Medication Refill

You may have been given a prescription in the emergency department for a few days of your medicine. It is important to refill your medicine before you completely run out. You need to follow up with your healthcare provider for a full prescription within the next few days. You will not be given additional refills in the emergency department.


Follow up with your healthcare provider:

Contact your healthcare provider before you are completely out of medicine. Write down your questions so you remember to ask them during your visits.

Refill tips:

Your medicine will treat your condition if you take the medicine regularly. Prevent missed doses by doing the following:

  • Keep a chart of your medicine. Include all of your current medicines. Write down the name and strength of each medicine, the prescription number, and the number of refills. Also write down the dates of your refills. Ask your pharmacy or insurance provider for other ways to help you keep track of your medicines.
  • Refill medicines a few days before you run out. This will decrease any problems that will prevent you from getting your medicines on time. Problems include a closed pharmacy, or the pharmacy may have to contact your healthcare provider.
  • If you know you are going to be traveling, refill your medicines before you leave. You may not be able to get refills if you do not use your local pharmacy. You may need to call your insurance provider to make them aware of your travels.


Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroidism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroidism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone–producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months. Treatment with high-dose acetylsalicylic acid or nonsteroidal anti-inflammatory drugs is directed toward relief of thyroid pain.

Iron Overdose

Ferrous sulfate overdose; Ferrous gluconate overdose; Ferrous fumarate overdose

Iron is a mineral found in many over-the-counter supplements. Iron overdose occurs when someone takes more than the normal or recommended amount of this mineral. This can be by accident or on purpose.

Iron overdose is particularly dangerous for children. A severe overdose can happen if a child eats adult multivitamins, such as prenatal vitamins. If the child eats too many pediatric multivitamins, the effect is usually minor.

This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with has an overdose, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

Iron can be harmful in large amounts.

Where Found

Iron is an ingredient in many mineral and vitamin supplements. Iron supplements are also sold by themselves. Types include:

  • Ferrous sulfate (Feosol, Slow Fe)
  • Ferrous gluconate (Fergon)
  • Ferrous fumarate (Femiron, Feostat)

Other products may also contain iron.


Below are symptoms of an iron overdose in different parts of the body. 


  • Buildup of fluids in the lungs


These are the most common symptoms in the first 6 hours after ingestion.

  • Black, and possibly bloody stools
  • Diarrhea
  • Liver damage
  • Metallic taste in mouth
  • Nausea
  • Vomiting blood


  • Dehydration
  • Low blood pressure
  • Fast and weak pulse
  • Shock (may occur early from blood loss from the stomach or intestines, or later from the toxic effects of iron)


  • Chills
  • Coma (decreased level of consciousness and lack of responsiveness, may occur within 1/2 hour to 1 hour after overdose)
  • Convulsions
  • Dizziness
  • Drowsiness
  • Fever
  • Headache
  • Lack of desire to do anything


  • Bluish-colored lips and fingernails
  • Flushing
  • Pale skin color
  • Yellowing of the skin (jaundice)

Note: Symptoms may go away in a few hours, then return again after 1 day or later.

Before Calling Emergency

Have this information ready:

  • Person’s age, weight, and condition
  • Name of the product (ingredients and strength, if known)
  • Time it was swallowed
  • Amount swallowed
  • If the medicine was prescribed for the person

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

Take the container to the hospital with you, if possible.

The health care provider will measure and monitor the person’s vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated.

Tests that may done include:

  • Blood and urine tests, including tests to check iron levels
  • ECG (electrocardiogram, or heart tracing)
  • X-ray to detect and track iron tablets in the stomach and intestines

Treatment may include:

  • Fluids through a vein (by IV)
  • Medicine to help remove iron from the body and treat symptoms
  • Endoscopy — camera and tube placed down the throat to view the esophagus and the stomach and to remove pills or stop internal bleeding
  • Whole bowel irrigation with a special solution to quickly flush the iron through the stomach and intestines (taken by mouth or through a tube through the nose into the stomach)
  • Breathing support, including tube through the mouth into the lungs and connected to a breathing machine (ventilator)

Outlook (Prognosis)

There is a good chance of recovery if the person’s symptoms are gone 48 hours after the iron overdose. But, severe liver damage can occur 2 to 5 days after the overdose. Some people have died up to a week after an iron overdose. The more quickly the person receives treatment, the better the chance for survival.

Iron overdose can be very severe in children. Children may sometimes eat large amounts of iron pills because they look like candy. Many manufacturers have changed their pills so they no longer look like candy.

Hypotension (resolved)

You have been diagnosed with low blood pressure (hypotension). When you have hypotension, your blood pressure is lower than normal. Low blood pressure can make you feel dizzy or faint. This condition is sometimes a side effect of taking certain medicines, including medicines for high blood pressure (hypertension). It can also result from medical conditions such as dehydration. Hypotension has many possible causes. Sometimes the cause is unknown, and you will need follow-up visits and tests.

