internal medicine part #2, more clinical notes

adding amiodarone to someone on coumadin? look for ^^^in INR

classic digitalis toxicity - supraventricular arrhythmia + heart block

Diabetic and Cr >2? no metformin (lactic acidosis) no ACEi (hyperkalemia)

repleting K? check Mg, if not normal K will not rise appropriately.

whats the mechanism behind that?

Mg is bound to ATP, low Mg, low ATP activity--> especially in the thick ascending limb where tonic ATP activity inhibits K efflux into tubular lumen. IF Mg is low then the normally ATP inhibited K channels open and K is lost in urine- and refractory to repletion.

multifocal atrial tachycardia most often associated w/COPD