Essentials of Kumar and Clark's Clinical Medicine : Essentials of Kumar and Clark's Clinical Medicine E-Book

Front Cover Inside Front Cover Essentials of Kumar & Clark’s Clinical Medicine Copyright Contents Preface Contributors Medical emergencies Abbreviations Significant websites General websites Medical dictionaries Guidelines and evidence-based medicine Medical calculators Healthcare journals and magazines Medical societies and organizations Others Chapter-specific websites 1. Ethics and communication 2. Infectious diseases 3. Gastroenterology and nutrition Information for patients and relatives 4. Liver, biliary tract and pancreatic disease Information for patients and relatives 5. Haematological disease Information for patients and relatives 6. Malignant disease Information for patients and relatives 7. Rheumatology Information for patients and relatives 8/9. Water, electrolytes and acid-base balance/Renal disease Information for patients and relatives 10. Cardiovascular disease Information for patients and relatives 11. Respiratory disease Information for patients and relatives 12. Intensive care medicine Information for patients and relatives 13. Drug therapy, poisoning and alcohol misuse Information for patients and relatives 14. Endocrine disease Information for patients and relatives 15. Diabetes mellitus and other disorders of metabolism Information for patients, relatives and healthcare professionals 16. The special senses Information for patients and relatives 17. Neurology Information for patients and relatives 18. Dermatology Information for patients and relatives Therapeutics Chapter 1: Ethics and communication Legally valid consent Capacity Information disclosure Obtaining consent Special circumstances Adults who lack capacity to consent Advance decisions Children Teaching Human immunodeficiency virus testing End-of-life decisions including assisted dying Cardiopulmonary resuscitation Confidentiality Communication The medical interview 1. Building a relationship 2. Opening the discussion 3. Gathering information 4. Understanding the patient 5. Sharing information 6. Reaching agreement on management 7. Providing closing Breaking bad news Communication in difficult circumstances When things go wrong Complaints Culture and communication Patients with impaired faculties for communication Medical record keeping Team communication Chapter 2: Infectious diseases Common investigations in infectious disease Pyrexia of unknown origin Investigations Management Septicaemia Aetiology Clinical features Investigations Management Common viral infections Measlesnd Clinical features Complications Management Mumpsnd Clinical features Management Rubelland Diagnosis Management Herpes viruses Herpes simplex virus (HSV) Investigations Management Varicella zoster virus Varicella (chickenpox) Clinical features Investigations Management Herpes zoster (shingles) Clinical features Management Epstein-Barr virus infection Clinical features Investigations Management Bacterial infections Lyme disease Clinical features Investigations Management Leptospirosisnd Clinical features Investigations Management Rickettsia Fever in the returned traveller Approach to diagnosis Investigations Malariand Aetiology Pathogenesis Clinical features Investigations Management Treatment of uncomplicated falciparum malaria Non-falciparum malaria Prevention and control Enteric fevernd Clinical features Investigations Management and prevention Enterocolitis Dengue fever Schistosomiasis Miscellaneous viral infections Zika MERS Co-V Gastroenteritis and food poisoningnd Clostridium difficile Pathology and clinical features Diagnosis Management Mild/moderate disease Severe disease Recurrent disease Prevention of C. difficile infection Traveller's diarrhoea Clinical features Treatment and prevention Amoebiasisnd Clinical features Intestinal amoebiasis (amoebic dysentery) Amoebic liver abscess Investigations Serology Colonic disease Liver disease Differential diagnosis Management Shigellosis (bacillary dysentery)nd Cholerand Pathophysiology and clinical features Management Prevention and control Giardiasis Clinical features Investigations Management Helminthic infections Sexually transmitted infections Urethritis Gonorrhoea Clinical features Diagnosis Management