Inhaled isopropyl alcohol for nausea

An elderly male presents to the emergency department with complaints of nausea, vomiting, and diarrhea starting a day and a half ago.  The diarrhea started abruptly, has occurred almost 10 times, and is non-bloody.  His abdomen is soft but has mild diffuse tenderness.  Vital signs and basic laboratory results are normal except for a potassium of 2.9 mEq/L and an EKG with a QTc interval of 490 msec. 

Use of sodium polystyrene sulfonate for hyperkalemia

Let's start with a patient case.  A 58 year old male is sent to the hospital from his PMD for hyperkalemia.  He has a past medical history of diabetes mellitus type 2, hypertension, osteoarthritis, and obesity for which he is taking sitagliptin 100 mg daily, lisinopril 20 mg daily, atorvastatin 80 mg daily, and aspirin 81 mg daily.  Pertinent findings on arrival to the emergency department are SCr = 1.2 mg/dL (at his baseline), K+ = 5.9 mEq/L (previously 4.2), blood pressure = 152/96 mm Hg, Hb A1c = 10.8%, and a normal EKG.  Upon further questioning about his medication and supplement use, he admits to occasional ibuprofen and oxycodone use this past month for his osteoarthritis and is newly using Morton's Salt Substitute (as he's trying to avoid salt because of his uncontrolled hypertension).  What is the role of sodium polystyrene sulfonate (SPS) in this situation?

Role for polyethylene glycol in treating hepatic encephalopathy?

Hepatic encephalopathy is a frequent and debilitating complication of liver disease.  The mainstay of treatment, lactulose, has been used since the 1960s, even without a strong evidence-base for efficacy.  Currently, in the AASLD guidelines for hepatic encephalopathy, updated in 2014, lactulose is recommended as first line therapy for the treatment of episodic overt hepatic encephalopathy (Grade II-1,B,1 which means controlled trials without randomization, moderate evidence strength, strong recommendation)1.  It's notable that there is a cost appeal of lactulose compared to alternative or add-on therapies such as rifaximin and this is considered in their recommendation.

Risk factors for stress ulcers and stress ulcer prophylaxis

Stress ulcer prophylaxis is a topic that comes up frequently on the internal medicine service but is not frequently given more than a moment of consideration.  Numerous studies have identified how acid-suppressive therapies (eg. namely proton pump inhibitors and histamine-2 receptor antagonists) are widely prescribed and often lacking an indication.  Studies of various designs have revealed that 46-73% of patients who receive acid-suppressive therapy while hospitalized do not have an indication.^1-3 

The most robust guideline to date for the use of acid-suppressive therapy for stress ulcer prophylaxis was published in 1999 and was comprised of data almost entirely from patients in the intensive care unit (ICU).⁴  At that time, there was only one randomized control trial addressing stress ulcer prophylaxis in the non-ICU setting.  These guidelines identified and determined the weight of various risk factors for the development of stress ulcers and these values are continued to be used today.  The presence or absence or risk factors should be used to determine the need for stress ulcer prophylaxis, not just admission to the ICU.  The summary of recommendations follows below.