Electrolyte Management In Palliative Care – A case based ：姑息治疗–基于案例的电解质的管理.pptVIP

* * * * * * * * * * * * * * * * * * * * Case 3 52 y.o. Woman with stage 4 cervical cancer Had chemo and radiation Bowel obstruction – entero-enterostomy and loop colostomy Persistent hypokalemia and hypocalcemia Anorexia, diarrhea, muscle weakness, twitching, parasthesia. Case 3 Na – 138 K – 2.9 Urea – 5.3 Creat – 57 Corr Ca – 1.57 Phos – 1.27 Any Ideas? Case 3 Magnesium 0.2 mmol/L (0.65-1.05) Case 3 Given IV MgSO4 - Dramatic Improvement! Ca and K normalize over next week Discharged home and went on ski trip Died 3 months later of renal failure Was her treatment appropriate? Should we routinely check for this in a palliative patient? Hypomagnesemia (Exton, Pall Med 2000) Hypomagnesemia 7-11% of hospital patients Common if other electrolytes Causes refractory K+ Ca++ Treat cautiously in: renal failure dehydration myasthenia bradycardia (Exton, Pall Med 2000) Diabetes in Palliative Care Common in palliative care Monitoring Unsure of best frequency or method Goal is 10-20 mmol/L and asymptomatic WRHA - implementing screening if on steroids Insulin preferred agent for treatment Primary goal - prevention of hypoglycemia Stop if patient unconscious Monitoring Ideal Blood Glucose 10-20 mmol/L Pharmacologic Management Treat only if patient conscious and desiring of treatment Best Oral Hypoglycemic Agents* Name Class Starting Doses Advantages Nataglinide Insulin secretagogue 60-120mg preprandial Short acting Well tolerated in renal hepatic failure Repaglinide Insulin secretagogue 0.5 - 1mg preprandial Short acting Gliclazide Sulphonylurea Insulin secretagogue 80 mg in morning Well tolerated in mild-moderate renal failure Best Basal Insulins Name Class Starting Doses Advantages NPH (Neutral Protamine Hagedorn) Basal insulin 10 units in morning Peaks during the day Glargine/Detemir Basal insulin 10 units in morning More consistent levels over 24 hours Best Prandial Insulins Name Class Starting Doses Advantages Lis