January 05, 2009 Archives - Clinical Advisor

Print Issue: January 05, 2009

Must both atria be in fibrillation?

I have always assumed that atrial fibrillation means that both atria are in a quiver. Is it possible for only one atrium to be in fibrillation while the other is in a normal sinus rhythm, atrial flutter, atrial standstill, or other rhythm?

Reaction to wood dust

A 42-year-old man lost 20 lb and suffered tachycardia, night sweats, anxiety symptoms, and shortness of breath for several weeks after constructing a deck with “pau laupe” wood from South America. Sawing and sanding put lots of dust in the air. Noteworthy lab studies at this time included transient blood sugar elevations up to 130…

Lowering an infant’s fever

What is the acceptable way to reduce an infant’s fever quickly and prevent febrile seizures? Should I use cold towels or a combination of ibuprofen (Motrin) and acetaminophen (Tylenol)?—Felix N. Chien, DO, Newport Beach, Calif. There is still some disagreement about if and when you should treat fever. Some believe that early and vigorous treatment…

Elevated liver enzymes and fatty liver

After all other potential causes have been ruled out, I attribute elevated liver enzymes (aspartate aminotransferase and alanine aminotransferase) to a fatty liver. This, of course, is usually noted on ultrasound or CT scan. How often should the enzymes be checked as part of routine monitoring? When should additional tests be ordered if the enzyme…

Fatty liver treatment

I am seeing fatty liver more frequently as an incidental finding in patients undergoing abdominal ultrasound for GI complaints without a history of alcohol abuse or liver disease (particularly in middle-aged, slightly obese women). Does this progress to a more serious problem if not treated? What is the proper treatment?—Jean Marsalla, ANP, Tucson, Ariz. Nonalcoholic…

Fluoride supplementation

For a patient whose water source does not contain fluoride, how important is supplementation? If supplementing, how much, how often, and at what age do you start and stop?—Amy Waggner, FNP-C, Washington, Ind. The American Dental Association and the CDC have very clear guideline statements regarding this topic. For urban areas with fluoridated water supplies,…

Addressing cardiac risk in the young

What should I do for patients younger than 40 who have zero to two risk factors for coronary artery disease (CAD) and LDL 130-160 mg/dL if they have not responded to lifestyle modifications?—Derek Olson, DO, Chicago There is no simple answer to this question. It depends what the “risk factors” are. For example, a strong…

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