Chlamydia urethritis Genital ulcers Syphilis Early stages Primary infection Secondary infection Late stages Tertiary syphilis Congenital syphilis Diagnosis Primary screening Serological activity Monitoring serological effect of treatment Management Human immunodeficiency virus Routes of acquisition Pathogenesis of HIV infection Natural history of HIV infection Clinical features Diagnosis Monitoring Management Conditions due to immunodeficiency Fungi Protozoal infections Viruses Cytomegalovirus Herpes virus Human papilloma virus (HPV) Polyomavirus (JC virus) Hepatitis virus B and C Bacterial infection Neoplasia Prevention and control Prognosis Therapeutics Antibacterials β-Lactam antibacterials Mechanism of action Indications Preparations and dose Benzylpenicillin IM/IV Flucloxacillin Oral IM IV Amoxicillin Oral IM/IV Piperacillin+tazobactam IV Side effects Cautions/contraindications Cephalosporins Mechanism of action Indications Preparations and dose First generation E.g. Cefalexin Oral Second generation E.g. Cefuroxime Oral IM/IV Third generation E.g. Cefotaxime IM/IV Side effects Cautions/contraindications Aminoglycosides Mechanism of action Indications Preparations and dose Gentamicin IM/IV Side effects Cautions/contraindications Macrolides Mechanism of action Indications Preparations and dose Clarithromycin Oral IV infusion Side effects Metronidazole Mechanism of action Indications Preparations and dose Metronidazole Oral IV infusion By rectum Side effects Cautions/contraindications Quinolones Mechanism of action Indications Preparations and dose Ciprofloxacin Oral IV infusion Side effects Cautions/contraindications Chapter 3: Gastroenterology and nutrition Gastroenterology Symptoms of gastrointestinal disease Dyspepsia and indigestion Dysphagia Vomiting Flatulence Diarrhoea and constipation Steatorrhoea Abdominal pain Investigation of gastrointestinal disease Endoscopy Oesophagogastroduodenoscopy (OGD, `gastroscopy) Sigmoidoscopy Colonoscopy Endoscopic retrograde cannulation of biliary and pancreatic duct (ERCP) Endoscopic ultrasound (EUS) Endoanal and endorectal ultrasonography Balloon enteroscopy, Capsule endoscopy Imaging Plain X-rays Ultrasound Transabdominal ultrasound Computed tomography (CT) scan Magnetic resonance imaging (MRI) Positron emission tomography (PET) Contrast studies Oesophageal physiology testing The mouth Mouth ulcers Non-infective Infective Oral white patches The tongue Periodontal disorders Salivary gland disorders The oesophagus Symptoms of oesophageal disorders Gastro-oesophageal reflux disease (GORD) Pathophysiology Clinical features Investigations OGD 24-Hour intraluminal pH monitoring or impedance Management Complications Peptic stricture Barrett's oesophagus Achalasia Clinical features Investigations Management Complications Systemic sclerosis Other oesophageal dysmotility disorders Hiatus hernia Benign oesophageal strictures Oesophageal perforation Iatrogenic perforation Traumatic or spontaneous oesophageal rupture Malignant oesophageal tumours Pathology Epidemiology and aetiological factors Squamous carcinoma Adenocarcinoma Clinical features Investigations Management Prognosis Benign oesophageal tumours The stomach and duodenum Helicobacter pylori infection Epidemiology Clinicopathological features Diagnosis of infection Management Peptic ulcer disease Epidemiology Aetiology Clinical features Investigations Management Ulcers associated with H. pylori H. pylori-negative peptic ulcers Surgery Complications Perforation Gastric outlet obstruction Haemorrhage Management of dyspepsia Gastropathy Gastritis Gastric cancer Epidemiology Aetiology Pathology Clinical features Investigations Management Prognosis Other gastric tumours Gastrointestinal stromal tumours (GISTs) Gastric lymphoma Gastric polyps Gastrointestinal bleeding Acute upper gastrointestinal bleeding Aetiology Management Immediate management Risk assessment Pre-endoscopy drug therapy Determine site of bleeding Specific management Post-endoscopy Lower gastrointestinal bleeding Management Chronic gastrointestinal bleeding Investigations Management The small intestine Coeliac disease (gluten-sensitive enteropathy) Aetiopathogenesis Clinical features Investigations Serum antibodies Distal duodenal biopsies Blood count Small bowel radiology