The Immobile Man: A Neurologists Casebook

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Osteitis cystica fibrosa. What are the malabsorptive complications that can arise from a Billroth II reconstruction of the stomach? Patients who have undergone partial gastrectomy Billroth II may have impaired calcium absorption, impair fatty acid absorption, B12 deficiency, and Iron deficiency. What ECG change is associated with Hypocalcemia? Hypocalcemia is associated with Prolonged QT and may be aggravated by both hypomagnesemia and alkalosis; Hypercalcemia is associated with Shortened QT.


Massive transfusion is associated with hypocalcemia secondary to chelation with citrate in banked blood. Severe, symptomatic hypocalcemia is most commonly encountered following parathyroid or thyroid surgery, or in patients with acute pancreatitis. What is the treatment for these patients? IV Calcium Gluconate!!! Alopecia, poor wound healing , night blindness or photophobia, anosmia, neuritis, and skin rashes are all characteristic of what mineral deficiency?

Zinc deficiency. The deficiency of this mineral is characterized by cardiomyopathy. Selenium deficiency.

The deficiency of this trace mineral is characterized by encephalopathy due to toxic accumulation of sulfur-containing amino-acids. Molybdenum deficiency. This trace mineral deficiency can occur in patients on long-term TPN and is characterized by difficult-to-control hyperglycemia and peripheral neuropathy and encephalopathy. Chromium deficiency. Normal saline and Lactated Ringer solution are examples of isotonic saline solutions. Following administration of large volumes of normal saline, a non-anion-ga metabolic acidosis can result from increased chloride concentrations.

These fluids can be used to replace the volume of blood lost in a patient in what ratio?

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The use of colloids in resuscitation of patients in hemorrhagic shock is controversial; in general, however, colloids can be used to replace blood volume lost at what ratio? What fluid is appropriate to resuscitate a patient with significant nasogastric suction or vomiting losses? Isotonic saline; this is particularly useful in hyponatremic or hypochloremic states and whenever a tendency to metabolic alkalosis is present.

When isotonic solutions are given in large quantities, they overload the kidney's ability to excrete chloride ion, which results in dilutional acidosis. They may also intensify preexisting acidosis by reducing the base bicarbonate-carbonic acid ratio in the body. Administration of what resuscitation fluid is appropriate for replacement of GI losses? Lactated Ringer solution; this is appropriate for replacing GI losses and correcting extracellular fluid deficits.

Lactated Ringer is sufficiently physiological to enable administration of large amount without significantly affecting the body's acid-base balance. Early sepsis is a physiologically hyperdynamic, hypermetabolic state representing a surge in catecholamines, cortisol, and other stress-related hormones. Changing mental status, tachypnea that leads to respiratory alkalosis and flushed skin are often the earliest manifestations of sepsis.

What early hemodynamic change is indicative of occult sepsis? Hyperglycemia and insulin resistance are typical in diabetic as well as non-diabetic patients. This relates to the gluconeogenic state of the stress response.

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The cardiovascular response to early sepsis is characterized by an increased cardiac output decreased systemic vascular resistance, and decreased peripheral utilization of oxygen, which yields a decreased arteriovenous oxygen difference. Trauma, stress, sepsis, burns and surgery all increase the BMR of the body. The BMR can be multiplied by stress factors to better approximate caloric requirements. What is the stress factor associated with routine operation? Multiple organ failure or severe injury? When a patient with a tracheostomy tube has a sentinel bleed from inside the tube days later, what is the proper course of action if the bleed has currently stopped?

If it is ongoing? If the bleeding has ceased then immediate fiberoptic exploration in the operating room is indicated.