As clinicians, we need to remind ourselves that congestive heart failure (CHF) is not a diagnosis but rather a complex of symptoms with one or more of five major causes: myocardial ischemia, valvular heart disease, chronic hypertension, arrhythmias, or cardiomyopathy. Thus, if a patient has symptoms of CHF, the diagnosis would be CHF secondary to…
According to immunization experts, the frequency and severity of local reactions to tetanus vaccines increases with the frequency of vaccine administration (Item 107-4). The local reaction is also more severe when the vaccine is inadvertently administered subcutaneously, which may occur when the needle is too short for the site or the patient is obese. This…
The American Heart Association has issued new Guidelines (Circulation. 2007;116:1736-1754) on when and where to use antibiotics to prevent endocarditis (Item 106-10). The Guidelines recommend that patients receive endocarditis prophylaxis for dental procedures only if they have one of the following conditions: (1) prosthetic heart valve; (2) previous history of infective endocarditis; (3) congenital heart…
What if the patient who needs isoniazid after a positive purified protein derivative test 10 years ago (Item 110-17) cannot take it because of its side effects?—Joel Stoia, PA-C, Dayton, Md. I would need to know more about the side effects of isoniazid in this particular case. Hepatotoxicity is uncommon, seen in about 0.1% of…
Do type 2 diabetics who show no evidence of proteinuria or retinopathy still need yearly eye evaluations?—Raymond Ramirez, MD, Mableton, Ga. The 2007 American Diabetes Association guidelines on the management of diabetes (Diabetes Care. 2007;30 Suppl 1:S4-S41; available at http://care.diabetesjournals.org/. Accessed December 12, 2007) state that type 2 diabetics with a normal eye exam may…
What, if any, are the medical benefits of “infrared” sauna? Does it “detoxify” the body, provide a cardiovascular workout, or promote healing? Have there been any reports of adverse effects?—Steven Olson, MD, MPH, Colebrook, N.H. Infrared sauna bathing has been proposed as a potential therapeutic option for conditions ranging from rheumatoid arthritis to ventricular arrhythmias.…
Which is better for treating hypokalemia—oral or IV potassium?—James Nahlik, MD, St. Louis Optimal treatment for hypokalemia depends on the severity of the potassium deficit and the underlying etiology. In general, when a patient has mild-to-moderate hypokalemia (serum potassium between 3.0 and 3.5 mEq/L), there are few if any symptoms, and oral potassium replacement is…
How should one approach chest-pain management in the pediatric population? —Madhu Gopal, MD, Chicago Chest pain in children usually has a benign etiology. Most patients will have a normal physical exam or findings consistent with a musculoskeletal origin (e.g., chest-wall tenderness); these patients do not require any further investigation. Any patients with abnormal physical findings…
A 34-year-old, healthy, African-American man with no chronic medical problems is found to have a high serum iron level (266 µg/dL, normal: 40-155) along with normal aspartate aminotransferase, alanine aminotransferase, and g-glutamyltransferase levels. The patient does not take any OTC or herbal medications, iron supplements, or vitamins. Given the normal liver enzyme levels, hemochromatosis seems…
In a case of suspected Campylobacter gastroenteritis, what is the best way to confirm the diagnosis? What provides the most effective treatment?—Clark G. Tristshauser, MD, Medina, N.Y. Stool culture is the best way to diagnose infection with Campylobacter, which is the most common bacterial cause of infectious colitis. In most patients, symptoms resolve without need…
