Guide to Acute Kidney Injury (AKI) What to ask/look for: - HPI, PMH, full ROS - Nephrotoxins (NSAlDs, contrast, OTCs, herbals, abx, illicits, chemo, immunosuppression) - Hx of AKI/CKD - Recent hypo/hypertension? - TTE/liver fxn? - BMP, cap, CBC w/ diff - Urinalysis/microscopy/UOP/weights - Urine Na/K/Cl/urea/protein/Cr - Renal/bladder US w/ PVR - CPK, uric acid (rhabdo/TLS) Causes of Inpatient AKI (Liano 1996) - ATN - 45% - Pre-renal disease — 21% - AKI on CKD— 13% (mostly ATN and pre-renal) - Urinary tract obstruction — 10% (most often prostate related) - Glomerulonephritis or vasculitis — 4% - Atheroemboli — 1% #AcuteKidneyInjury #AKI #Nephrology #Diagnosis #Algorithm #Causes #Differential

# Acute Kidney Injury # AKI #algorithm #differential #nephrology

Typical Withdrawal Characteristics of Various Opiates / Time course of opiate withdrawal. - Half-life - Onset of withdrawal symptoms after Exposure - Typical duration of withdrawal #Opiates #Opioid #Withdrawal #Timecourse #timeline #pharmacology #diagnosis

Adrenal Insufficiency Algorithm - Cosyntropin Stimulation Test T-1m: Baseline cortisol drawn T0: 250 µg cosyntropin given IV T30m: Repeat cortisol level drawn T60m: Final cortisol level drawn BCM IM Residency @BCM_InternalMed #Adrenal #Insufficiency #Testing #Algorithm #Cosyntropin #Stimulation #endocrinology

Emergency Treatment Algorithm for Convulsive Status Epilepticus #Seizure #Management #status #epilepticus #algorithm #neurology

ADA 2020 Diabetes #management #algorithm #treatment

Penicillin Allergy Pathway for Antibiotic Prescription in Patients With Penicillin Allergy Mild Reaction - Itching, Minor rash (not hives), Maculopapular rash (mild type IV HSR), EMR lists allergy, but patient denies • Use full-dose third-/fourth-generation cephalosporin OR • Use penicillin or first-/second- generation cephalosporin by Test Dose Procedure OR • Use carbapenem Type I (lgE-Mediated) HSR - Anaphylaxis, Angioedema, Wheezing, Laryngeal edema, Hypotension, Hives/urticaria OR Unknown reaction WITHOUT mucosal involvement, skin desquamation, or organ involvement • Use third-/fourth-generation cephalosporins or carbapenems by Test Dose Procedure OR • Use alternative agent by microbial coverage OR • Aztreonam • If infectious disease consult determines that penicillin or a first-/second- generation cephalosporin is the preferred therapy, or that one of the alternative agents is substandard, consult Allergy Type II-IV HSR - Serum sickness, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Acute interstitial nephritis, Drug rash eosinophilia systemic symptoms syndrome, Hemolytic anemia • Avoid using penicillin or cephalosporin; use alternative agents by microbial coverage • If there is a strong clinical indication for use of penicillin or cephalosporin, please involve the Allergy and Infectious Disease services #Penicillin #Allergy #Pathway #Antibiotics #Prescription #algorithm #management

Antibiotics - Spectrum and Coverage Antibiogram #Antibiogram #Antibiotics #Classes #Bacterial #Spectrum #Coverage #Susceptibility #Susceptibilities #InfectiousDiseases #Pharmacology