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Oassification. The international classification of retinopathy of prematurity (i crop) is used to classify rop. This classification system consists of four components (see fig. 64.1). 1. Location refers to how far the developing retinal blood vessels have progressed. The retina is divided into three concentric circles or zones. A. Zone 1 consists of an imaginary circle with the optic nerve at the center and a radius of twice the distance from the optic nerve to the macula. B. Zone 2 extends from the edge of zone 1 to the ora serrata on the nasal side of the eye and approximately half the distance to the ora serrata on the temporal side.

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Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology. 2011;115:879-890. Doi:10.1097/aln.0b013e31822e9499. 17. Sappen ield jw, martz dg. Patients with disease o brain, cerebral vasculature, and spine. Med clin north am. 2013;97:993-1013. Doi:10.1016/j.Mcna.2013.05.007. 18. Marcantonio er. In the clinic. Delirium. Ann intern med. 2011;154:6-16. Doi:10.1059/0003-4819-154-11-20110607001006. 19. Ely ew, margolin r, francis j, et al. Evaluation o delirium in critically ill patients. Validation o the con usion assessment method or the intensive care unit (camicu). Crit care med. 2001;29:1370-1379. Doi:10.1097/ 00003246-200107000-00012. 20. Brummel ne, girard d. Preventing delirium in the intensive care unit. Crit care clin. 2013 jan;29(1):51-65. Doi.

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2 l/kg three times daily, titrate protein viagra spray uk binding. Dose to effectiveness, 47%–80% usually 3–5 mg daily in two primary elimination route. Or three divided doses hepatic loading dose. Half-life. Not recommended due to 60 hours increased adverse effects apparent volume of maintenance dose. Distribution. Initiate at 250 mg twice daily 0. 6–0. 7 l/kg and titrate to 500–1000 mg protein binding. Twice daily none primary elimination route. Hepatic hepatotoxicity, neutropenia, rash (continued) 485 486 table 31–3  characteristics of common aeds (continued) drug felbamate (felbatol) mechanism of action inhibit glutamate activity gabapentin (neurontin, generic) modulate calcium channels and enhance gaba activity lacosamide (vimpat) slow sodium channel inactivation. Modulate collapsin response. Mediator protein-2 lamotrigine (lamictal, lamictal xr, generic) fast sodium channel inactivation pharmacokinetic parameters half-life. Monotherapy. 20 hours concurrent enzyme inducers. 11–16 hours apparent volume of distribution. 0. 7–0. 8 l/kg protein binding. 25%–35% primary elimination route. Hepatic loading dose. Half-life. Not recommended due to 5–7 hours (proportional to short half-life creatinine clearance) maintenance dose. Apparent volume of 900–3600 mg/day in three or distribution. Four divided doses (doses 0. 6–0. 8 l/kg up to 10,000 mg/day have protein binding. Been tolerated) < 10% primary elimination route. Renal loading dose. Half-life. Data unavailable approximately 13 hours maintenance dose.

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5–2. 5 miu/l or μiu/ml). When patient is euthyroid, consider reducing dose of antithyroid drug to avoid hypothyroidism. •• consider stopping antithyroid therapy in patients with graves disease after 12 to 18 months to see if remission has occurred. •• several months after radioactive iodine, expect that the patient will require permanent lt4 replacement. Thus, evaluate for such. 692  section 7  |  endocrinologic disorders medical illness, surgery, or starvation causes a decrease in serum t3 levels owing to decreased peripheral conversion of t4 to t3. The reduced t3 levels do not correlate with ultimate mortality and are thought to be an adaptive response to stress. Patients with more severe illness, especially those in the intensive care unit, frequently have reduced total t4 levels, although ft4 levels often are normal. In critically ill patients, there is a correlation between degree of serum t4 reduction and mortality. In most acutely ill patients who are euthyroid, tsh level is normal. However, administration of dopamine, octreotide, or high doses of glucocorticoids can reduce tsh levels. During recovery from acute illness, the tsh level may become modestly elevated to renormalize serum t4 levels. During this time, thyroid function tests may be misinterpreted to indicate hypothyroidism. Despite the sometimes very low t4 levels, there is no evidence that lt4 administration has any survival benefit. 47 patients with possible thyroid abnormalities during acute illness should be evaluated by an endocrinologist. Thyroid cancer and lt4 suppression the growth and spread of thyroid carcinoma are stimulated by tsh. An important component of thyroid carcinoma management is the use of lt4 to suppress tsh secretion. Early in therapy, patients receive the lowest lt4 dose sufficient to fully suppress tsh to undetectable levels. Controlled trials show that suppressive lt4 therapy reduces tumor growth and improves survival. These patients are purposefully “overtreated” with lt4, sometimes to a fully suppressed tsh level, and rendered subclinically or mildly hyperthyroid. Postmenopausal women should receive aggressive osteoporosis therapy to prevent lt4-induced bone loss. Other thyrotoxic complications, such as atrial fibrillation, should be monitored and managed appropriately. Drug-induced thyroid abnormalities drugs can affect thyroid function in a number of ways. 3,11 the effects of drugs on thyroid hormone protein binding, lt4 absorption, and metabolism have been discussed previously. Several commonly used medications can alter thyroid hormone secretion. Amiodarone amiodarone is a commonly prescribed antiarrhythmic drug that contains two iodide atoms, constituting 38% of its mass. 48 each 200-mg dose of amiodarone provides 75 mg of iodide. Amiodarone deiodination releases about 6 mg of free iodine daily, 20 to 40 times more than the average daily intake of iodine in the united states. Amiodarone blocks conversion of t4 to t3, inhibits entry of t3 into cells, and decreases t3 receptor binding. Amiodarone causes rapid reduction in serum t3 levels, increases free and total t4 levels, and increases tsh level. After 3 months of therapy, tsh levels usually return to normal, although the serum t3 and t4 level changes may remain. Most of these patients are euthyroid because the ft3 levels are in the low-normal range.