clot to collect serum

  • Pseudohyperkalemia can be excluded by repeating the sample collection as atraumatically as possible and obtaining serum and plasma potassium levels

  • Judicious monitoring of potassium levels is important in at-risk patients receiving these medicines

    IGA Nephropathy, The Transplant
    A personal story of Darryl who had this disease. From the beginning, to the
    diagnosis, the kidney transplant and the update.

    eMedicine - Hypermagnesemia : Article by Nona Novello, MD
    Nona Novello, MD explains the importance of magnesium in the function of the
    human body. Includes synonyms, symptoms, causes, lab studies, medication, ...

  • Magnesium levels of 2-4 mEq/L are associated with the following: Nausea Vomiting Skin flushing Weakness Lightheadedness High magnesium levels are associated with depressed levels of consciousness

  • Physical: Physical findings are related to the serum magnesium levels

  • Serum magnesium levels of 3.5-5.0 mEq/L are associated with the following: Disappearance of deep tendon reflexes Muscle weakness Serum magnesium levels of 5.0-6.0 mEq/L are related to the following: Hypotension Vasodilatation Serum magnesium levels of 8.0-10.0 mEq/L are associated with the following: Arrhythmia, including atrial fibrillation Intraventricular conduction delay Levels of serum magnesium greater than 10.0 mEq/L are related to the following: Asystole Heart block Ventilatory failure Stupor or coma Death Elevated levels of magnesium also are associated with the following: Delayed thrombin formation Platelet clumping Causes: Most cases of hypermagnesemia are due to iatrogenic interventions and administration, especially errors in calculating appropriate infusions

  • Lab Studies: Electrolytes, including potassium, magnesium, and calcium levels A test for ionized magnesium is not clinically available


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    eMedicine - Hypokalemia : Article by Eleanor Lederer, MD
    Eleanor Lederer, MD discusses why potassium is essential to life. Includes three
    mechanisms that cause a decrease in serum blood levels, risk factors, ...

  • Excretion is increased by (1) aldosterone, (2) high sodium delivery to the collecting duct (eg, diuretics), (3) high urine flow (eg, osmotic diuresis), (4) high serum potassium level, and (5) delivery of negatively charged ions to the collecting duct (eg, bicarbonate)

  • Excretion is decreased by (1) absence or relative deficiency of aldosterone, (2) low sodium delivery to the collecting duct, (3) low urine flow, (4) low serum potassium level, and (5) renal failure

  • Therefore, potassium levels can remain relatively normal under stable conditions, even with advanced renal insufficiency

  • Serum potassium level Potassium is predominantly an intracellular cation; therefore, serum potassium levels can be a very poor indicator of total body stores

  • Because potassium moves easily across cell membranes, serum potassium levels reflect movement of potassium between intracellular and extracellular fluid compartments as well as total body potassium homeostasis

  • Frequency: In the US: In the general population, data are difficult to estimate; however, probably fewer than 1% of people on no medications have a serum potassium level of lower than 3.5 mEq/L

    Postgraduate Medicine: Management of hypercalcemia
    Presents a diagnostic workup, therapeutic options for hyperparathyroidism, and
    other common causes.

    Postgraduate Medicine: Staphylococcal toxic shock syndrome
    Explores the scientific and medical aspects of the organism and the disease.

    THE MERCK MANUAL, Sec. 2, Ch. 12, Water, Electrolyte, Mineral, And ...
    The Merck Manual: A look at total body water, intake, losses, osmolality, water
    balance and sodium balance, increase and decrease in extracellular fluid volume ...

  • Benefits

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    THE MERCK MANUAL, Sec. 13, Ch. 158, Systemic Fungal Diseases<BR ...
    Provides detailed information on each of the major mycotic infections, including
    symptoms, diagnosis, prognosis, and treatment.

  • Some tests, such as complement fixation assays for anti-coccidioidal antibodies, are specific and do not require proof of rising levels and thus can provide invaluable confirmatory evidence for diagnosis as well as an indication of the relative risk of extrapulmonary dissemination

  • It has high penetration into CSF (&#62;= 70% of serum levels) and has been especially useful for the treatment of cryptococcal and coccidioidal meningitis (see )

  • However, fluconazole sometimes causes elevated serum levels of cyclosporine, rifabutin, phenytoin, warfarin-type oral anticoagulants, sulfonylurea drugs such as tolbutamide, or zidovudine

  • Rifampin may lower fluconazole blood levels

  • Because of its high lipid solubility and protein binding, itraconazole blood levels tend to be low, but tissue levels are generally high

  • Drug levels are negligible in urine or CSF

  • Itraconazole, like ketoconazole, requires an acid pH for absorption, so that blood levels may vary after oral administration

  • Itraconazole also inhibits metabolic degradation of other drugs, causing blood level elevations with potentially serious consequences

    LIVING with Wegener's Granulomatosis
    The author tells of her ordeal because there are millions of people who could
    contract this disease, and in the hopes that this article helps them or their ...

  • At this time my creatinine level was 9.6 (normal is .5) my potassium level was 6.1 (normal is under 5.0) and my blood pressure was 210/106

  • By the next day the poison levels had receded enough to stay the execution, and tell us that while badly damaged, my kidneys were working on their own to some degree

    Species Jump: Human Ehrlichiosis- Mutant or Emergence?
    Research article on the disease. Includes organism description, similar organisms,
    symptoms, bibliography, and speculation on the origin of the rickettsia.

  • Occasionally, renal (kidney) abnormalities will be noted as an increase in blood urea, nitrogen and creatinine levels

  • The best that can be hoped for is that we continue to devise new ways of slowing down microbes or form treatments which lessen infection severity to a level where the host immune system is able to prevail

    Ontario Association of Medical Laboratories
    Represents independently-owned community-based medical labs in dealing with the
    government, other professions and the public.

