#labresults

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ATJAZZ // TOUCH THE SUN [RMX] (DZIHAN & KAMIEN'S SUN CARE) [LABRESULTS, 2002]

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Prophylax/treat Tumor Lysis Syndrome (TLS) with high rates of normal saline (not alkaline fluids), allopurinol, and q8-12h labs. If uric acid is high, add rasburicase. The AKI will usually resolve with fluids and time. The hypocalcemia will only resolve if you treat the hyperphosphatemia, with dialysis if necessary.

Source: Westley Spiro, Tumor Lysis Syndrome, Core EM.

[supercodi]

I am 19 Days away from phalloplasty and my anxiety is getting the best of me. I had a few days of calm until I got my pre-op lab results done and it showed some questionable things. If anyone has any information on this please feel free to let me know!

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Testosterone Deficiency - Establishing A Biochemical Diagnosis

Testosterone deficiency is a common and often unrecognized disorder impacting the lives of many men. Symptoms related to low testosterone ar

Total testosterone is made up of 2% free testosterone, 38% testosterone bound to albumin, and 60% testosterone bound to sex hormone binding globulin (SHBG). Only the free and albumin-bound testosterone is bioavailable. Yet, SHBG levels are increased in liver disease, hyperthyroidism, hypogonadism, anticonvulsant medications, prepubertal children, and elderly men; they are decreased in hypothyroidism, obesity, Cushing Disease, polycystic ovarian syndrome, diabetes mellitus, elderly women, and exogenous steroid use. So total testosterone levels need to be analyzed in conjunction with SHBG levels and the clinical picture.

A good review of the laboratory tests is Yonah Krakowsky and Ethan Grober, "Testosterone Deficiency--Establishing a Biochemical Diagnosis" (2015).

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Q. How can you diagnose a Gram-positive UTI before the culture comes back?

A. If a urinalysis has (+) leukocyte esterase from WBCs but (-) nitrites from Gram-negative bacteria, then the UTI could be caused by Staphylococcus saprophyticus (a cluster-forming GPC) or Enterococcus.

Pro-Tip: Staph aureus doesn't cause ascending urinary tract infections, but it might seed the kidney hematogenously if there is bacteremia from another source.

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Since the beginning of clinical use in the 1970s, hemoglobin A1c (A1c) has become the standard tool for monitoring glycemic control in patients with diabetes. The role of the A1c test was broadened in 2010, when the American Diabetes Association added ...

Q. Can you think of anything about red blood cells that might affect a hemoglobin A1c?

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A. Yes! Anything that causes increased RBC turnover (splenomegaly, chronic kidney disease) will falsely lower HgbA1c, while conditions that prolong RBC lifespan (iron-deficiency anemia, asplenia) or stimulate glycosylation (storing a blood sample above room temperature) falsely elevate HgbA1c. Non-Caucasians tend to have higher average values than Caucasians. Hemoglobin variants, erythropoietin treatment, pregnancy, and blood transfusions muddy the picture as well. Read more at Michael Fadin, "Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading," Journal of General Internal Medicine 29:2 (Feb. 2014): 388–394. #TeachingRounds, #FOAMed, #endocrinology, #endo, #primarycare, #labresults, #diabetes

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Monocytes

Monocytes typically make up 2-8% of white blood cells. Monocytopenia can be seen, for instance, if a patient is being immunosuppressed with glucocorticoids. Monocytosis can be seen with inflammatory states such as during viral illness or other stressors like sepsis or surgery, granulomatous disease like sarcoidosis. The rest of this week will be about a condition called Juvenile Myelomonocytic Leukemia (JMML).

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PERCs of the Wells Score — Taming the SRU

Pulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigat

"The most important thing to remember is that these decision rules do not replace clinical judgment. The PERC rule requires a clinical suspicion of <15% before it can be applied; it should not be applied to all patients in whom you are considering PE. Similarly, the WELLS score is not meant to be used on all patients with chest pain or dyspnea; you must first have a genuine clinical suspicion for PE. Furthermore, these tools do not force you to order any diagnostic testing. A positive PERC is not an indication for ordering a d-dimer, and a high-risk WELLS score does not necessarily mean you must order a CTPA [CTA chest]." ~Dr. Christina Pulvino (University of Cincinnati Department of Emergency Medicine)