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Unintentional Weight Loss Causes

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61. When and how to treat hyponatremia in the ED

polydipsia, and water intoxication (intentional or unintentional). In infants and children, GI fluid loss and unintentional ingestion of excessive water are most common 5 . Besides thiazide and SSRIs, medications that can cause hyponatremia include other anti-depressants, anti-psychotics, anti-epileptics, and NSAIDs 1 . Why does this matter? Pathophysiology and Complications of Hyponatremia Left untreated, hyponatremia can be a life-threatening condition. Hypotonic plasma leads to a shift of water from (...) Additional testing can be performed to identify whether the hyponatremia is hypo-, hyper-, or euvolemic. which is crucial in identifying the underlying etiology and guide treatment. Failure to identify the underlying cause of hyponatremia can lead to therapy that harms the patients 4 . Hypovolemic Euvolemic Hypervolemic Definition Loss of sodium and relatively lesser loss of body water Normal total body sodium and excess total body water Increased sodium with relatively greater increase in body water

2018 CandiEM

62. Improving Quality of Life: Substance Use and Aging

services. This chapter provides an overview of some of the harmful consequences of substance use among the aging population, including hospitalization, falls, vehicular accidents, cognitive impairment, depression, substance withdrawal and death, including by suicide. Mortality rates are much higher among older adults who have substance use disorders. Because the use of alcohol and medication, whether prescribed or misused, causes greater harm in older adults than illicit drugs, this chapter focuses (...) on the term as clinical indicators and outcomes. Whenever the sources use these terms, they are reflected in the text of the report by being included in quotation marks to indicate they come from another source. These terms are left intact to preserve the integrity of the original research being cited. Addiction: 1 A health condition characterized by compulsive drug use, despite harmful consequences. Someone suffering from addiction is unable to consistently abstain from substance use, even when it causes

2018 Canadian Centre on Substance Abuse

63. Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients

) to classify prescription opioid analgesic abuse as an epidemic. This appears to be due in large part to individuals using a prescription drug non-medically, most often an opioid an- algesic. Drug-induced deaths have rapidly risen and continue to be one of the leading causes of death in Americans. In 2011, the Office of National Drug Control Policy established a multifaceted approach to address prescription drug abuse, including Prescrip- tion Drug Monitoring Programs (PDMPs) that allow practitioners

2018 Publication 4890876

64. British guideline on the management of asthma

obstruction Significant smoking history (ie, >30 pack-years), age of onset >35 years COPD Chronic productive cough in the absence of wheeze or breathlessness Bronchiectasis*; inhaled foreign body*; obliterative bronchioitis; large airway stenosis New onset in smoker, systemic symptoms, weight loss, haemoptysis Lung cancer*; sarcoidosis* * may also be associated with non-obstructive spirometry 3.3.4 INTERMEDIATE PROBABILITY OF ASTHMA BASED ON INITIAL STRUCTURED CLINICAL ASSESSMENT Adults and children who (...) Prominent systemic features (myalgia, fever, weight loss) Failure to thrive Unexpected clinical findings (eg crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Unexplained clinical findings (eg focal signs, abnormal voice or cry, dysphagia, inspiratory stridor) Persistent non-variable breathlessness Symptoms present from birth or perinatal lung problem Chronic sputum production Excessive vomiting or posseting Unexplained restrictive spirometry Severe upper respiratory tract

2016 SIGN

65. Spotlight: Subacute Endocarditis: The Great Masquerader

with hypertension, hypothyroidism and no known history of valvular heart disease presented to his primary care doctor with one month of generalized weakness and unintentional weight loss. The patient felt unwell, with neck and shoulder pain. He reported fever to 102 degrees Fahrenheit and cough at home. The patient had a dental procedure one month prior to admission. His blood work revealed white blood cells of 13.6mg/dL, hemoglobin of 13mg/dL, iron 27 ug/dl, TIBC 306 ug/dL with ferritin >800 ug/L and ESR 101mm (...) the risk of embolization with improvement in symptoms. The cause of his endocarditis was thought to be secondary to the dental procedure months before diagnosis; teeth #14 and #19 were found to have extensive carious lesions requiring extraction prior to surgery. Discussion : Why does Streptococcus viridans have a predilection toward heart valves in bacteremia? In population studies, viridans group Streptococcus is among the most common cause of endocarditis. Both host and bacterial factors contribute