  • Ontario&rsquo;s community laboratories have begun routine reporting of an estimated glomerular filtration rate (eGFR), based on the Modification of Diet in Renal Disease (MDRD) equation, for all adult patients (19 and older) for whom a serum creatinine level is ordered


    Hypermagnesemia - New Treatments, May 2, 2006
    Medical library journal explains advances in the treatment of high magnesium.
    Includes normal levels, clinical evaluation, effect on the heart and muscles, ...

  • Cardiovascular Manifestations of Hypermagnesemia Lower levels of hypermagnesemia &lt;10 mEq/L

  • Levels greater than 10 mEq/L

  • Heart block progressing to complete heart block and asystole occurs at levels greater than 12.5 mMol/L (&gt;6.25 mMol/L)

  • Neuromuscular Effects Hyporeflexia occurs at a Mg level &gt;4 mEq/L (&gt;2 mMol/L); an early sign of magnesium toxicity is diminution of deep tendon reflexes caused by neuromuscular blockade

  • Respiratory depression due to respiratory muscle paralysis occurs at levels &gt;13 mEq/L (&gt;6.5 mMol/L)

  • Somnolence and coma occur at very elevated levels

    Lithium Carbonate, Eskalith, Lithane, Lithobid Pharmacology ...
    Information sheet covers description, pharmacology, uses, dosage, side effects,
    and other advice for patients.

  • Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to therapeutic levels

  • Usage in the Elderly: Elderly patients often require lower lithium dosages to achieve therapeutic serum levels

  • They may also exhibit adverse reactions at serum levels ordinarily tolerated by younger patients

  • Caution should be used when lithium and diuretics are used concomitantly because diuretic-induced sodium loss may reduce the renal clearance of lithium and increase serum lithium levels with risk of lithium toxicity

  • Patients receiving such combined therapy should have serum lithium levels monitored closely and the lithium dosage adjusted if necessary

  • Interactions Indomethacin and piroxicam have been reported to increase significantly, steady state plasma lithium levels

  • When such combinations are used, increased plasma lithium level monitoring is recommended

  • There is evidence that angiotensin-converting enzyme inhibitors, such as enalapril and captopril, may substantially increase steady-state plasma lithium levels, sometimes resulting in lithium toxicity

  • When such combinations are used, lithium dosage may need to be decreased, and plasma lithium levels should be measured more often

    Mepron Suspension
    Prescribing information in pdf format.

    ATSDR - MMG: Phenol
    Phenol is corrosive and causes severe chemical burns on contact. Systemic effects
    can occur from all routes of exposure. There is no antidote for phenol.

  • Children exposed to the same levels of phenol vapor as adults may receive larger doses because they have greater lung surface area:body weight ratios and increased minute volumes:weight ratios

  • In addition, they may be exposed to higher levels than adults in the same location because of their short stature and the higher levels of phenol vapor found nearer to the ground

  • Most people can detect sulfur dioxide at levels of 1 to 3 ppm (1 ppm is equivalent to 2.62 mg/m³)

  • Respiratory Protection : Positive-pressure, self-contained breathing apparatus (SCBA) is recommended in response situations that involve exposure to potentially unsafe levels of phenol vapor

  • Rescuer Protection If exposure levels are determined to be safe, decontamination may be conducted by personnel wearing a lower level of protection than that worn in the Hot Zone (described above)

    The Juvenile Diabetes Forum at Med Help
    Interactive medical question and answer format about all aspects of juvenile (type
    1) diabetes.

    Streptococcal Toxic-Shock Syndrome
    Research article discusses the spectrum of the disease, pathogenesis, and new
    concepts in treatment.

  • The serum creatinine kinase level is useful in detecting deeper soft-tissue infections; when the level is elevated or rising, there is a good correlation with necrotizing fasciitis or myositis

    How to review your blood test results
    Explains glucose, electrolytes, minerals, thyroid and others.

  • This is a measure of the sugar level in your blood

  • A precursor, Impaired Fasting Glucose (IFG) is defined as reading of fasting glucose levels of 110 - 125

  • These are your potassium, sodium, chloride, and CO2 levels

  • There are numerous causes of high and low sodium levels, but the most common causes of low sodium are diuretic usage, diabetes drugs like chlorpropamide, and excessive water intake in patients with heart or liver disease

  • Low CO2 levels can be due to either to increased acidity from uncontrolled diabetes, kidney disease, metabolic disorders, or low CO2 can be due to chronic hyperventilation

  • BUN is also affected by high protein diets and/or strenuous exercise which raise levels, and by pregnancy which lowers it

  • High values, especially with high BUN levels, may indicate problems with the kidneys.

  • If blood is not processed promptly and properly, high levels may occur

  • However, when the level gets too high, vascular disease can result

  • The levels that your doctor will recommend depend upon whether you are at high risk for cardiovascular disease

  • As the level of blood cholesterol increases, so does the possibility of plugging the arteries due to cholesterol plaque build-up

    FLUCONAZOLE a Commonly Used Medication
    aka Diflucan.

  • Contraindication: terfenadine, astemizole, cisapride, pimozide Drug Interactions: Oral contraceptives: higher level of levonorgestrel

  • Cimetidine and rifampin decrease flucon level

  • Rifabutin has increased levels and toxicity

  • Phenytoin levels may increase, as may zidovudine, delavirdine, and theophylline; oral hypoglycemics of the sulfonylurea type may have increased level, producing hypoglycemia

  • May increase sildenafil (Viagra) levels

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