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does AIP lead to anaemia? given reduced haem synthesis?
How does AIP cause SIADH?
Do you think we miss these diagnoses much? Is there a long delay from initial presentation to diagnosis?
Are there any tests that can predict if a patient who is being started on valproate who has an ucd will respond adversely? If so are they advised in pre initiation monitoring?
In the first case of someone recently taking up exercise, symptoms could be put down aches and pains of getting fitter especially as initial observations were fine. Any tips for spotting these patients?
Helena - you’re of course correct, I think in this case the “very dark urine” would be a clue that something more is going on. Of course it may well make you think of rhabdomyolysis in the first instance. Having excluded this then it makes sense to consider other causes. The clinical features I described were deliberately a bit vague, but in the acute setting, abdominal pain + neuropsychiatric symptoms are the classical presentation. Other things that might make you think would be recent medication changes, commoner in women, recent increase in alcohol intake. The latter means that there is a spike in presentations for people starting at university.
When would metabolic medicine team get involved in management of hyper/hypocalcaemia in a hospital setting?
We have a telephone advice service and also a path email for queries.
we run the calcium stone and bone clinic, and when the calcium is abnormal get called
With regards the use of QRISK. Currently we are still using QRISK2. Whilst QRISK3 helpfully includes antipsychotics and severe mental illness there are potential flaws in the way the tool was updated. Data on severe depression was pooled with data from schizophrenia and other psychoses. The risk in severe depression should be separated from schizophrenia. The tool therefore potentially underestimates risk in schizophrenia and overestimates risk in severe depression. Any thoughts on this?
One of our clinicians routinely does a vitamin D level to see if this is the cause of the muscle pain rather than the statin
If statin leads to new DM does stopping the statin lead to improved blood sugars?
Which is the most important marker in the lipid profile for CV risk? Non-HDL?
Kathryn Le Grice
in hypertryglyceridaemia when would you choose a statin rather than a fibrate?
How does insulin help acute hypertriglyceridaemia?
is there one statin that is more diabetogenic than another?
can you give atorvastiatin 80mg if patient on amlodipine 10mg
Is there any clinical significance in a patient with normal T4, normal TSH and low T3? They are normally on levothyroxine for hypothyroidism
Max- no interaction between amlodipine and atorva 80. I checked BNF too ;)
if you put the edta bottle first then the serum bottle into the vacutaner with needle, will that contaminate the serum bottle
Kathryn Le Grice
why is a patient euvolaemic in siadh when free water is being re-absorbed?
Thanks for your question Kathryn, reabsorbing free water will increase the plasma volume
This can lead to euvolaemia, reabsorbing Na and H2O will lead to a greater increase in plasma volume than free H20 alone
They will not be hypovolaemic because they are reabsorbing water and they will not be hypervolaemic unless they have a comorbidity that will cause this
What should you do with mixed insulins when they come in with DKA?
Fang Wen Gan
Falsely low hba1c
Would blood ketones being outside the normal range (but trending down) prevent you from stopping the fixed rate insulin infusion if the patient is E+D, acidosis has resolved and they're receiving their long acting insulin?
Hemolysis due to dapsone? Falsely low HbA1c
Theresa May is the classic example!
In addition to antibodies, is there a role for baseline/serial c peptide and paired glucose measurements if there is diagnostic confusion?
Thank you- very useful talks!