2017 Clinical Correlations

66. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review

and Definitions Appendix G. Strength of Evidence Table Appendix H. Head-to-Head Studies for Predictive Utility Appendix I. Indirect Studies for Predictive Utility Appendix J. Studies of Reliability and Ease of Use Appendix K. Quality Assessment of Studies of Predictive Utility Appendix L. Quality Assessments of Studies of Reliability and Ease of Use xi Executive Summary Background Unintentional injuries are the leading cause of death among people in the United States ages 1 to 44, and the third leading cause (...) among people ages 45 to 64. 1 Among all age groups, motor vehicle crashes are the first or second leading cause of unintentional injury death. 2 In 2011, there were approximately 40,000,000 emergency department (ED) visits for injuries; of these approximately 2.5 million were due to trauma complications and unspecified injuries. 3 Approximately 18 percent of patients seen in the ED for an injury were transported by emergency medical services (EMS) personnel. 4 Traumatic brain injury (TBI

2017 Effective Health Care Program (AHRQ)

67. Food Deserts and Food Swamps: A Primer

-processed food consumed, the poorer the diet quality and the higher risk of developing nutrition-related chronic conditions .8,9 Our long-term diet patterns are a determinant of health outcomes such as the development of nutrition-related chronic conditions, e.g., excess weight gain, cardiovascular disease, type 2 diabetes and some types of cancer. 10 Some symptoms of poor mental health such as depression and anxiety have also been linked to suboptimal diet patterns. 11-13 FOOD DESERTS AND FOOD SWAMPS (...) and cancer in Canada were $19.8 billion in 2015. 16 Inadequate vegetable and fruit consumption alone costs 3.3 billion per year through a mix of direct healthcare costs and losses in productivity. 16 What Factors Influence Food Choices? Income is a primary determinant of diet quality. In 2012, almost 13% of Canadian households experienced food insecurity, 19 defined as “inadequate or insecure access to food because of financial constraints.” 20 Not having enough money makes it difficult

2017 National Collaborating Centre for Environmental Health

68. CrackCAST E129 – Bacteria

for the primary location of infection. Cutaneous diphtheria can occur as a primary skin infection or as a secondary infection of a preexisting wound. Circulating exotoxin causes the systemic symptoms of diphtheria, most profoundly affecting the nervous system, heart, and kidneys. Progression of symptoms/signs: Generic URTI symptoms Low grade fever and sore throat are the most frequent presenting complaints. Weakness, dysphagia, headache, voice changes, and loss of appetite ⅓ develop cervical lymphadenopathy (...) , an important , is deficient Asplenia chronic alcohol abuse, active and passive smoking, Corticosteroid use recent respiratory illness. Clinical presentation- All of the major pathophysiologic events of meningococcal sepsis are caused by the host’s inflammatory response to the organism causing functional and histologic damage to the microvasculature, resulting in increased vascular permeability, pathologic vasoconstriction and vasodilation, loss of thromboresistance, DIC, and profound myocardial dysfunction

2017 CandiEM

69. CRACKCast E125 – Electrolyte Disorders

. Ion exchange resin 1. Emergently in cardiac arrest, urgently in renal failure; may delay if renal function is normal 2. In patients with rhabdomyolysis or tumor lysis syndrome with intact urine output, not effective acutely [4] What are the five most common causes of hypokalemia? Most common cause in the outpatient world = thiazide diuretics. The five most common causes of hypokalemia are: renal losses, increased nonrenal losses (sweating, diarrhea, vomiting, laxatives) decreased potassium intake (...) , with simultaneous oral and IV replacement. [7] What are the three main types of hypernatremia? Give 3 examples of each. By far, the most common cause is a patient with an altered thirst mechanism (elderly, disabled patient) without access to free water. Hypernatremia can be divided into three physiologic pairings: hypernatremia with dehydration and low total body sodium, hypernatremia with low total body water and normal total body sodium, hypernatremia with increased total body sodium [1] Double loss

2017 CandiEM

70. Consolidated guideline on sexual and reproductive health and rights of women living with HIV

assessing conditions that may be caused or complicated by intimate partner violence, in order to improve diagnosis/identification and subsequent care. Strong recommendation, indirect evidence Strong recommendation, indirect evidence 1. Reference for this and all the existing recommendations in the next section on integration of services: Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, second edition

