How to investigate hypokalaemia

Hypokalaemia is very common, and can be exceedingly dangerous. Most of the time we look for the loop diuretic on the chart, or confirm that they aren’t having a major gastrointestinal upset – but where do you go from there?

This nice little review from the BMJ comes from Exeter, and nicely outlines a stepwise approach to hypokalaemia. It covers everything from the common to the rare, and includes a little section on acid base disturbance as well. There’s a great algorithm there for later perusal if you’d like as well. Check out the article over at the BMJ, here.

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A patient’s perspective on melanoma – and the treatment of patients

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This isn’t just about melanoma – it’s about how many doctors approach patients in general. Some doctors trust what they say, others assume what they know themselves is right – and some find the right balance, about taking the complete history and interpreting it based on your clinical knowledge, experience, and investigations. And because of that, you can change someone’s life. Continue reading

Enoxaparin tops heparin for outcomes post PCI – and especially for STEMI

For your stock standard NSTEMI, the go to drug of choice is enoxaparin – easy to administer, only twice a day, no ongoing APTT to continually monitor – and effective. Some people, particularly for a STEMI, prefer the old school unfractionated heparin – partly because of previous equivocal evidence, past experience, and because it can be monitored and you can be sure it’s working (remind anyone of the upcoming warfarin vs. the new anticoagulants?). The current ACC/AHA guidelines still have heparin as a class 1 recommendation – but how effective is it? This systematic review and meta-analysis from the BMJ compared the two. Continue reading