Calcium and phosphate can precipitate in TPN if not carefully managed. Best practices include using calcium gluconate (less dissociation than calcium chloride), adding phosphate first and calcium last, using lower final concentrations, and ensuring proper refrigeration. Calcium and phosphate added should not exceed 45 mEq/L. Maintain proper pH (lower pH = less risk of precipitation). Refrigerate the bag once prepared.

Toxic symptoms include coarse tremor, GI upset, and ataxia at this level. Toxicity at lithium levels > 3mEq/L can result in CNS depression, seizures, irreversible brain damage, coma, arrhythmia.

In patients with type 2 diabetes and established CVD or heart failure, SGLT2 inhibitors have shown both cardiovascular and renal benefit. Empagliflozin specifically is indicated for use in patients with HFrEF and CKD, including those with eGFR ?20, depending on the specific agent and FDA label. Canagliflozin should be avoided in eGFR <30. Exenatide and lixisenatide (GLP-1 receptor agonists) primarily show benefit in reducing atherosclerotic cardiovascular disease (ASCVD) events, like stroke or myocardial infarction, but not heart failure–specific outcomes.

ESAs increase the risk of thrombotic events like DVT; patients should be monitored for signs of clots.

Oxybutynin is an anticholinergic that frequently causes dry mouth, along with constipation, dizziness, and blurry vision.

600 mg ÷ 200 = 3 mg each --> 84 × 3 = 252 mg

10 g --> 20 mEq --> 12 mEq = 6 g

10% Intralipid = 1.1 kcal/mL --> 400×1.1 = 440 kcal/week --> 440/7 ~ 62.9 kcal/day

Corticosteroids like prednisone are well-known to cause hyperglycemia. Mycophenolate may also contribute, although less commonly.

Betaxolol is beta-1 selective and less likely to exacerbate respiratory conditions. The others are non-selective.