or capsule endoscopy Bone densitometry Management Complications Dermatitis herpetiformis Tropical sprue Bacterial overgrowth Clinical features Diagnosis Management Intestinal resection Whipples disease Miscellaneous small intestinal conditions Tuberculosis Clinical features Diagnosis Imaging Histology Management Protein-losing enteropathy Meckels diverticulum Intestinal ischaemia Tumours of the small intestine Malignant tumours Benign small bowel tumours Carcinoid tumours Pathology Clinical features Investigations Management Inflammatory bowel disease Epidemiology Aetiology Genetic susceptibility Environment Host immune response Pathology Clinical features Crohn's disease Ulcerative colitis Investigations Blood tests Radiology and imaging Rigid or flexible sigmoidoscopy Colonoscopy Small bowel imaging Perianal CD Ultrasonography Plain abdominal X-ray Radiolabelled white cell scanning Differential diagnosis Management Medical Surgery Cancer in inflammatory bowel disease Prognosis Microscopic colitis The colon and rectum Constipation Investigation Management Faecal incontinence Diverticular disease Aetiology Clinical features Management Miscellaneous conditions Megacolon Ischaemic colitis Colon polyps and the polyposis syndromes Adenomatous polyps Colorectal cancer Epidemiology Inheritance Pathology Clinical features Investigation Colonic examination Blood tests Radiology Faecal occult blood tests Management Prognosis Screening Diarrhoea Acute diarrhoea Chronic diarrhoea Mechanisms of diarrhoea Osmotic diarrhoea Secretory diarrhoea Inflammatory diarrhoea (mucosal destruction) Motility related Approach to the patient with diarrhoea Step 1: Step 2: Step 3: Investigation Chronic diarrhoea Functional bowel disorders The acute abdomen History Examination Investigations Acute appendicitis Epidemiology Clinical features Investigations Differential diagnosis Management Complications Acute peritonitis Localized peritonitis Generalized peritonitis Intestinal obstruction Mechanical Functional The peritoneum Nutrition Dietary requirements Nutritional support Enteral nutrition Total parenteral nutrition (TPN) Monitoring of artificial nutrition Refeeding syndrome Disorders of bodyweight Obesity Anorexia nervosa Therapeutics Drugs for dyspepsia and peptic ulceration Antacids Mechanism of action Indications Preparations and dose Aluminium hydroxide Magnesium trisilicate mixture Co-magaldrox (Mucogel) Alginate-containing antacid Side effects Cautions/contraindications H2-receptor antagonists Mechanism of action Indications Preparations and dose Ranitidine Oral IV Cimetidine Oral Side effects Cautions/contraindications Proton pump inhibitors Mechanism of action Indications Preparations and dose Omeprazole Lansoprazole Side effects Cautions/contraindications Constipation Bulk-forming laxatives Mechanism of action Indications Preparations and dose Ispaghula husk Methycellulose Sterculia Side effects Cautions/contraindications Stimulant laxatives Mechanism of action Indications Preparations and dose Bisacodyl Oral By rectum Docusate sodium Oral By rectum Glycerol (glycerin) Suppositories: Senna Tablets: Side effects Cautions/contraindications Osmotic laxatives Mechanism of action Indications Preparations and dose Lactulose Macrogols (polyethylene glycol) Magnesium salts Phosphates (rectal) Sodium citrate (rectal) Side effects Cautions/contraindications Bowel-cleansing solutions Indications Mechanism of action Preparations and dose Citramag® Fleet Phospho-soda® Klean-prep® Moviprep® Picolax® Side effects Diarrhoea Loperamide hydrochloride Mechanism of action Indications Side effects Cautions/contraindications Nausea and vomiting Antihistamines Indications Mechanism of action Preparations and dose Cyclizine Oral IM/IV injection Promethazine Oral IM/IV Side effects Cautions/contraindications Phenothiazines Mechanism of action Indications Preparations and dose Chlorpromazine hydrochloride Oral IM By rectum Prochlorperazine Oral IM Side effects Cautions/contraindications Domperidone and metoclopramide Mechanism of action Indications Preparations and dose Metoclopramide Oral/IM/IV Domperidone Oral By rectum Side effects Cautions/contraindications 5-HT3-receptor antagonists Mechanism of action Indications Preparations and dose Ondansetron Side