2017 World Health Organisation Guidelines

71. Influencing the trajectories of ageing

; and psychosocial factors such as social vulnerability. 21 A recent innovation has been the development of an electronic frailty index that can be calculated from routine data in primary care. In contrast, the phenotype approach identifies physical frailty in individuals with three out of five criteria: unintentional weight loss; exhaustion; low physical activity; reduced grip strength; and slow gait speed. 22 The first three items are self-reported whilst grip strength and gait speed are usually measured (...) and pharmacological – to slow the trajectory of ageing and maintain health in later life. A report by the Academy highlighted the urgent need to understand the connections between underlying processes of ageing and the causes of age-related disease, and identified a range of strategic priorities for ageing research in the UK. 1 One of the report’s five recommendations was to develop interventions in ageing and age-related diseases. In addition, the Academy’s recent report ‘Improving the health of the public

2016 Academy of Medical Sciences

72. Screening and Diagnosis of Obstructive Sleep Apnea

. Clinical symptoms for OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring. If other causes have been ruled out (for example, thyroid disease, gastroesophageal reflux disease, or other respiratory diseases), further evaluation for OSA may be warranted in patients with daytime sleepiness, which is the clinically relevant OSA symptom most responsive to treatment. Evidence is lacking on the effect of CPAP on improving other (...) prediction rules can be used to effectively predict OSA diagnosis, the applicability of these rules to the general population cannot be determined from the existing literature, adds the ACP. Areas of Difference Screening The ACP recommends that clinicians target their assessment of OSA to individuals with unexplained daytime sleepiness, the clinically relevant OSA symptom most responsive to treatment. Additional common presenting symptoms cited by the developer include unintentional sleep episodes during

2017 National Guideline Clearinghouse (partial archive)

73. Alcohol: Adult Unhealthy Drinking

Advantages Disadvantages ? Useful for decreasing heavy drinking in patients with a goal of reducing drinking. ? Not FDA-approved for this indication. ? Tapering up to effective dose, which is required to minimize side effects, takes 6–10 weeks. ? Potential side effects include dizziness, ataxia, somnolence, memory difficulties, depression, anxiousness, confusion, nystagmus, weight loss, and nausea. ? Many patients cannot tolerate. ? Avoid in patients with history of renal calculi. Disulfiram Advantages (...) alcohol consumption accounts for 10% of deaths among working-age adults in the United States (Stahre 2014). Recommended drinking limits differ for men and women. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. Alcohol is water soluble, so women typically achieve higher blood-alcohol concentration (BAC) because they have less body water. Although some evidence from observational studies indicates that light

2016 Kaiser Permanente Clinical Guidelines

74. Considerations on glycaemic control in older and/or frail individuals with diabetes and advanced kidney disease

].Oldageanddiabetesare the two most important causes of decline in renal function [4]. Inolderindividualswithchronickidneydisease(CKD)anddia- betes,theriskoffrailtyisconsiderable[5].Frailtycanherebybe definedasaclinicalsyndromeinwhichthreeormoreofthefol- lowing criteria are present: unintentional weight loss (10 lbs in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed and low physical activity [6]. A major characteristic of the frailty diathesis is an increased sus- ceptibility (...) was different in this regard, with a mean age of 66 years [10]. Observational stud- ies suggested that, in patients with diabetes and more than 75 years old, an HbA 1c below 6.9% can be protective when comparedwiththegeneralpopulation[11].However,ifCKD is one of the comorbidities, then all-cause mortality can increaseinthediabetesgroupfrom37%upto333%,depend- entontheestimatedglomerularfiltrationrate(eGFR)[11]. However, in patients over 75 years old with CKD (eGFR 7% for peo- ple with limited life expectancy

2017 European Renal Best Practice

75. Management of Dyslipidaemia

& Head, Department of Cardiology, Hospital Pulau Pinang Prof Dr Tilakavati Karupaiah Professor & Head of Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia Dr Wardati Mazlan Kepli, Phd Clinical Pharmacist Pharmacy Department Hospital Serdang Edition of Clinical Practice Guidelines 5 th5 RATIONALE AND PROCESS OF GUIDELINE DEVELOPMENT Rationale: In Malaysia, cardiovascular disease (CVD) is the leading cause of death in both men and women 1 . CVD includes coronary heart (...) C: Comparison: ? Therapeutic lifestyle intervention vs placebo ? Pharmacological therapy vs lifestyle intervention O: Outcome: ? Reduction in Cardiovascular Disease- Events, vascular mortality ? Reduction in All cause mortality 7Edition of Clinical Practice Guidelines 5 th Type of Question- Involves: ? Therapy – Lipid lowering ? Harm – Increase in Cardiovascular Event Rate, Adverse effects due to Lipid lowering and/or Pharmacotherapy ? Prognosis – Cardiovascular Risk Reduction ? Prevention

