Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hyperemesis Gravidarum Hyperkalemia 747

specific therapy

■Enteral feeding if not resolved on gut rest, of if persistent

■Rarely, parenteral feeding

follow-up

■Recovery with resolution of nausea by week 20 of gestation

■Rarely persists into second trimester

■Jaundice only in untreated, severe cases that in previous eras lead to

death

■Successful outcome to the pregnancy

complications and prognosis

■Associated hyperthyroidism that resolves with resolution in nausea

Hyperkalemia.......................................

BIFF F. PALMER, MD

history & physical

■clinical setting helpful in determining etiology

■does patient have leukocytosis (>100,000) or thrombocytosis

(>500,000), hemolysis during process of phlebotomy

■intravenous or oral K load in setting of chronic renal failure

■uncontrolled diabetes

■acute oligo-anuric or end-stage renal disease

■History of drugs such as K sparing diuretics, cyclosporine, nons-

teroidal antiinflammatory agents, heparin, ketoconazol

tests

■check EKG

➣severe hyperkalemia and a normal EKG suggests pseudohyper-

kalemia

➣EKG changes of hyperkalemia warrant urgent treatment is

required (see below)

■serum creatinine, BUN, HCO3, creatinine clearance

■measure glucose to screen for diabetes

■other testing is based on clinical setting

differential diagnosis

■pseudohyperkalemia

➣WBC count >100,000 or platelet count >500,000