Who is at risk of B12 Deficiency?

It isn’t uncommon that I see a patient admitted to nursing home with advanced dementia and a very low level of vitamin B12. I always wonder how much of vitamin B12 deficiency may be contributing to the progression of dementia, even though it isn’t the cause. I am not a big fan of any vitamin supplements but Vitamin B12 is one where I would advocate supplementation where indicated.

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Drug Induced Hyponatremia

Electrolyte disturbances can be caused by many medications. While an imbalance in potassium, calcium and magnesium has garnered greater attention due to their potential for clinical complications such as cardiac arrhythmia, myocardial infarction and / or bone fractures and calcification of internal organs, drug-induced hyponatremia is also common and should not be overlooked.

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Understanding Fibromyalgia

Every time when I hear the term fibromyalgia, I always need to look up what it means, its pathophysiology, clinical presentations and its guidelines and management strategies. In fact, Hauser et al recently published a review article, looking at the management of fibromyalgia.  The authors describes the various diagnostic criteria and recommendations from Canada, Germany and Israel and highlighted how they differ to a great extent in their overall approach in symptoms description, recommended investigations and screening procedures.

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World Hypertension Day – May 17

It’s World Hypertension Day.  Last year, I talked about how important it is to know your numbers and what they mean. Check out last year’s post here. This year, I want to highlight few simple things you can do to help reduce blood pressure without medications.  The Mayo Clinic has nicely outlined 10 things you can do.

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Subclinical Hypothyroidism for the Elderly Population

Hypothyroidism is a common condition affecting many individuals.  Symptoms of hypothyroidism can be very non-specific and include the following: fatigue, cold intolerance, constipation, and weight gain. According to Up-to-date (accessed on May 6, 2017), primary hypothyroidism is characterized by a high serum thyroid-stimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration, whereas subclinical hypothyroidism is defined biochemically as a normal free T4 concentration with an elevated TSH concentration.

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Is it time for Drug Holiday of Bisphosphonate in Osteoporosis?

A common scenario in the geriatric population is that the post-menopausal patient may be on a bisphosphonate for the treatment of osteoporosis. But when the patient is no longer mobile, wheelchair bound and the risk of fall is deemed to be low or moderate, the question arises as to whether she needs to continue her bisphosphonate therapy.

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Holding Direct Oral Anticoagulant (DOAC) for Elective Procedure or Surgery

A 78 yo lady is on rivaroxaban 15mg po daily for atrial fibrillation. She was scheduled for an elective procedure on Friday. The surgeon instructed the rivaroxaban to be held for the previous 2 days before the procedure. The order was transcribed as “Hold Rivaroxaban for 2 days, restart on Friday”. The intent of the order was to restart rivaroxaban after the procedure. No one made the connection that the rivaroxaban was scheduled at 0800 in the morning. So on Friday the morning of the procedure, the patient was given a dose of rivaroxaban.   Unfortunately, the procedure had to be cancelled due to the administration of rivaroxaban.

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