Browsing by Autor "Mauricio Paz del Rio"

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    Chapter 3. Key Hormones: ADH and the Renin–Angiotensin–Aldosterone System
    (2025) Mauricio Paz del Rio; Isis Scarleth Funes-Galindo; Jorge Márquez-Molina
    Objetivos: Comprender el papel de la hormona Antidiurtica (ADH) y
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    Chapter 6. Hypercalcemia in Emergency Care
    (2025) Mauricio Paz del Rio; Jorge Márquez-Molina; Willy Eustaquio Mollo Marca
    Objetivos Comprender la fisiologa normal del calcio y su regulacin hormonal. Identificar las principales causas de hipercalcemia. Aplicar los mecanismos fisiopatolgicos a la evaluacin y tratamiento del paciente en emergencias. INTRODUCCINLos pacientes con hipercalcemia presentan un espectro que va desde asintomtico hasta coma, dependiendo del grado y cronicidad de la hipercalcemia.Es posible que los niveles totales de calcio srico no se correlacionen con precisin con la forma libre fisiolgicamente activa del calcio, lo que se puede estimar calculando el calcio corregido para corregir el calcio unido a la albmina srica o midiendo directamente como el nivel de calcio ionizado. Caso clnicoA manera de interpretar se presenta el siguiente caso clnico: un paciente masculino de 64 aos, con antecedente con antecedente de carcinoma pulmonar, acude a emergencias por cuadro de vmitos persistentes y alteracin progresiva del estado mental.Al examen fsico presenta mucosas secas y evidencia de deshidratacin.Se observa dolor difuso a la palpacin de msculos y huesos, acompaado de debilidad generalizada.El paciente se encuentra confuso y responde de manera incoherente a las preguntas.Se realiza un electrocardiograma donde se identifican intervalos PR y QT acortados, hallazgo compatible con hipercalcemia significativa (figura 6.1). AnamnesisPregunte sobre antecedentes de hipercalcemia conocida, enfermedad paratiroidea o malignidad.Estos son los factores de riesgo histricos ms comunes y las etiologas subyacentes de la hipercalcemia.Es fundamental indagar sobre los sntomas que orientan al diagnstico de hipercalcemia y que determinan la urgencia de los estudios y del tratamiento.Clsicamente, las manifestaciones clnicas se resumen con la regla mnemotcnica "piedras, huesos, gemidos, tronos y matices psiquitricos", que refleja la amplia afectacin multisistmica del exceso de calcio srico. Las "piedras" hacen referencia a la presencia de clculos renales por nefrolitiasis recurrente, acompaada en ocasiones de insuficiencia renal secundaria a la hipercalciuria prolongada.Los "huesos" aluden al compromiso del sistema esqueltico, con dolor seo difuso, artralgias y prdida de densidad mineral sea, manifestaciones que pueden progresar hacia osteoporosis o fracturas patolgicas. Los "gemidos" abdominales corresponden a sntomas digestivos como nuseas, vmitos, anorexia y dolor abdominal, ocasionalmente asociados con pancreatitis aguda
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    Electrolyte and Internal Environment Imbalances in Emergencies (Spanish Edition)
    (2025) Jorge A. Barrios Flores; Freddy Ednildon Bautista-Vanegas; José Bernardo Antezana-Muñoz; Mauricio Paz del Rio; Luis Mariano Tecuatl-Gómez; Alberto Martin Diaz-Seminario; Manuel Alejandro Brito del Castillo; Ariel Sosa Remón; Adalid Rimer Condo-Gutierrez; Isis Scarleth Funes-Galindo
    Electrolyte and internal environment disorders represent some of the most frequent and clinically significant challenges in emergency and critical care settings. Their impact can be abrupt, severe, and life-threatening. In many cases, a subtle change in sodium, potassium, chloride, or water balance may determine the difference between stability and rapid clinical deterioration. For this reason, the ability to recognize, interpret, and intervene promptly is a core skill for physicians who care for critically ill patients, whether in emergency departments, intensive care units, or high-dependency hospital settings.This book was conceived as a practical and accessible clinical tool. It is designed to integrate physiological understanding with bedside decision-making, providing a clear bridge between foundational science and real-time therapeutic action. Each chapter has been developed collaboratively by clinicians actively engaged in emergency and critical care practice across various healthcare systems. Their contributions reflect not only scientific knowledge, but the lived experience of caring for patients in contexts where urgency, uncertainty, and limited time demand clarity and precision.While electrolyte and internal environment alterations are deeply rooted in complex physiology, our goal has been to make their clinical reasoning straightforward. Diagnostic approaches, pathophysiological mechanisms, and treatment strategies are presented in a concise and applicable manner. We emphasize concepts that are essential for rapid assessment, careful correction, and prevention of iatrogenic harm.This work is dedicated to the medical professionals who stand at the bedside in the most critical moments, and to the patients whose resilience gives meaning to every clinical effort. It is our hope that this book will serve as a support, a guide, and a companion in the demanding and noble responsibility of emergency medicine and critical care.