ABSTRACT
Asthma is the most common chronic respiratory illnessworldwide, and makes up a large part of primary carepractice. Family physicians need to be well-versed inasthma diagnosis, while avoiding overdiagnosis ormisdiagnosis. The tetrad of cough, chest tightness,wheezing and dyspnea are conventionally thought to bethe key presenting symptoms of asthma. However, thesesymptoms can occur in many other conditions, makingaccurate diagnosis of asthma challenging. This article aimsto outline the clinical features and investigations that can help the family physician diagnose asthma and formpossible differential diagnoses in adolescents and adults.Diligent history-taking remains paramount for diagnosis,while no investigation is definitive.
ABSTRACT
Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group), received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020). When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069), but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001).