Vinod Kurup

Hospitalist/programmer in search of the meaning of life

Hospitalist Notes 1

My last night shift was a little less busy than most, so I forced myself to pick something about each patient I admitted and look it up. I tend to do this anyway, but I never keep notes or write about it. Here’s what I wrote about that night:

Does Buspar (buspirone) need to be tapered?

Answer: No. The full report on Micromedex was a little conflicting, because it stated that there may be some withdrawal symptoms from Buspar, but this quote in the same profile suggests otherwise:

Data suggest that buspirone does not cause physical dependence and as such, no withdrawal effects have been noted (Rickels et al, 1988a; Tyrer et al, 1985; Cole et al, 1982).

Staging COPD

I always forget the cutoffs for the stages of COPD. There are 2 different guidleines - GOLD and ATS/ARS, but fortunately they are almost identical:

Patients need to have an FEV1/FVC ratio < 0.70. Staging is then based on the FEV1.

  • Stage I (Mild): FEV1 > 80% predicted
  • Stage II (Moderate): FEV1 50-80% predicted
  • Stage III (Severe): FEV1 30-50% predicted
  • Stage IV: (Very Severe): FEV1 < 30% predicted, or < 50% with signs of chronic respiratory failure

Reference: Annals

How to determine calorie level of ADA diet?

We always put diabetic patients on an ADA diet and I choose the calorie level by gestalt. I figured there must be some formula to calculate the calorie level based on the patient’s weight. Looking it up, I found a different answer altogether. The ADA no longer recommends an ADA diet in the hospital. Instead, they recommend a consistent-carbohydrate diet. In long-term care facilities (i.e. nursing homes), they go a step further and recommend a ‘Regular’ diet with consistency in the amount and timing of carbohydrate. They specifically state that there is no evidence to support the classic ‘No concentrated sweets’ diet. These guidelines are from 2007, but they obviously have not been widely disseminated yet.

It is recommended that the term “ADA diet” no longer be used, since the ADA no longer endorses a single nutrition prescription or percentages of macronutrients.

Reference: Diabetes Care