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Thursday, April 24, 2014

Clerk Case - Pharmacist Concern

Below is the list of information i get today during discussion with the pharmacist.
Thiazide is more potent than other types of diuretics.
Spironolactone is more preferable than other diuretic in chronic liver disease patient because spironolactone also exhibit aldosterone antagonist.
Decrease aldosterone with decrease water retention and thus decrease ascites volume.
If heart rate < 50, beta blocker should be withold.
For hypoalbuminemia, salt intake will increase dehydration state. Therefore this patient should take high protein  diet.

Hypoalbuminemia will cause hypotension and dehydration because of water moving out into peritoneal cavity.
AST level usually 2x ALT level
Acute liver disease has albumin level >30 (normal albumin)
Chronic liver disease has albumin level <30 (abnormal)
Alcohol consumption will cause hypoglycemia and vitamin B1 deficiency in brain. This vitamin B1 deficiency will lead to wernicke encephalopathy.

Treatment: Give vitamin B1 first followed by glucose. If give vice versa order, this will cause depletion of B1.
CaCo3 is a phosphate binder.
CaCO3 has 40% calcium but Ca lactate has 30% calcium
Insulin may cause hypokalemia because glucose movement into the cell couple with potassium.
Oral hypoglycemic agent should be off when the patient is in stress condition.
Lactulose can be used as ammonia detoxicant beside treating constipation.

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