General Medical issues thread

[ellen10]

I had my second one 5 weeks ago. Yes sore red arm for almost a week.
Maybe wait until after Christmas @Pushka

 

[SuePa]

I turn 65 in Feb and I'm going to book in for my shangrix straight away.
I've had shingles once and I never want them again ! (Ha, ha, auto correct keeps changing shingrix to shangri-la. )

 

[cove]

Shangri-La hotels are very nice and shingles is the opposite of that.
My mother got shingles around her eyes and it was nasty. We paid for our two shots in Los Angeles several years ago. I think it cost $280 USD per person and I cannot remember if the second shot was a further $280 USD 6 months later.

 

[SuePa]

Shangri-La hotels are very nice and shingles is the opposite of that.
My mother got shingles around her eyes and it was nasty. We paid for our two shots in Los Angeles several years ago. I think it cost $280 USD per person and I cannot remember if the second shot was a further $280 USD 6 months later.

It's truly awful and the pain recurs for months. Well mine did.
I was lucky and got the antivirals early, but I'd hate to have a full-blown dose.

 

[drron]

And watching one of those medico programmes on Netflix they just doscussed the anion gap. What are the chances of that after 8 years of blood tests and never doscussed the anion gap before.

Actually very high chance with most people walking around that have many blood tests will never have a discussion re the Anion Gap as usually it is "normal".
Here is a discussion of it. And note it has CATMUDPILES which we learnt doing Respiratory Medicine.

Biochemistry, Anion Gap - StatPearls - NCBI Bookshelf

 

[Pushka]

Actually very high chance with most people walking around that have many blood tests will never have a discussion re the Anion Gap as usually it is "normal".
Here is a discussion of it. And note it has CATMUDPILES which we learnt doing Respiratory Medicine.

Biochemistry, Anion Gap - StatPearls - NCBI Bookshelf

Thanks. Mine seems to range between 15 and 17 over the last 18 months of monthly tests. 17 being 'upper limit'.

 

[VPS]

If bothanion and osmolar gap elevated then it's alcohol poisoning - ethanol/methanol or antifreeze poisoning. Metabolic acidosis generally also occurs which is part of the anion gap so it's also suspected - in these cases it's going to be bad.


However if anion gap alone, then suspect methanol but never forget diabetic ketoacidosis or (other metabolic acidosis)

Anion gap calculator.
Change units from mEq/L to mol/L
The menu at top lists the differentials including MUDPILERS and HARDUPS etc

Never seen albumin used in Anion Gap - normally Na K Cl HCO3

 

[Quickstatus]

Never seen albumin used in Anion Gap - normally Na K Cl HCO3

K often not used but Albumin is definitely used as a correcting factor under some circumstances

Albumin is the greatest "source" of un- measured anions in the blood under normal conditions. Most of the normal AG is due to albumin. There is a correcting formula for it. Observed AG needs to be corrected especially in cases of abnormal albumin.

But yes in an otherwise healthy person who comes into emergency with symptoms of poisoning, albumin correction would be irrelevant. Where it makes a difference is a patient who is in ICU with low albumin due to illness/malnutrition who has a "normal AG" but once corrected for low albumin actually has a high anion gap.

Edit you can see how albumin is used in the "evidence" section of the MDCalc