and we’re back! with BRAND SPANKIN' NEW tangents!
welcome redditors!to snoo-finity ... and beyond!
Welcome to johnson's page.
Contributor score: 1
School:


Comments ...




Subcomments ...

How do you distinguish this from testicular torsion? Is it just because it started in the left flank?

neels11  and there's no mass in the scrotum, whereas testicular torsion will have that "bag of worms" feel (along with a lack of cremaster reflex) testicular torsion usually happens in a younger age group +1  
medpsychosis  @neels11 I would like to clarify a piece of information. I believe you are confusing Varicocele with Testicular Torsion. Varicocele will present with "bag of worms" feeling. While the absence of cremasteric reflex is a sign of testicular torsion. +  
johnson  This is the classic "loin to groin pain" of nephrolithiasis. +  


Ugh... got tripped up with "Refer both patient and her parents to a dietician"

Over thinking...I thought the source of their arguments were at meal times especially...so maybe they can find a good solution with a dietician.

OCCAMs RAZOR THIS SHIT. keep it simple stupid. The answer fits the best after re reading it.

nwinkelmann  SAME.... ugh! +  
johnson  Also - you're almost NEVER referring/passing on a patient with the USMLE. +1  


Can someone explain why does this patient have hypokalemia?

colonelred_  Catecholamines activate the Na/K pump, which will drive K inside. +5  
trazabone  Read online that catachelamines are released following tonic clonic seizures. Besides that, BP of 180/100 could indicate that catecholamines are circulating. +  
fulminant_life  This mechanism is why giving albuterol for hyperkalemia works +3  
nbmehelp  Why does this guy have increased catecholamines tho +  
johnson  His SNS activity is seriously increased --> increased catecholamines. +  
nbmehelp  Why is his SNS activity increased? Is the BP literally the only hint? +  
youssefa  Alcohol withdrawal creates a hyper- catecholaminergic state + Seizures do that as well. +1  
water  My best guess is that withdrawal puts the body in a state of stress (same for seizures) and with stress you have release of catecholamine which we'll see in the BP and the hypokalemia. +  


submitted by m-ice(117),

The most important ethical principle that supersedes all others is autonomy. From an ethical standpoint, this patient has the right to refuse further treatment as he is mentally competent, in this case in the form of having the respiratory removed. From a legal standpoint, the physician is allowed to discontinue treatment for a patient if that is what the patient wants. This is different from situations of physician assisted suicide, which is more complicated and has variable ethics and legality.

rhsteps  isnt this considered physician assisted suicide? +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  


submitted by m-ice(117),

The most important ethical principle that supersedes all others is autonomy. From an ethical standpoint, this patient has the right to refuse further treatment as he is mentally competent, in this case in the form of having the respiratory removed. From a legal standpoint, the physician is allowed to discontinue treatment for a patient if that is what the patient wants. This is different from situations of physician assisted suicide, which is more complicated and has variable ethics and legality.

rhsteps  isnt this considered physician assisted suicide? +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  


submitted by m-ice(117),

The most important ethical principle that supersedes all others is autonomy. From an ethical standpoint, this patient has the right to refuse further treatment as he is mentally competent, in this case in the form of having the respiratory removed. From a legal standpoint, the physician is allowed to discontinue treatment for a patient if that is what the patient wants. This is different from situations of physician assisted suicide, which is more complicated and has variable ethics and legality.

rhsteps  isnt this considered physician assisted suicide? +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  
johnson  No - treatment is being withdrawn per the mentally competent patient's wishes. m-ice explained it well. +  


submitted by mcl(189),

lolol so instead of using fomepizole they just gonna get him real drunk

johnson  yep - supposedly, ethanol is used when a hospital/facility doesn't have fomepizole. +  


submitted by vshummy(48),

So the best i could find was in First Aid 2019 pg 346 under Diabetic Ketoacidosis. The hyperglycemia and hyperkalemia cause an osmotic diuresis so the entire body gets depleted of fluids. Hence why part of the treatment for DKA is IV fluids. You might even rely on that piece of information alone to answer this question, that DKA is treated with IV fluids.

fulminant_life  I just dont understand how that is the cause of his altered state of consciousness. Why wouldnt altered affinity of oxygen from HbA1c be correct? A1C has a higher affinity for oxygen so wouldnt that be a better reason for him being unconscious? +3  
toupvote  HbA1c is more of a chronic process. It is a snapshot of three months. Also, people can have elevated A1c without much impact on their mental status. Other organs are affected sooner and to a greater degree than the brain. DKA is an acute issue. +1  
snafull  Can somebody please explain why 'Inability of neurons to perform glycolysis' is wrong? +1  
johnson  Probably because they're sustained on ketones. +  
doodimoodi  @snafull glucose is very high in the blood, why would neurons not be able to use it? +1  
soph  @snafull maybe u are confusing bc DK tissues are unable to use the high glucose as it is unable to enter cells but I dont think thats the case in the neurons? +  
drmomo  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909073/ states its primarily due to acidosis along wth hyperosmolarity. so most relevant answer here would be dehydration +