2017 Ministry of Health, Malaysia

76. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

14) • When considered separately from other CVDs, stroke ranks No. 5 among all causes of death, behind dis- eases of the heart, cancer, chronic lower respiratory disease, and unintentional injuries/accidents. • Globally, in 2013 there were 6.5 million stroke deaths, making stroke the second-leading cause of death behind ischemic heart disease. • Approximately 795 000 strokes occur in the United States each year. On average, every 40 seconds, someone in the United States has a stroke (...) , and other government agencies, brings together in a single document the most up- to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure 1 ), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals

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2017 American Heart Association

77. Constipation in older adults: Stepwise approach to keep things moving

for alarm features ( ) that require additional investigations to rule out structural diseases (eg, colon cancer). , Mrs N.M. does not have any alarm features. Box 2. Alarm features of constipation Most important questions to ask your patient: Have you had any fever, had unintentional weight loss, had blood in or on your stool, felt any masses (abdominal or rectal), had night symptoms, or had any other unexplained symptoms? Are you vomiting? Do you have a lot of abdominal pain? Are you still passing gas (...) to reduce constipation. (In this article, PEG 3350 is without electrolytes, unless otherwise stated.) Three months ago she fell in her bungalow and fractured a rib. She is now living in a seniors’ apartment building and gets help from her daughter who lives nearby. Today, upon questioning, Mrs N.M. describes her bowel movements as infrequent (2 to 3 times per week), with hard lumpy stools and some straining. She denies having any nausea, vomiting, blood in the stool, rectal bleeding, fever, weight loss

2016 RxFiles

78. Management of Type 2 Diabetes Mellitus

, a fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) may also be used to diagnose diabetes. The diagnosis can be made if a fasting glucose level is greater than or equal to 126 mg/dL (7.0 17 UMHS Management of Type 2 Diabetes Mellitus June, 2017 mmol/l), but should be confirmed on a separate day. Diabetes may also be diagnosed on the basis of symptoms (polydipsia, polyuria, unintentional weight loss) and elevated glucose level (= 200 mg/dL), but should also be confirmed on a separate day (...) diet, exercise, and weight loss), acarbose, and metformin have all been shown to reduce the progression of pre-diabetes to diabetes. Diagnosis. The American Diabetes Association (ADA) has added HbA1c as a screening as well as diagnostic test for diabetes. While some disagreement exists concerning the specific level that defines type 2 diabetes, the current ADA definition is that diabetes is diagnosed if A1c is 6.5% or higher. This cut point is specific but not sensitive and thus individuals

2017 University of Michigan Health System

79. Management of Opioid Therapy (OT) for Chronic Pain

prescriptions were still written in 2012.[11] The increase in opioid prescribing is matched by a parallel increase in morbidity, mortality, opioid-related overdose death rates, and substance use disorders (SUD) treatment admissions from 1999 to 2008.[12,13] In 2009, drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents.[14] In 2014, 1.9 million Americans were affected by an OUD related to non-medical use of prescription pain relievers,[15 (...) associated with changes in the central nervous system (CNS) known as central sensitization.[38] Whereas acute and subacute pain are thought to involve primarily nociceptive processing areas in the CNS, chronic pain is thought to be associated with alterations in brain centers involved with emotions, reward, and executive function as well as central sensitization of nociceptive pathways across several CNS areas.[39-41] There are many causes of chronic pain. Pain arising from persistent peripheral

2017 VA/DoD Clinical Practice Guidelines

80. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

and in school. Parents and children need to know the basic rules for safer Internet use. The periodic health visit is an ideal opportunity to talk with patients about protecting their hearing during especially loud activities (e.g., a rock concert) and by keeping the volume down on personal music devices. Permanent hearing loss is caused by loudness and length of exposure to noise. Rock concerts and personal music players can reach an intensity of 110 to 120 dB. Using appropriately fitting earbuds (...) . Sequelae of sleep deprivation Getting inadequate sleep may be harmful. Insomnia is common, affecting an estimated 10% of U.S. adolescents and 6% of European adolescents. Chronic sleep loss in adults is associated with a greater risk of mortality. There is fair evidence that short sleep duration over time is associated with subsequent weight gain and increased risk of concurrent and adult obesity. - The combination of short sleep duration and variable sleep patterns is associated with adverse metabolic

2016 Canadian Paediatric Society

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