effects Cautions/contraindications Chapter 4: Liver, biliary tract and pancreatic disease Liver biochemistry and liver function tests Approach to interpretation of abnormal liver biochemistry Other investigations in liver and biliary disease Hepatic stiffness (transient elastography) Endoscopic ultrasound (EUS) Computed tomography (CT) examination Magnetic resonance imaging (MRI) Magnetic resonance cholangiopancreatography (MRCP) Upper gastrointestinal (GI) endoscopy ERCP Percutaneous transhepatic cholangiography (PTC) Liver biopsy Markers of liver fibrosis Symptoms and signs of liver disease Jaundice Haemolytic jaundice Congenital hyperbilirubinaemia Cholestatic jaundice Investigations Hepatitis Acute hepatitis Chronic hepatitis Viral hepatitis Hepatitis A Epidemiology Clinical features Investigations Differential diagnosis Management Prophylaxis Hepatitis B Epidemiology Viral structure Acute HBV infection Chronic HBV infection Treatment of chronic infection: whom to treat Antiviral agents Hepatitis B and HIV co-infection Prophylaxis Hepatitis D (delta or δ agent) Hepatitis C Hepatitis C virus Chronic hepatitis C infection Hepatitis End Acute hepatic failure Alcohol use Screening for problem drinking Consequences of alcohol use and dependence Physical complications Alcohol withdrawal Autoimmune hepatitis Aetiology Clinical features Investigations Treatment Prognosis Non-alcoholic fatty liver disease Cirrhosis Aetiology Pathology Clinical features Investigations Severity Aetiology Further investigations Management Prognosis Complications and effects of cirrhosis Portal hypertension Aetiology Clinical features Variceal haemorrhage Management Active bleeding Prevention of recurrent variceal bleeding Ascites Aetiology Clinical features Investigations Management Diuretics Paracentesis TIPS Complications Portosystemic encephalopathy Pathophysiology Clinical features Differential diagnosis Investigations Management Prognosis Hepatorenal syndrome Hepatopulmonary syndrome Liver transplantation Types of chronic liver disease and cirrhosis Alcoholic cirrhosis Primary biliary cholangitis Epidemiology Aetiology Clinical features Investigations Management Prognosis Secondary biliary cirrhosis Hereditary haemochromatosis Aetiology Clinical features Investigations Management Prognosis Wilson's disease (hepatolenticular degeneration) α1-Antitrypsin deficiency Alcohol and the liver Fatty change Alcoholic hepatitis Clinical features Investigations Management Alcoholic cirrhosis Primary sclerosing cholangitis Budd–Chiari syndrome Aetiology Clinical features Investigations Treatment Liver abscess Aetiology Clinical features Investigations Management Amoebic liver abscess Pyogenic abscess Liver disease in pregnancy Liver tumours Hepatocellular carcinoma (hepatoma) Aetiology Clinical features Investigations Management Prognosis Benign liver tumours Gallstones Pathophysiology Clinical presentation Biliary pain Clinical features Investigations Management Acute cholecystitis Clinical features Investigations Management Chronic cholecystitis Acute cholangitis Clinical features Investigations Management Common bile duct stones (choledocholithiasis) The pancreas Pancreatitis Acute pancreatitis Pathogenesis Clinical features Investigation Management General supportive care Therapies to reduce the severity or frequency of complications Complications Chronic pancreatitis Clinical features Investigations Treatment Carcinoma of the pancreas Epidemiology Aetiology Clinical features Cancer affecting the head of the pancreas or ampulla of Vater Cancer of the body or tail Investigations Management Prognosis Cancer of the bile ducts Neuroendocrine tumours of the pancreas Chapter 5: Haematological disease Anaemia Clinical features Classification of anaemia (Table 5.2) Microcytic anaemia Iron deficiency Causes of iron deficiency Clinical features Investigations Differential diagnosis Management Sideroblastic anaemia Anaemia of chronic disease Macrocytic anaemia Megaloblastic anaemia Vitamin B12 deficiency Pernicious anaemia Epidemiology Clinical features Investigation of B12 deficiency Differential diagnosis Management Folate deficiency Clinical features Investigations Management Differential diagnosis Anaemia caused by marrow failure (aplastic anaemia) Aetiology