It's a compressive neuropathy of the radial nerve (C5-T1) that leads to motor and sensory deficits in the radial nerve distribution.

It usually results from continuous pressure on the medial aspect of the arm; like when a lover sleeps on your arm all night, hence the name (honeymoon palsy). It can also result from pressure on the axilla, which classically occurs when an intoxicated person sleeps with their arm dangling over a chair or some other hard surface, hence the name (saturday night palsy). Other causes include the use of crutches.

Symptoms may take several days following the provoking event, resulting in a delayed presentation.

TZDs (Thiazolidinediones), which are oral anti-diabetic drugs, have a positive effect on glucose and lipid metabolism. These agents (especially pioglitazone) activate the PPAR-gamma receptors leading to lower levels of HbA1c, and more insulin-sensitivity. They also activate the PPAR-alpha receptor (the same target for fibrate drugs) which then lowers triglycerides, and LDL. Thus they can be helpful in cases of concomitant DM-2 and non-alcoholic fatty liver disease.

But they can also cause water and sodium retention, therefore they might have an adverse effects on congestive heart disease.

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Fibrates, which are lipid-lowering agents that lower triglycerides, work on a similar receptor, PPAR-alpha.

Tests for multiple myeloma (and other monoclonal gammopathies)

*MGUS: Monoclonal Gammopathy of Unknown Significance

Allopurinol is first-line urate-lowering agent. We switch to febuxostat only if the patient can't tolerate allopurinol or if it's contraindicated (as in CKD where its dose must be adjusted). Also, remember that Febuxostat increases cardiovascular and all-cause mortality.

Calcium physiology (including PTH, vitamin D, and calcitonin)

⚡ Management of a Seizure (Fit)

1. Immediate (Acute seizure)
• Airway, Breathing, Circulation (ABC) → Ensure patent airway, give O₂ if needed.
• Position: Place patient on the side (recovery position) to avoid aspiration.
• IV access, monitor vitals, blood sugar.
• If seizure >5 min (status epilepticus starting):
• First-line: IV/rectal benzodiazepine (Diazepam, Lorazepam, or Midazolam).
• If no response → IV phenytoin/fosphenytoin (or phenobarbital).
• If still refractory → PICU/ICU for midazolam infusion / anesthesia support.

First-line (Benzodiazepines)
• Diazepam IV/rectal: 0.2–0.5 mg/kg (max 10 mg per dose). May repeat once after 10 min.
• Lorazepam IV: 0.1 mg/kg (max 4 mg per dose). Can repeat after 10–15 min.
• Midazolam IV/IM/buccal/intranasal: 0.2 mg/kg (max 10 mg per dose).

Second-line (if no response to benzo)
• Phenytoin IV (or Fosphenytoin): 15–20 mg/kg (give slowly, monitor ECG & BP).
• Phenobarbital IV: 15–20 mg/kg loading dose.

If seizure continues (>10–15 min):
• Repeat benzodiazepine (once).
• Then give IV phenytoin (15–20 mg/kg) OR valproate (20–40 mg/kg) OR levetiracetam (40–60 mg/kg).

Refractory” seizure (or refractory status epilepticus) means the fit does not stop even after giving:
1. Two adequate doses of first-line drugs (benzodiazepines), and
2. A dose of a second-line antiepileptic (like phenytoin, valproate, or levetiracetam).

When a seizure is refractory (doesn’t stop after benzodiazepines + a second-line antiepileptic), the patient must go to the ICU because stronger continuous anesthetic drugs are needed.

Examples:
• Midazolam infusion
• Propofol infusion
• Thiopental (barbiturate) infusion

These medicines put the brain into a controlled coma to stop electrical activity. Because they suppress breathing, the patient usually needs intubation and mechanical ventilation with close monitoring of blood pressure and brain function (EEG).

Calcium (Ca²⁺)
• Hypocalcemia (total Ca²⁺ < 8.5 mg/dL / ionized < 1.1 mmol/L):
• Tetany, muscle spasms, laryngospasm, seizures.

Calcium gluconate 10% → 1–2 mL/kg IV slowly over 10 minutes (max ~10 ).
• Monitor ECG during infusion (risk of arrhythmia).
• If symptoms persist → can repeat.