Drugs causing dyspepsia

NSAIDs including aspirin

Corticosteroids

Bisphosphonates

Potassium chloride

Iron

Antibiotics

Calcium channel blockers

Nitrates

Theophylline

Drugs with antimuscarinic effects, e.g. tricyclic antidepressants



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Source: Clinical Pharmacy and Therapeutics, 4th ed. by Roger Walker and Cate Whittlesea, p. 152.

Acidosis and dopamine

"If you're monitoring a patient receiving dopamine (Intropin) and the dopamine isn't raising his blood pressure as expected, check the patient's pH. A pH level below 7.1, which can happen in severe metabolic acidosis, causes resistance to vasopressor therapy. Correct the pH level and the dopamine may be more effective."


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Source: Expert LPN Guides: Fluids & Electrolytes (2007), p.169.

Challenges to raising potassium level

If you're having difficulty raising a patient's potassium level, reevaluate his fluid and electrolyte status and ask yourself the following questions:

• Is the patient still experiencing diuresis or suffering losses from the GI tract or the skin? If so, he's losing fluid and potassium.

• Is the patient's magnesium level normal or does he need supplementation? Keep in mind that low magnesium levels make it difficult for the kidneys to conserve potassium.

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Source: Expert LPN Guides: Fluids & Electrolytes (2007), p. 91.

Causes of hypokalemia

Shift of potassium to the intracellular compartment

Acute alkalosis

Following correction of metabolic acidosis (e.g., diabetic acidosis)

Hypokalemic periodic paralysis

Insulin administration

Administration of beta 2-agonists

Conditions of catecholamine excess

• Cardiac surgery
• Myocardial infarction
• Delerium tremens

Barbiturate intoxication

Vitamin B12 therapy

Thyrotoxicosis (rare)

Inadequate potassium intake (uncommon because of renal conservation of potassium)

Starvation

Postoperative state without replenishment

Gastrointestinal potassium loss

Diarrhea

Laxative abuse

Villous adenoma of rectum

Vomiting

Fistulas

Renal potassium loss (renal cause of hypokalemia should be sought if the urinary loss of potassium exceeds 20mEq/day)

Osmotic diuresis

Magnesium depletion

Acute leukemia

Antimicrobial agents (such as carbenicillin, gentamicin, amphotericin B)

Cisplatin administration

Renal conditions with metabolic acidosis

• Distal renal tubular acidosis
• Proximal renal tubular acidosis
• Ureterosigmoidostomy
• Administration of acetazolamide

Conditions with metabolic acidosis

• Cushing's syndrome
• Exogenous corticosteriod administration
• Primary aldosteronism
• Licorice usage
• Renovascular hypertension
• Malignant hypertension
• Renin-producing renal tumor
• Diuretics (thiazides, furosemide)
• Liddle's sydrome
• Bartter's sydrome

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Source: the portable internist by Anthony J. Zollo Jr., MD (1995), p. 328-329.