Podcast 647: INR and Liver Failure

Podcast 647: INR and Liver Failure

Contributor: Erik Verzemnieks, MD

Educational Pearls:

  • INR measures the clotting cascade including factors II, VII, IX, and X
  • Coumadin most commonly elevates the INR, and it is used to monitor the anticoagulant's effectiveness
  • Liver failure can cause a similar elevation in the INR due to lack of synthesis of factors II, VII, IX, X
  • An elevated INR in liver failure does not mean that the patient is anticoagulated, at increased risk for bleeding, or is at less risk of forming a clot
  • There is more commonly an increased risk of clot formation due to lack of production of protein C and S, which are natural anticoagulants
  • Lack of production of proteins C and S have a larger effect and lead to typically a net clotting risk
  • Levels of these can be indirectly measured through albumin
  • Portal venous thrombosis is one of the most common examples of this phenomenon

References

Harrison MF. The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting. West J Emerg Med. 2018;19(5):863-871. doi:10.5811/westjem.2018.7.37893

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

Donate to EMM today!

Jaksot(1147)

Podcast # 432: Hunting for UTIs

Podcast # 432: Hunting for UTIs

Author: Michael Hunt, MD Educational Pearls: As many as 20% of women in assisted living have asymptomatic bacteriuria This can present a diagnostic conundrum when seeing these patients in the emergen...

7 Helmi 20193min

Podcast # 431: Medication Errors

Podcast # 431: Medication Errors

Author: Rachel Brady, MD Educational Pearls: Medication errors are estimated to be the 3rd leading cause of death A 2016 study estimated 250,000 errors occur per year, with 7000-9000 leading to death...

4 Helmi 20193min

Podcast # 430: Humeral IO

Podcast # 430: Humeral IO

Author: Aaron Lessen, MD Educational Pearls: Choose the longest needle for the humeral IO Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the site Aim 1 cm su...

30 Tammi 20193min

Podcast # 429: Oldschool Syphilis Treatment

Podcast # 429: Oldschool Syphilis Treatment

Author: Chris Holmes, MD Educational Pearls: In WWI, the 2nd leading cause of soldier disability were STDs. An early treatment of syphilis included topical and inhaled mercury Bloodletting, vitriol, ...

28 Tammi 20194min

Podcast # 428: Severe Hypothyroidism

Podcast # 428: Severe Hypothyroidism

Author: Gretchen Hinson, MD Educational Pearls: Clinical manifestations of severe hypothyroidism may include: Pale, cool, diaphoretic skin Myxedema is the non-pitting edema seen in hypothyroidism Hy...

27 Tammi 20193min

Podcast # 427: Cookie Dough is Delicious

Podcast # 427: Cookie Dough is Delicious

Author: Eric Miller, MD Educational Pearls: Recent CDC statement warms against consumption of cookie dough Two common ingredients can pose risk: eggs and flour Flour in dough is a raw agricultural ...

24 Tammi 20192min

Podcast # 426: Ho Ho - Oh No!

Podcast # 426: Ho Ho - Oh No!

Author: Katrina Iverson, MD Educational Pearls: The winter holiday months present a unique picture of patient presentations to the emergency department Some of the unique presentations include: Chi...

22 Tammi 20192min

Podcast # 425: Oseltamivir Efficacy in Children

Podcast # 425: Oseltamivir Efficacy in Children

Author: Aaron Lessen, MD Educational Pearls: Recent meta-analysis reviewed efficacy oseltamivir (Tamiflu) in pediatric populations treated for influenza, showing an 18 hour reduction in duration of i...

18 Tammi 20193min

Suosittua kategoriassa Tiede

rss-poliisin-mieli
rss-mita-tulisi-tietaa
tiedekulma-podcast
docemilia
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-duodecim-lehti
radio-antro
utelias-mieli
filocast-filosofian-perusteet
rss-lapsuuden-rakentajat-podcast
rss-lihavuudesta-podcast
rss-sosiopodi