小兒科day three雜記

Pediatrics 小兒科day three  notes

Now there are some young patients with CKD in our department...So review some Nephrology!

1. Causes of high anion gap acidosis?

MUD PILES

-- Methanol

-- Uremia

-- Diabetes ketoacidosis

-- Propylene glycol

-- Infection, INH ( isoniazide )

-- Lactate acidosis( ex. Metformin may induce this!)

-- Ethylene glycol , Ethanol( leading to lactate acidosis?)

-- Salicylates

For Chinese users, we can use this mnemonic: 甲醇乙醇丙二醇；尿素乳酸水楊酸；DM/Infection/INH另外記

2. Causes of decreased anion gap acidosis?

USED CARP; If you cannot remember all, just remember these two: 

-- GI loss of bicarbonate

-- RTA

3. After long-term dialysis

-- EPS=  encapsulating peritoneal sclerosis; irreversible and associated with poor outcome

4. After kidney transplantation

-- OPD F/U: creatinine, drug concentration, fever; DDx: infection or rejection

-- Final tool: biopsy

-- Rejection: B cell type -->  use plasmapheresis, Rituximab

                     T cell type --> use immunosuppresants

5. Continue with previous notes on UTI

-- HPF: 6~10 WBC↑, suspect UTI

-- if orange urine--> more likely to be crystals instead of blood

-- Infection--> pyuria, not just bacteria in the urine

-- APN may last a few days without response to antibiotics.

6. Hemophagocytic syndrome (HLH)

-- Pancytopenia in the blood, Histiocytosis in the bone marrow

-- Fever

7. Pediatric IDA

-- Around 1 y/o, High Hgb is common in normal newborns (15~16 mg/dl)

-- Breast feeding: potential iron insufficiency