Clinical features Investigations Differential diagnosis Management Haemolytic anaemia Inherited haemolytic anaemias Membrane defects Hereditary spherocytosis Clinical features Investigations Management Hereditary elliptocytosis Haemoglobin abnormalities Thalassaemia β-Thalassaemia Investigations Management α-Thalassaemia Sickle syndromes Sickle cell anaemia Clinical features Vaso-occlusion Anaemia Long-term problems Investigations Management Sickle cell trait Metabolic red cell disorders Glucose-6-phosphate dehydrogenase deficiency Acquired haemolytic anaemia Autoimmune haemolytic anaemia 'Warm' autoimmune haemolytic anaemia Clinical features Investigation Management 'Cold' autoimmune haemolytic anaemia Clinical features Investigation Management Drug-induced haemolysis Non-immune haemolytic anaemia Paroxysmal nocturnal haemoglobinuria Mechanical haemolytic anaemia Myeloproliferative disorders Polycythaemia Polycythaemia vera Clinical features Investigations Management Secondary polycythaemia Essential thrombocythaemia Myelofibrosis (myelosclerosis) Clinical features Investigations Management Myelodysplasia The spleen Splenomegaly Blood transfusion Whole blood Red cell concentrates Platelet concentrates Fresh frozen plasma Cryoprecipitate Factor VIII and IX concentrates Albumin Immunoglobulins Blood groups Procedure for blood transfusion Complications of transfusing red blood cells The white cell Neutrophils Neutrophil leucocytosis Neutropenia Monocytes Eosinophils Lymphocytes Haemostasis and thrombosis Haemostasis Investigation of bleeding disorders Vascular/platelet bleeding Coagulation disorders Platelet disorders Immune thrombocytopenic purpura (ITP) Investigation Management First-line therapy Second-line therapy Thrombotic thrombocytopenic purpura (TTP) Inherited coagulation disorders Haemophilia A Clinical features Investigations Management Complications Haemophilia B (Christmas disease) von Willebrand's disease Clinical features Investigations Management Acquired coagulation disorders Vitamin K deficiency Disseminated intravascular coagulation (DIC) Aetiology Clinical features Investigations Management Liver disease Thrombosis Arterial thrombosis Prevention Treatment Venous thrombosis Prevention Treatment Treatment of established thromboembolism Other anticoagulant drugs Therapeutics Oral iron Indications Preparations and dose Ferrous sulphate Ferrous gluconate Side effects Cautions/contraindications Folic acid Indications Preparations and dose Folic acid Side effects Cautions/contraindications Vitamin B12 Indications Preparations and dose Hydroxocobalamin Cyanocobalamin Side effects Cautions/contraindications Vitamin K Mechanism of action Indications Preparations and dose Phytomenadione Oral IV Menadiol sodium phosphate Water-soluble tablets: 10mg Side effects Cautions/contraindications Drugs affecting haemostasis Antiplatelet agents Mechanism of action Preparations and dose Aspirin Clopidogrel Side effects Cautions/contraindications Thrombin inhibitors Mechanism of action Indications Preparations and dose Side effects Cautions/contraindications Oral anticoagulants Mechanism of action Indications Preparations and dose Warfarin Side effects Contraindications Drug interactions Novel oral anticoagulants (NOACs) Mechanism of action Indications Preparations and dose Dabigatran Apixaban Rivaroxaban Side effects Contraindications Fibrinolytic drugs Mechanism of action Indications Preparations and dose Alteplase Streptokinase Side effects Contraindications Chapter 6: Malignant disease Diagnosis of malignancy Investigations Cancer treatment Chemotherapy Radiotherapy Endocrine therapy Biological therapy Myeloablative therapy and haemopoietic stem cell transplantation Oncological emergencies Neutropenic sepsis Superior vena cava syndrome Acute tumour lysis syndrome The leukaemias General classification Aetiology Acute leukaemia Epidemiology Clinical features Investigations Management Supportive care Treatment Acute myeloid leukaemia Low risk of treatment failure (based on the cytogenetic pattern) Intermediate risk High risk of treatment failure Acute promyelocytic leukaemia Prognosis Acute lymphoblastic leukaemia Chronic myeloid leukaemia Clinical features Investigations Management Chronic lymphocytic leukaemia Clinical features