Home care

These steps can help manage your condition:

  • Follow your healthcare provider’s instructions. Go to all your follow up appointments.
  • Rest in bed and ask for help with daily activities until you feel better. You may need to slowly increase the amount of time you spend sitting or doing light activity.
  • Don’t drive while your blood pressure is not controlled.
  • Be careful when you get up from sitting or lying down.
    • Take your time. Sudden movements can cause dizziness or fainting.
    • When you first sit up after lying down, be sure to sit in bed for 30 seconds or so before getting up to walk.
  • Tell your healthcare provider about the medicines you are taking. Many kinds of medicines trigger low blood pressure.
  • Limit your alcohol intake to no more than 2 drinks a day for men and 1 drink a day for women. Alcohol can dehydrate you even further. It can also interfere with the effectiveness of medicines.
  • Prevent dehydration by drinking plenty of fluids, unless otherwise instructed by your healthcare provider.
  • Learn to take your own blood pressure. Keep a record of your results. Ask your healthcare provider which readings mean that you need medical attention.
  • Tell your family members to call an ambulance if you become unconscious. Ask them to learn CPR.

Follow-up care

Make a follow-up appointment, or as advised.

Call 911

Call 911 right away if you have:

  • Chest pain
  • Shortness of breath

When to call your healthcare provider

Call your healthcare provider right away if you have any of the following:

  • Dizziness or fainting spells
  • Black, maroon, or tarry stools
  • Irregular heartbeat
  • Stiff neck
  • Severe upper back pain
  • Diarrhea or vomiting that doesn’t go away
  • Inability to eat or drink
  • Burning sensation when you urinate
  • Urine with a strong, unpleasant odor
  • Fainting with exercise


Hypocalcemia is a low level of calcium in your blood.

It occurs when your body loses too much calcium or does not absorb enough from the foods you eat.



  • Medicines will be given to bring your calcium and vitamin D levels back to normal. You may also need medicines to prevent bone loss.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your healthcare provider or endocrinologist every 3 to 6 months, or as directed:

You will need to return to have your calcium levels checked. Bring a list of any questions you have so you remember to ask them during your visits.

Eat foods rich in calcium:

Foods that contain calcium include milk, yogurt, cereals, and cheese. Leafy green vegetables, oranges, canned salmon, shrimp, and peanuts also contain calcium. Do not have caffeine or alcohol. These can slow your body’s ability to absorb calcium. You may need to meet with a dietitian to help plan the best meals for you.

Get safe amounts of sunlight:

You may need to expose your skin to more sunlight if your body lacks vitamin D. Ask your healthcare provider how to safely expose yourself to UV light if you need it.

Do not smoke:

If you smoke, it is never too late to quit. Smoking increases the amount of calcium that leaves your body through your urine. Ask your healthcare provider for information if you need help quitting.

Contact your healthcare provider or endocrinologist if:

  • You have dry skin and brittle nails.
  • Your symptoms do not go away, or they get worse.
  • You feel depressed, anxious, angry, or confused.
  • You have questions or concerns about your condition or care.

Seek care immediately or call 911 if:

  • You have a seizure.
  • You have a slow or uneven heartbeat and feel lightheaded.
  • You see or hear things that are not really there.

Hot Flashes

Your doctor can usually diagnose hot flashes based on a description of your symptoms. Your doctor might suggest blood tests to check whether you’re in menopausal transition.


The most effective way to relieve the discomfort of hot flashes is to take estrogen, but taking this hormone carries risks. If estrogen is appropriate for you and you start it within 10 years of your last menstrual period or before age 60, the benefits can be greater than the risks.

Medications such as antidepressants and anti-seizure drugs also might help reduce hot flashes, although they’re less effective than hormones.

Discuss the pros and cons of various treatments with your doctor. If hot flashes don’t interfere with your life, you probably don’t need treatment. Hot flashes subside gradually for most women, even without treatment, but it can take several years for them to stop.

Hormone therapy

Estrogen is the primary hormone used to reduce hot flashes. Most women who have had a hysterectomy can take estrogen alone. But if you still have a uterus, you should take progesterone with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).

With either regimen, the therapy needs to be tailored to your needs. Guidelines suggest using the smallest effective dose for symptom control. How long you use the treatment depends on the balance of your risks and benefits from hormone therapy. The goal is to optimize your quality of life.

Some women who take progesterone with estrogen therapy experience progesterone-related side effects. For women who can’t tolerate oral progesterone, a combination drug of bazedoxifene with conjugated estrogens (Duavee) is also approved for treating menopausal symptoms. Like progesterone, taking bazedoxifene with estrogen may help you avoid the increased risk of endometrial cancer from estrogen alone. Bazedoxifene might also protect your bones.

