Category Archives: Ambulatory Report

Cox’s Conference: Hypokalemia

In today’s Cox’s Conference, Dr. Ezim Ajufo presented a case of profound hypokalemia to expert discussant, Dr. Biff Palmer. We had an excellent discussion about the differential diagnosis and mental framework for hypokalemia. A previous blog post that summarizes this framework is linked here: Cox’s Conference: Recurrent hypokalemia.

In addition to the linked blog post, additional pearls from our discussion are paraphrased here.

Manifestations and Consequences of Hypokalemia:

Clinical Symptoms and Signs
  • Muscle weakness (or paralysis in extreme cases)
    • Decreased extracellular potassium leads to hyperpolarization of cell membranes. This results in decreased sensitivity of muscle cells to generate an action potential to excitatory stimuli.
  •  Confusion or affective disorders
    • Alterations in central nervous system conduction due to membrane polarization disturbances
  • Ileus
    • Due to smooth muscle depolarization abnormalities due to membrane polarization disturbances
  • Rhabdomyolysis
    • Extracellular potassium normally mediates vasodilation. When muscle cells depolarize, intracellular potassium is released, leading to vasodilation and increased blood flow to the muscle fibers. In states of hypokalemia, this vasodilation is attenuated, leading to relative ischemia and rhabdomyolysis
  • Cardiac
    • EKG
      • U-wave amplitude increased (may be misread as QT prolongation)
      • ST depression
      • T-wave flattening
    • ventricular or supraventricular tachyarrhythmias
  • Renal
    • Impaired urinary concentration
      • leads to polyuria and polydipsia
      • due to decrease in the medullary gradient AND due to decreased responsiveness to antidiuretic hormone (mechanism poorly understood)
    • chronic tubulointerstitial nephropathy
  • Endocrine
    • Glucose intolerance/hyperglycemia
      • hypokalemia decreases pancreatic beta-cell insulin release

References:

Am J Kidney Dis. 2010 Dec;56(6):1184-90.

 

Cox’s Conference: Left ventricular wall thickening…not always hypertension

In this week’s Cox’s Conference, Dr. Mehwish Ismaily presented a fascinating case of wet beri beri to expert discussant, Dr. Justin Grodin. During our discussion, there was an interesting segue into the differential diagnosis of left ventricular wall thickening. Key points and lessons are summarized here.  Continue reading Cox’s Conference: Left ventricular wall thickening…not always hypertension

Cox’s Conference: Should I get that renal biopsy?

In today’s Cox’s Conference, Dr. Donghai Wen presented a case of acute kidney injury with nephrotic range proteinuria due to collapsing glomerulopathy in a patient with sickle cell anemia to expert discussant Dr. Christopher Lu with guest discussant Dr. Allen Hendricks from the Department of Pathology. Below are key pearls generated from the discussion. Continue reading Cox’s Conference: Should I get that renal biopsy?

Cox’s Conference: Constriction vs. Restriction

In today’s Cox’s Conference, Dr. Grace Liu presented a case of suspected pericardial constriction to expert discussant, Dr. Ian Neeland. Below are key pearls and links to Dr. Neeland’s slideshow on restrictive versus constrictive heart disease and an excellent review from the Journal of the American College of Cardiology.  Continue reading Cox’s Conference: Constriction vs. Restriction

Cox’s Conference: Dermatology presentation

In today’s Cox’s Conference, dermatology resident, Dr. Meredith Orseth, along with expert discussant, Dr. Arturo Dominguez presented us with several dermatology cases through which we discussed the differential diagnosis of erythroderma, nail changes, and much more. Below is a link to the slideshow of the discussion.

Derm presentation with notes

Cox’s Conference: A case of persistent headache and visual field deficits

In today’s Cox’s Conference, Dr. Megan Kypreos presented a case of acromegaly to expert discussant, Dr. Jessica Abramowitz. In this post, we will summarize the case, discussion, and relevant clinical pearls. Clinical asides by either Dr. Abramowitz, our residents, and chief residents are paraphrased in bold. Continue reading Cox’s Conference: A case of persistent headache and visual field deficits