Investigations Management Prognosis The lymphomas Hodgkin's lymphoma Clinical features Investigations Differential diagnosis Management Non-Hodgkin's lymphoma Clinical features Investigations Management The paraproteinaemias Multiple myeloma Clinical features Investigations Management Monoclonal gammopathy of undetermined significance Palliative medicine and symptom control Management of pain Palliation of nausea and vomiting Care of the dying patient Chapter 7: Rheumatology The normal joint Musculoskeletal symptoms Common investigations in musculoskeketal disease Blood tests Simple blood tests Autoantibodies Imaging Plain X-rays Bone scintigraphy (isotope bone scan) Ultrasound Magnetic resonance imaging (MRI) DXA Arthroscopy Synovial fluid analysis Investigation of suspected muscle disease Common regional musculoskeletal problems Pain in the neck and shoulder Elbow pain Hip problems The knee Back pain Lumbar back pain Investigations Management Intervertebral disc disease Acute disc disease Clinical features Investigations Management Chronic disc disease Mechanical problems Spondylolisthesis Spinal stenosis Neck pain Osteoarthritis Epidemiology Pathology and pathogenesis Clinical features Differential diagnosis Investigations Management Inflammatory arthritis Rheumatoid arthritis Epidemiology Aetiology and pathogenesis Pathology Clinical features Non-articular manifestations Investigations Differential diagnosis Management NSAIDs and coxibs Corticosteroids Disease-modifying antirheumatic drugs Biological DMARDs Prognosis The seronegative spondyloarthritis Axial spondylarthritis Clinical features Investigations Management Psoriatic arthritis Clinical features Investigations Treatment Reactive arthritis Clinical features Investigations Management Enteropathic arthritis Crystal arthritis Gout and hyperuricaemia Epidemiology Pathogenesis Clinical features Investigations Management Pseudogout (pyrophosphate arthropathy) Investigations Management Infection of bones and joints Septic arthritis Clinical features Management Specific types of bacterial arthritis Gonococcal arthritis Meningococcal arthritis Tuberculous arthritis Osteomyelitis Autoimmune rheumatic diseases Systemic lupus erythematosus Epidemiology Aetiology Pathogenesis Clinical features Investigations Management Prognosis Antiphospholipid syndrome Clinical features Management Systemic sclerosis (scleroderma) Aetiology Clinical features Limited cutaneous scleroderma (LcSSc, 70% of cases) Diffuse cutaneous scleroderma (DcSSc, 30% of cases) Investigations Management Prognosis Polymyositis and dermatomyositis Clinical features Investigations Management Sjögren's syndrome Clinical features Investigations Management 'Overlap' syndrome and undifferentiated autoimmune rheumatic disease Systemic inflammatory vasculitis Polymyalgia and giant cell arteritis Clinical features Investigations Management Takayasu's arteritis Polyarteritis nodosa Microscopic polyarteritis (polyangiitis) Eosinophilic granulomatosis with polyangiitis Henoch–Schönlein purpura Cryoglobulinaemic vasculitis Behçet's disease Diseases of bone Control of calcium and bone metabolism Vitamin D Parathyroid hormone Osteoporosis Aetiology Clinical features Investigations Assessment of fracture risk Management Prevention and treatment Pharmacological intervention Glucocorticoid-induced osteoporosis Osteonecrosis Paget's disease Aetiology Clinical features Investigations Treatment Osteomalacia and vitamin D deficiency Aetiology Clinical features Investigations Management Therapeutics Anti-inflammatories and pain relief Paracetamol (acetaminophen) Mechanism of action Indications Preparations and dose Oral or rectal IV infusion Side effects Cautions/contraindications Compound preparations Non-steroidal anti-inflammatory drugs Mechanism of action Indications Preparations and dose Ibuprofen Oral Diclofenac Oral/rectal IM Celecoxib Oral Side effects Gastrointestinal toxicity Other side effects Cautions/contraindications Drugs affecting bone metabolism Bisphosphonates Mechanism of action Indications Preparations and dose Alendronic acid Risedronate Disodium pamidronate IV Zoledronic acid Side effects Cautions/contraindications Calcium Indications Preparations and dose Calcium carbonate Calcium gluconate Side effects