Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Pseudohypoaldosteronism Pseudomonas Infections 1231

management

■Sodium supplements

■Kayexalate and low-potassium diet

specific therapy

■N/A

follow-up

■Frequent follow-up to follow electrolytes, whether pt is thriving

complications and prognosis

■Patients do not tolerate volume depletion from GI losses.

■Hyperkalemia can be life-threatening.

■Patients may have failure to thrive.

PSEUDOMONAS INFECTIONS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Pseudomonas aeruginosais an oxidase-positive, aerobic Gram-

negative bacillus that is ubiquitous in nature.

■Predilection for moist environments; colonizes skin, ear canal, upper

respiratory tract and gastrointestinal tract, particularly in hospital-

ized, burn, immunocompromised and intensive care unit patients

and those receiving broad-spectrum antimicrobial therapy; colo-

nization of the hospital environment and equipment common

■Most infections nosocomial, but community-acquired infection

seen in those with comorbid diseases

Signs & Symptoms

■Urinary Tract Infections – usually associated with instrumentation

or catheterization; outpatient infection associated with obstruction,

stones or superinfection after antibiotic therapy; clinical manifesta-

tions same as infection with other bacteria

■Pneumonia – usually nosocomial; seen in ventilator-dependant,

neutropenic or immunosuppressed patients; outpatient pneumonia

associated with chronic lung disease, cystic fibrosis, HIV infection

and chronic care facilities; symptoms indistinguishable from other

serious bacterial pneumonias