If you have had or are at risk of breast or endometrial cancer, heart disease, stroke or blood clots, talk to your doctor about whether estrogen therapy is right for you.


A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration. Other antidepressants that have been used to treat hot flashes include:

  • Venlafaxine (Effexor XR)
  • Paroxetine (Paxil, Pexeva)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

These medications aren’t as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can’t use hormones. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction.

Other prescription medications

Other medications that might offer relief for some women include:

  • Gabapentin (Neurontin, Gralise, others). Gabapentin is an anti-seizure medication that’s moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, water retention in the limbs (edema) and fatigue.
  • Pregabalin (Lyrica). Pregabalin is another anti-seizure medication that can be effective in reducing hot flashes. Side effects can include dizziness, drowsiness, difficulty concentrating and weight gain.
  • Oxybutynin (Ditropan XL, Oxytrol). Oxybutynin is a pill or patch most often used to treat urinary conditions like overactive bladder. It may also help relieve hot flashes in some women. Side effects can include dry mouth, dry eyes, constipation, nausea and dizziness.
  • Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.

Nerve block procedure

A procedure known as stellate ganglian block has shown promise for treating moderate to severe hot flashes, but more research is needed. It involves injecting an anesthetic into a nerve cluster in the neck. The treatment has been used for pain management. Side effects include pain and bruising at the injection site.


Viral Hepatitis

Hepatitis A

Hepatitis A is a virus which gets into the liver and causes acute illness with symptoms of diarrhea, fatigue and loss of appetite. This virus is spread when people eat raw foods or drink water that has been contaminated with stool (“poop”) from an infected person. This happens if food is sprayed with water with fecal contamination or, in the case of shellfish the food is grown in water that is contaminated with raw sewage.

The hepatitis A virus can also be transmitted by a cook or food handler who is ill and does not wash his or her hands thoroughly before handling food. The truth is that people who get hepatitis A have somehow gotten an infected person’s “poop” into their mouth. From there the virus has moved into the gut and liver and has made the person sick.

Almost everyone gets over this infection. People who get hepatitis A sometimes will feel sick and tired for a week or two and then they get better. If you have had hepatitis A once you will never get it again because you develop antibodies that protect you against the virus.

There is also a vaccine to protect us from hepatitis A. So if you have never had hepatitis A you can be protection against the virus with a series of two shots.

Hepatitis B

Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus.  It can range in severity and duration – some will only have a short-term, mild form of the virus, while others will develop long-term, chronic infection.  Hepatitis B is transmitted when blood, semen, or another body fluid from a person infected with the hepatitis B virus enters the body of someone who is not infected.  This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment.  Hepatitis B can also be passed from an infected mother to her baby at birth but is not tranmitted through breastmilk.

Hepatitis B can be either acute or chronic.  Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Acute infection can — but does not always — lead to chronic infection.  Chronic Hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person’s body.  Chronic hepatitis B is a serious disease that can result in long-term health problems, and even death.  Those with chonic hepatitis B should maintain regular contact with a medical provider to monitor their liver health over time and consider treatment.

The best way to prevent Hepatitis B is by getting vaccinated.

Hepatitis C

Hepatitis C is a blood-borne viral infection which can, over decades, lead to liver fibrosis (scarring), cirrhosis, and in some patients liver cancer and death. It is transmitted through blood-to-blood contact, and in rare cases, sexual transmission.  Approximately 4 million Americans have chronic hepatitis C; however, only 25 to 30% have been diagnosed.  The diagnosis is made by specific laboratory (blood) testing.  Liver biopsy may be recommended to assess the degree of fibrosis and need for treatment.

Hepatitis C is curable and treatment for most people is 12 weeks, although some people can acheive cure with only 8 weeks of treatment and others may require 24 weeks.  Cure rates for almost all patients range from 90-100%, depending on the hepatitis C genotype (strain) and severity of liver disease.  Previously, treatment consisted of pegylated interferon and ribavirin, which resulted in viral clearance in approximately 50% of those patients treated.  Fortuntately for patients, none of regimens used to cure hepatitis C today include interferon.

HIV/HCV Co-Infection

HIV and Hepatitis C (HCV) coinfection has become an increasing concern in the medical field.  As improvements in HIV treatment have reduced the rate of death due to acute opportunistic infections (i.e pneumonia), liver disease has emerged as a leading cause of hospitalization and death among persons living with HIV and AIDS.  It is estimated that prevalence rates of HCV among people living with HIV/AIDS may be as high as 30%*.

