By J. R. Playfer (auth.), M. Lye (eds.)
Most sufferers in constructed international locations with clinical difficulties requiring medical institution care are aged. more and more the dividing line among common inner medi cine and acute geriatric drugs is changing into extra blurred. it really is, however, obvious that a few aged sufferers on clinical or sub-specialty health facility wards turn into 'bed blockers'. Why? additionally, why are 'bed blockers' much less of an issue on an acute geriatric ward? Many clinicians think this is often with regards to a quicker entry to the long-stay beds of the geriatric unit. Even a quick examine of health center working statistics will express this isn't and can't be the case. while geria tricians are requested to work out aged 'bed blockers' on colleagues' wards they method with anxiousness simply because those sufferers frequently need to be put on an extended ready record for those scarce and extremely dear carrying on with care beds. Do geria tricians see diversified acute scientific difficulties in comparison with their colleagues? the answer's now not instantly noticeable, even though geriatricians are inclined to obtain extra power 'bed blockers' than their normal clinical colleagues. How is it then, that geriatricians appear to cope greater than their colleagues? All geriatricians have adventure of common inner drugs however the contrary regrettably doesn't carry. This publication is written within the desire of redressing the imbalance.
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Extra info for Acute Geriatric Medicine
Because digoxin is quite heavily protein bound in the blood hypoalbuminaemia should be sought. At the same time hypokalaemia and hypercalcaemia should be excluded as both potentiate digoxin toxicity. Any abnormalities in serum electrolytes require investigation (Chapter 4) and correction, preferably before commencing digoxin. Finally, the patients' potential compliance should be assessed - if they live alone and are confused, digoxin therapy should be strongly reconsidered (Chapter 7). If the doctor actively excludes all the reasons for not prescribing digoxin, he is less likely to poison his patient.
N. and Emslie-Smith, D. (1982). Severe hyponatraemia and cardiac failure successfully treated with captopril. British Medical Journal, 284, 1085-6 Morgan, D. , Burkinshaw, L. and Davidson, C. (1978). Potassium depletion in heart failure and its relation to long-term treatment with diuretics: a review of the literature. Postgraduate Medical Journal, 54, 72-9 Morgan, D. B. and Davidson, C. (1980). Hypokalaemia and diuretics: an analysis of publications. British Medical Journal, 1, 905-8 Opie, L. H.
This is especially common in the elderly patient admitted to hospital acutely with a respiratory infection associated with some degree of heart failure, a situation seen every day in all general medical and geriatric wards. Paradoxically, the loop diuretics have less effect on plasma potassium and glucose levels than the less potent thiazide agents though the situation still requires some monitoring. Their effects on magnesium excretion are similar. Management of electrolytes following the introduction of loop diuretics is DRUGS IN CARDIAC FAILURE 29 the same as previously described for thiazide agents.