American family physician
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Single-dose therapy for selected genitourinary tract infections is an effective alternative to multiple-dose regimens. Candidal vulvovaginitis and trichomonal vaginitis may be routinely treated with single-dose regimens. With acute cystitis, candidates for single-dose therapy include patients who have a short duration of symptoms and are likely to comply with follow-up.
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Diabetic ketoacidosis can be effectively treated by using a few properly selected tests and more physiologic administration of insulin and intravenous fluids. Insulin is given by intravenous drip at an initial rate of about 0.1 u per kg per hour. The initial hydrating fluid is 5 percent glucose in 0.45 percent saline plus 40 mEq of potassium chloride or buffered potassium phosphate, given at a rate of 250 mL per hour. Arterial blood gas measurements are not needed.
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Family physicians provide a significant amount of mental health care in the form of psychotropic medication and supportive psychotherapy. Providers of primary psychiatric care face a number of legal dangers and ethical pitfalls. Most often, these derive from negligent diagnosis or treatment, failure to prevent suicide and exploitation of the patient. By adhering to sound clinical guidelines and ethical principles, physicians can both protect themselves and provide better care for their patients.