Box with 5 vials of 5 ml each
Tirzepatide does cause diarrhea in a significant portion of users, particularly during the first 4-8 weeks of treatment or during dose increases
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Test your liver health from home Measure ALT, AST, GGT, your AST:ALT ratio, HbA1c, hsCRP, and visceral fat with one simple finger-prick test
239) Definite: Extra-uterine embryo with cardiac activity (seen in 15-20% of ectopic pregnancies) Suggestive: Free pelvic or Intra-peritoneal fluid, tubal ring, complex adnexal mass Incidence of heterotopic (ectopic + IUP) in General population: 1:4,000-30,000 Incidence in assisted reproduction: 1 in 100, therefore cannot exclude ectopic and further work-up needed in this population Treatment of Ectopic Pregnancy Unstable Treat as ruptured ectopic Clinical: Severe abdominal pain, peritonitis, hypotension/shock FAST US: Intraperitoneal free fluid, complex adnexal mass Type and Cross vs transfusion Emergent GYN consult for OR Stable Expectant management Indication: unknown location pregnancy or suspected ectopic with low/declining -HCG Contraindications: Risk factors for rupture (increasing abdominal pain), not able to follow-up, and lack of timely access to medical care Methotrexate See table for indications Surgery Indications: Hemodynamic instability, contraindications to methotrexate, suspicion or risk factors for rupture, or failed medical therapy 3
The goal is the lowest effective dose, not the highest tolerated one