HIV and HCV share many characteristics – both are RNA viruses and have blood to blood transmission methods.  The effects of coinfection on the body are still poorly understood, but it is generally accepted that coinfection accelerates the progression of HCV, leading to higher viral load counts and increased risk of severe liver damage; however and most studies indicate that HCV does not accelerate the progression of HIV.

Contact Dermatitis

Contact dermatitis is a skin rash.

It develops when you touch something that irritates your skin or causes an allergic reaction.


Call 911 for any of the following:

  • You have sudden trouble breathing.
  • Your throat swells and you have trouble eating.
  • Your face is swollen.

Contact your healthcare provider if:

  • You have a fever.
  • Your blisters are draining pus.
  • Your rash spreads or does not get better, even after treatment.
  • You have questions or concerns about your condition or care.


  • Medicines help decrease itching and swelling. They will be given as a topical medicine to apply to your rash or as a pill.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Manage contact dermatitis:

  • Take short baths or showers in cool water. Use mild soap or soap-free cleansers. Add oatmeal, baking soda, or cornstarch to the bath water to help decrease skin irritation.
  • Avoid skin irritants , such as makeup, hair products, soaps, and cleansers. Use products that do not contain perfume or dye.
  • Apply a cool compress to your rash. This will help soothe your skin.
  • Keep your skin moist. Rub unscented cream or lotion on your skin to prevent dryness and itching. Do this right after a bath or shower when your skin is still damp.

Follow up with your healthcare provider or dermatologist in 2 to 3 days:

Write down your questions so you remember to ask them during your visits.


A pingueculum is a common, noncancerous growth of the conjunctiva. This is the clear, thin tissue that covers the white part of the eye (sclera). The growth occurs in the part of the conjunctiva that is exposed when the eye is open.Eye anatomy

The cornea is the clear layer covering the front of the eye. The cornea works with the lens of the eye to focus images on the retina.


The exact cause is unknown. Long-term sunlight exposure and eye irritation may be factors. Arc-welding is a major job-related risk.


A pingueculum looks like a small, yellowish bump on the conjunctiva near the cornea. It can appear on either side of the cornea. However, it more often occurs on the nose (nasal) side. The growth may increase in size over many years.

Exams and Tests

An eye exam is often enough to diagnose this disorder.


The only treatment needed in most cases is the use of lubricating eye drops. Keeping the eye moist with artificial tears may help prevent the area from becoming inflamed. Temporary use of mild steroid eye drops can also be helpful. Rarely, the growth may need to be removed for comfort or for cosmetic reasons.

Outlook (Prognosis)

This condition is noncancerous (benign) and the outlook is good.

Possible Complications

The pingueculum may grow over the cornea and block vision. When this happens, the growth is called a pterygium. These two conditions occur under similar conditions. However, they are thought to be separate diseases.

When to Contact a Medical Professional

Call your health care provider if the pingueculum changes in size, shape, or color, or if you would like to have it removed.


Things you can do that may help prevent a pingueculum or keep the problem from getting worse include:

  • Keeping the eye well lubricated with artificial tears
  • Wearing good quality sunglasses
  • Avoiding eye irritants

Periorbital Cellulitis

Periorbital cellulitis is inflammation and infection of one or both eyelids caused by bacteria. Periorbital cellulitis is most common in children younger than 5 years old.

Cellulitis of the Eye


Call 911 for any of the following:

  • Your child has trouble breathing.
  • Your child has a seizure.
  • Your child is more sleepy than usual or is hard to wake.

Return to the emergency department if:

  • Your child says his or her neck feels stiff.
  • Your child has a headache and is vomiting.
  • Your child has blurred or double vision and cannot see well in bright light.
  • Your child’s infected eye bulges from his or her head.

Contact your child’s healthcare provider if:

  • Your child has a fever higher than 101.5°F (38.6°C) and chills.
  • You see red streaks on the skin of the infected area.
  • Your child’s eye is more red and swollen, or starts to drain pus.
  • You have questions or concerns about your child’s condition or care.


Your child may need any of the following:

  • Antibiotics help treat a bacterial infection.
  • Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to give your child and how often to give it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.
  • Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child’s medicine labels for aspirin, salicylates, or oil of wintergreen.
  • Give your child’s medicine as directed. Contact your child’s healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child’s medicine list with you in case of an emergency.

Prevent periorbital cellulitis:

  • Have your child wear proper safety equipment. Protect his or her face from injury during sports and other activities.
  • Keep wounds clean and dry. Clean wounds on the face with soap and water. Cover wounds with a dry bandage. Use antibiotic ointment on skin breaks to help prevent infection. Do not let your child swim with a skin wound.
  • Ask your child’s healthcare provider about vaccines. The Hib and pneumococcal vaccines help prevent periorbital cellulitis.

Follow up with your child’s healthcare provider in 1 to 2 days:

Write down your questions so you remember to ask them during your visits.