1. DKA: most common cause of death is the thing that precipitated the DKA.
- If someone has abdominal pain, look for the source, don't just chalk it up to DKA. People typically only get abdominal pain from DKA if their bicarb is <10. Even if it's less than that, there's still other things that can cause it.
- Get lactate - if its high look for the source.
2. Symptom approach to dyspnea:
- Dyspnea + fever : pna, pna, pna, PE, COPD/Asthma with infection, endocarditis,
- Dyspnea and pleuritic chest pain: pna, PE (Ultrasound for UE DVT is not as sensitive because the large UE veins go behind the clavicle bones)
- Dyspnea  + nonpleuritic chest pain: Angina,
- Dyspnea with nothing else: look for highest yield diseases: heart failure, pna, asthma, copd, PE
3. Meds that directly cause edema:
- Direct vasodilators, like hydralazine.
- Dihydropuridine Ca channel blockers (peripherally acting)
- Glitazones: 1/3 of patients who use get significant edema (now only pyoglitazone is used)
- Steroids
- Estrogen.
- Don't forget that anemia is always on the differential for edema!
5. Primary Nephrotic syndrome (i.e. idiopathic)
- FSGS (33%)
- Membranous (33%) 5-20% of adults with this have cancer
- Minimal change (15%) - can occur in adults.
6. Secondary causes of nephrotic
- DM
- lupus
- infections (hep b, c, hiv, syphillis, malaria)
- amyloid
- MM
- CAncer
- Meds - NSAIDs, ACE, tamoxifen, lithium, heroin.
7. Types of nephropathy
- Hypertensive nephropathy- modest proteinuria,
- DM nephropathy- more significant proteinuria (Nephrotic- pr/cr ratio > 3-3.5)
8. Types of pulmonary hypertension 
- PAH (3%) idiopathic, genetic, drug/toxin, 2/2 - connective tissue dx, HIV, portal hypertension, congenital heart dx, chronic hemolytic anemia, schistosomiasis
-  PVH (66%): heart failure. 83% of ppl with diastolic HF have PH.
- PH 2/2 hypoxia: COPD (50% hae PH), ILD (1/3 have PH), OSA, high altitude.
- Chronic PE (<2%)
- Misc causes of PH: myeloproliferative, sarcoid,
9. Diagnosing Cirrhosis
- Plt <110 LR+ 9.8
- Plt > 160 LR 0.29
- Alb <3.5 or elevated INR: LR+ 5
- MRI - LR ~5
10. SBP
- 10-30% in hospitalized patients
- Usu GN, and s.pneumo
- 25-75% abdominal pain
- Indication for paracentesis: active GI bleed, labs suggestive of infection, new renal problems, change in clinical status,
- Paracentesis with single organism, >250 polys = diagnostic of SBP
- Paracentesis with polymicrobial - secondary BP (i.e. perforated viscous)