Ch04-9781975113285

1 4   INTERNSHIP SURVIVAL GUIDE

MORTALITY BASED ON MODEL FOR END-STAGE LIVER DISEASE (MELD) SCORE

TABLE 4-1

MELD Score

Observed Mortality (over 3 mo) (%)

>40

71.3 52.6 19.6

30-39 20-29 10-19

6.0 1.9

<9

Adapted from Wiesner R, et al. Model for end stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124:91-6, with permission.

• To correct for isopropyl alcohol + ([IPA]/6). And in this case, IPA does not stand for India pale ale.

• To correct for ethylene glycol + ([EG]/6.2). • To correct for mannitol + ([mannitol]/18.2). OSMOLAL GAP

−  calculated S

Osmolal gap = measured S osm

osm

• Causes of increased osmolal gap: decreased serum water, hyper- proteinemia, hypertriglyceridemia, and presence of unmeasured osmoles (e.g., sorbitol, glycerol, mannitol, ethanol, isopropyl alco- hol, acetone, ethyl ether, methanol, and ethylene glycol) • Every time you drink alcohol you have an osmole gap! Unless you correct for it as mentioned. RETICULOCYTE INDEX Reticulocyte index = [reticulocyte count × (Hct/45)]/maturation factor Maturation factor = 1 + (0.5 × [(45  − Hct)/10]) • Good marrow response = 3.0-6.0. You go marrow! • Borderline response = 2.0-3.0 • Inadequate response = <2.0. Gosh marrow, is that the best you can do?