🔹Respiratory alkalosis involves an increase in respiratory rate and/or tidal volume (hyperventilation).

🔹Hyperventilation occurs most often as a response to hypoxia, metabolic acidosis, increased metabolic demands (eg, fever), pain, or anxiety.

🔹Do not presume anxiety is the cause of hyperventilation until more serious disorders are excluded.

🔹Treat the cause; respiratory alkalosis is not life threatening, so interventions to lower pH are unnecessary.

💊 commonly linked to #Stevens-Johnson_syndrome :

🔹Allopurinol
🔹carbamazepine
🔹lamotrigine
🔹nevirapine
🔹oxicam anti-inflammatories, such as meloxicam and piroxicam
🔹phenobarbital
🔹phenytoin
🔹sulfamethoxazole and other sulfa antibiotics
🔹sulfasalazine

#Note:
In children, Stevens-Johnson syndrome can sometimes be caused by infections like cold or flu, cold sores and glandular fever.

#Note :

If a woman is BRCA positive or has ≥2 first-degree relatives, give tamoxifen or an aromatase inhibitor for 5 years starting age 35.

This primary prevention cuts the risk of breast cancer by 50%.

✔️Metabolic Acidosis Causes

"KUSSMAL"

🔹Ketoacidosis
🔹Uremia
🔹Sepsis
🔹Salicylates
🔹Methanol
🔹Alcohol
🔹Lactic Acidosis.

🧧Type Of Metabolic acidosis:

1-Normal anion gap
Mechanism :-
• Loss of bicarbonate
Etiologies :-
• Severe diarrhea
• Renal tubular acidosis
• Excesssaline infusion
• Intestinal or pancreatic fistula
• CAI & MRA diuretics

2 -Elevated anion gap
Mechanism :-
• Accumulation of unmeasured acidic compounds
Etiologies :-
• Lactic acidosis
• Diabetic ketoacidosis
• Renal failure (uremia)
• Methanol, ethylene glycol
• Salicylate toxicity.

A 3 year old boy with this lesion on the face, 2 weeks after bee bite

1⃣ Differential diagnosis?

2⃣ Management?

▶️ Cellulitis is an infection of deeper layer of the skin. It is commonly caused by bacteria that normally live on the skin surface. The infection happens when bacteria find a break on the skin to enter the body. Some risk factors can increase the chance of developing cellulitis such as insect bite, any kind of injury on the skin like cut, burn or fracture, Underlying disease such as diabetes or weakened immune system, use intravenous drugs and chronic edema of arms or legs. Cellulitis can affect any area of the body but it is more common on the arms, legs and face.

▶️ symptoms:

1⃣ Swelling, in case of insect bite, it usually occurs around the site of the insect bite
2⃣ The skin may be tender or painful
Redness and erythema of the affected area
3⃣ The skin can be warm and tight in touch
4⃣ And in some cases, patients may experience fever and malaise

▶️ The diagnosis is based on physical examination of the affected area. Any sign of swelling, redness, tender and warmness should be assessed.

👉🏻 Laboratory testing is not required in uncomplicated situation when the patient has no comorbidities or complications. Laboratory testing and culture are needed in some special circumstances:

📌 Severe local infection
📌 Recurrent or multiple abscesses
📌 No response to initial antibiotic therapy
📌 Systemic sign of infection like presence of fever and general malaise
📌 And presence of underlying comorbidities such as diabetes, malignancy or immunodeficiency

✅ The treatment of cellulitis after an insect bite typically involves:

1⃣ Oral antibiotic that is commonly prescribed to eliminate the bacterial infection. Our choice of antibiotic depends on the severity and the location of the cellulitis and the suspected bacteria. In some special cases we need to use parenteral antibiotic therapy instead of oral forms. These circumstances include:
📌Systemic signs of infections such as presence of high degree fever, hypotension and tachycardia,
📌 Inability to tolerate oral antibiotics,
📌 Rapid progression of erythema
📌 and progression of symptoms despite of taking oral antibiotics after 48 hours.
2⃣ Elevating the affected limb can reduce swelling and pain and promote fluid drainage
3⃣ Using warm compress to help relieve pain and promote healing
Resting
4⃣ Avoid moving the affected area can aid in the recovery process
5⃣ Using over the counter pain relievers can alleviate the pain and reduce fever

In addition to these prescribed treatments, there are some other tips that can ease the symptoms such as:

🍀 Cleaning the affected area gently with mild soap and water several times daily to prevent further infection
🍀 Using local corticosteroid creams like hydrocortisone to reduce itching and inflammation.
🍀 Drinking plenty of water to keep body hydrated to boost the healing process
🍀 Avoid scratching the bite site to prevent worsening the infection

➖➖➖➖➖➖➖➖➖➖
Final diagnosis:

✅ Cellulitis after insect bite.

TM #vs GBS

Tm #vs GBS

Encorate 200 MG Tablet is an anticonvulsant medication that is used alone or in combination with other medicines for the treatment of certain types of epilepsies, a brain disorder characterized by uncontrolled jerking movements and loss of consciousness. It is also used in the treatment of mania which is a mental disorder characterized by hyperactivity and racing thoughts. This medicine is used to prevent migraine headaches characterized by severe headache, eye pain, nausea, and vomiting.

The active ingredient Sodium valproate in Encorate can affect the synthesis and metabolism of a naturally occurring amino acid that acts as a transmission inhibitor. neurotransmitter called Gamma aminobutyric acid (abbreviated as GABA), thereby inhibiting the activity of this amino acid.

What is the difference between valproic acid and sodium valproate?

Sodium valproate is a white crystalline powder with a very slight characteristic odor of valproic acid. Valproic acid is 2-propylpentanoic acid. It is also known as n-dipropylacetic acid, 2-propylvaleric acid, DPA, and by many slight variations of the particular nomenclature.

Traverse Myelitis

✨ Types of pylorplasty ✨

* Heineke-Mikulicz pyloroplasty involves a longitudinal incision across the pylorus that is closed transversely; this is the most commonly performed pyloroplasty

* Jaboulay pyloroplasty involves a side-to-side gastroduodenostomy without a pylorus incision (ie, the pylorus remains intact)

* Finney pyloroplasty also involves a side-to-side gastroduodenostomy but with a pylorus incision (ie, the pylorus is divided)

🎈#Note :

Therapeutic options for cirrhotic portal hypertension:

Carvedilol, a unique type of NSBB that displays additional α1 adrenergic effects, has the capacity to:

✔️ enhance nitric oxide release

✔️and therefore has both extrahepatic and intrahepatic effects.

🔹Medical Mnemonics


Mnemonic to assess for risk factors for OSA(Obstructive sleep apnea):

🫥 STOP - BANG

🕸 Snore
🕸 Tired
🕸 Observed apnea
🕸 high-blood Pressure

❄ BMI >35
❄ Age >50
❄ Neck circumference >40
❄ Gender Male.