Friday, February 26, 2010

Today's vocabulary list

Gregarious: from
1. seeking and enjoying the company of others
2. tending to form a group with others of the same kind

Antipyretic 解熱剤 Antitussive 鎮咳薬

[taken from First Aid for USMLE part 2]
A 45-year-old patient presents with altered mental status. His wife states that over the last week her husband has been taking acetaminophen for some abdominal discomfort. He uses no illicit drugs but drinks 4-5 beers daily. Over the last 24 hours, the patient has become progressively lethargic. Vital signs reveal temp. 97°F, BP 100/70, HR 120, RR 26. The patient is jaundiced with RUQ abdominak tenderness on palpation. He has no rebound tenderness or splenomegaly but has an enlarged liver. There is no ascites or peripheral edema. Heart and lung examinations are normal. Patient responds to painful stimuli and has asterixis. He has no neurologi deficit. Which of the following is the most likely diagnosis?
a. Alcohol intoxication
b. Alcohol withdrawal
c. Delirium tremens
d. Acetaminophen toxicity
e. Wilson's disease __________answer: d. acetaminophen toxicity

[Signs of alcohol intoxication]
include euphoria, dysarthris, ataxia, labile mood, lethargy, coma, respiratory depression, and death

[Signs of alcohol withdrawal] hyperexcitable state (e.g., hypertension, tachycardia, flushing, sweating, and mydriasis) and have tremors. disordered perceptions, seizures, and delirium tremens (DTs)

[Delirium tremens]
occur 2-4 days after alcohol abstinence
characterized by hallucinations (which may be dangerous, combative, and/or destructive)

[Acetaminophen toxicity] taken from e-medicine
> maximum recommended daily dose of acetaminophen:
adults: 4 g and children: 90 mg/kg
> amount of toxicity may be lower in the settings of chronic ethanol use, malnourishment,
or diminished nutritional status, fasting, or viral illness with dehydration, or certain medications
> when dosing recommendations are followed, the risk of hepatotoxicity is extremely small
> antidote for acetaminophen poisoning is N -acetylcysteine (NAC)
> one of the most common pharmaceutical agents involved in overdose,
as reported to the American Association of Poison Control Centers
> most common cause of hepatic failure requiring liver transplantation in the UK
> replaced viral hepatitis as the most common cause of acute hepatic failure in US
> second most common cause of liver failure requiring transplantation in the US

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