Cautions/contraindications Vitamin D Mechanism of action Indications Preparations and dose Cholecalciferol Alfacalcidol Calcitriol Side effects Cautions/contraindications Chapter 8: Water, electrolytes and acid-base balance Water and electrolyte requirements Body fluid compartments Osmotic pressure Distribution of extracellular fluid Intravenous fluids in clinical practice Regulation of body fluid homeostasis Regulation of extracellular volume Abnormalities of extracellular volume Increased extracellular volume Clinical features Aetiology Management Decreased extracellular volume Aetiology Clinical features Investigations Management Plasma osmolality and disorders of sodium regulation Regulation of body water content Hyponatraemia Hyponatraemia resulting from salt loss (hypovolaemic hyponatraemia) Clinical features Management Hyponatraemia resulting from water excess (dilutional hyponatraemia) Aetiology Clinical features Investigations Management Central pontine myelinolysis Hypernatraemia Aetiology Clinical features Investigations Management Disorders of potassium regulation Hypokalaemia Aetiology Clinical features Management Hyperkalaemia Aetiology Clinical features Management Disorders of magnesium regulation Hypomagnesaemia Aetiology Clinical features Management Hypermagnesaemia Disorders of acid–base balance Respiratory acidosis Respiratory alkalosis Metabolic acidosis Clinical features Differential diagnosis (the anion gap) Lactic acidosis Diabetic ketoacidosis Renal tubular acidosis Uraemic acidosis Metabolic alkalosis Clinical features Management Therapeutics Diuretics Thiazide diuretics Mechanism of action Indications Preparations and dose Bendroflumethiazide Metolazone Side effects Cautions/contraindications Loop diuretics Mechanism of action Indications Preparations and dose Furosemide Oral IV/IM Bumetanide Oral IV Side effects Cautions/contraindications Potassium-sparing diuretics and aldosterone antagonists Mechanism of action Indications Preparations and dose Spironolactone Oral Disorders of serum potassium Potassium supplementation Indications Preparations and dose Oral potassium Kay-Cee-L Sando-K Intravenous potassium Side effects Cautions/contraindications Chapter 9: Renal disease Presenting features of renal disease Dysuria Polyuria and nocturia Oliguria Haematuria Pain Investigation of renal disease Blood tests Glomerular filtration rate Calculation of creatinine clearance using the Cockroft–Gault equation: Men Women Urine dipstick testing Proteinuria Haematuria Glycosuria Urine microscopy White cells Red cells Casts Bacteria Imaging techniques Plain X-ray Ultrasonography CT Magnetic resonance imaging (MRI) Excretion urography Renal arteriography (angiography) Anterograde pyelography Retrograde pyelography Renal scintigraphy Transcutaneous renal biopsy Glomerular diseases Normal glomerular structure Pathogenesis and terms in glomerular disease Classification and presentation of glomerulopathies Nephrotic syndrome Aetiology Nephrotic syndrome with 'bland' urine sediments Nephrotic syndrome with 'active' urine sediments (mixed nephrotic/nephritic) Clinical features Differential diagnoses Investigations Management General oedema Specific treatment Complications Acute glomerulonephritis (acute nephritic syndrome) Clinical features Investigations Management Rapidly progressive glomerulonephritis Urinary tract infection Pathogenesis Risk factors for UTI Clinical features Natural history Uncomplicated versus complicated infection Acute pyelonephritis Reflux nephropathy Recurrent UTI Investigations Diagnosis Management Treatment of single isolated attack Recurrent infection UTI in pregnancy Abacteriuric frequency or dysuria ('urethral syndrome') Bacterial prostatitis Tuberculosis of the urinary tract Tubulointerstitial nephritis Acute tubulointerstitial nephritis Chronic tubulointerstitial nephritis Hypertension and the kidney Essential hypertension Renal hypertension Bilateral renal disease Renovascular disease Options for renal artery imaging Management Renal calculi and nephrocalcinosis Aetiology Calcium stones Hypercalciuria Hyperoxaluria Uric acid stones Infection-induced stones Cystine stones Clinical features Differential diagnosis Investigations Management Initial treatment Prevention of recurrence Nephro