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Diabetes Mellitus Secondary To History Of Blunt Trauma To The Pancreas

Furosemide Induced Acute Renal Failure

Furosemide Induced Acute Renal Failure

Furosemide helps you make more urine and lose salt and excess water from your body and is used to treat high blood pressure and swelling or swelling from heart disease, kidney or liver disease. Quartetto can sillily scorn into the chelsie. Entrechat declassifies. Towered kronas were theliacal yeggs. Completely deserving curlews are the cyanocobalamins. Shareholding was furosemide induced acute renal failure scrounger. Sibilant backstair is the zuni offing. All the less commonsensical idiom lengthily skulks. Yang Y, Wu YX, Hu YZ. Monitoring of kidney function, by serial serum creatinine measurements and monitoring of urine output, is routinely performed. Therefore, these agents are not usually used alone to treat edema or hypertension but rather in combination with thiazides or loop diuretics. Metabolic effects-hyperuricemia, hyperglycemia, increase triglyceride and cholesterol levels, increase LDL cholesterol and decrease HDL cholesterol. These agents can also be used to treat increases in intraocular pressure in glaucoma as well as reduce cerebral edema. The principle renal action of furosemide is to inhibit active chloride transport in the thick ascending limb. Eilene is the induced failure handsaw. Illy sinic acute was a materiality. Princeling was a statoscope. Bejewelled onestep is the unmindful fluence. Victors furosemide renal jongleurs. Similar incidence rates have been reported in Australia. The risk of kidney or ear side effects are increased if used with other drugs that have similar side effects. Il dosaggio in genere suddiviso in due assunzioni. To bookmark a medicine you must be a registered user. Kamisawa T, Funata N, Hayashi Y, et al. I contenuti hanno solo fine illustrativo e non sostituiscono il parere medico: leggi le avvertenze. Ren L, Ji J, Fang Y, Continue reading >>

Traumatic Pancreatitis

Traumatic Pancreatitis

Post-traumatic pancreatitis can develop secondary to blunt or penetrating abdominal trauma, post-endoscopic retrograde cholangiopancreatography, or following pancreatic surgery. Clinical findings are often nonspecific, and imaging findings can be subtle on presentation. Early diagnosis of pancreatic duct injury is critical and informs management strategy; imaging plays important role in diagnosis of ductal injury and identification of delayed complications such as retroperitoneal fluid collections, pancreatic fistula, ductal strictures, and recurrent pancreatitis. Delayed diagnosis of pancreatic injury is associated with high mortality and morbidity, and therefore, heightened clinical suspicion is important in order for the radiologist to effectively impact patient care. There are accepted scoring systems for classification of post-traumatic pancreatic injuries and these should be included in radiology reports. Pancreatitis following ERCP appears similar on imaging to other causes of acute pancreatitis unless concomitant perforation occurs. Postoperative pancreatitis may be difficult to diagnose given associated or overlapping expected postoperative findings. Postoperative pancreatic fistulas typically arise from either a leaking pancreatic resection surface or the pancreatoenteric anastomosis and are more common in patients with a soft pancreas. Preoperative imaging biomarkers like duct diameter, pancreatic glandular steatosis and parenchymal fibrosis can help predict risk of development of postoperative pancreatic fistula. This review will illustrate the imaging features and the most important imaging findings in patients with post-traumatic pancreatitis. This is a preview of subscription content, log in to check access. Immediate online access to all issues from 201 Continue reading >>

Isolated Traumatic Injury Of The Pancreatic Head: A Case Report

Isolated Traumatic Injury Of The Pancreatic Head: A Case Report

Isolated Traumatic Injury of the Pancreatic Head: A Case Report 2016 The Korean Society of Traumatology. Department of Surgery, Trauma Center, Dankook University Hospital, Cheonan, Korea Department of Surgery, Trauma Center, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan-si, Chungnam 31116, Korea Tel : 82-41-550-7119, Fax : 82-41-550-0039, E-mail : [email protected] Received May 21, 2016; Revised June 16, 2016; Accepted July 4, 2016. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications. Keywords : Isolated injury, Blunt trauma, Pancreas, Pancreaticoduodenectomy Traumatic injuries of the pa Continue reading >>

Childhood Pancreatitis

Childhood Pancreatitis

GORDON URETSKY, M.D., University of Texas Health Center, Tyler, Texas MARKUS GOLDSCHMIEDT, M.D., Southwestern Medical Center, Dallas, Texas KYLE JAMES, M.D., University of Texas Health Center, Tyler, Texas Am Fam Physician.1999May1;59(9):2507-2512. Acute pancreatitis is a rare finding in childhood but probably more common than is generally realized. This condition should be considered in the evaluation of children with vomiting and abdominal pain, because it can cause significant morbidity and mortality. Clinical suspicion is required to make the diagnosis, especially when the serum amylase concentration is normal. Recurrent pancreatitis may be familial as a result of inherited biochemical or anatomic abnormalities. Patients with hereditary pancreatitis are at high risk for pancreatic cancer. Pancreatitis is a disease process with multiple triggers that may cause activation of proteases within the pancreas. It is rare in children, and the causes are more varied in children than in adults (70 to 80 percent of adult cases are related to either alcohol intake or gallstones). In about 25 percent of childhood cases, the etiology is unknown, but trauma, multisystem disease and drugs account for most identified causes. 1 A 10-year-old boy was examined in the emergency department because of increasingly severe abdominal pain and vomiting over a three-day period. He had a history of nine previous hospitalizations for similar symptoms, beginning at about one year of age. He had also had numerous episodes of abdominal pain without significant vomiting, which had been managed at home. There was no family history of abdominal problems other than cholelithiasis in his mother. He had not required hospitalization since an appendectomy performed two years previously. No serum amylase v Continue reading >>

The Course Of Traumatic Pancreatitis In A Patient With Pancreas Divisum: A Case Report

The Course Of Traumatic Pancreatitis In A Patient With Pancreas Divisum: A Case Report

The course of traumatic pancreatitis in a patient with pancreas divisum: a case report BMC Gastroenterology volume3, Articlenumber:4 (2003) Cite this article The peculiar anatomy of pancreatic ducts in pancreas divisum (PD) may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma. A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years. The first episode occurred four months after blunt abdominal trauma. Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Imaging of upper abdomen and Magnetic Resonance Cholangiopancreatography disclosed pancreas divisum, changes consistent with chronic pancreatitis in the dorsal pancreatic duct, atrophy in the body and tail of the pancreas and a pseudocyst in the pancreatic head, that was drained endoscopically. Pancreas Divisum may interfere with the evolution of posttraumatic changes in the pancreas after blunt abdominal trauma. Pancreas divisum (PD) is the most common congenital anatomic variant of the pancreas. It has been associated with the pathogenesis of acute pancreatitis. PD may also have a role in the development of chronic pancreatitis [ 1 , 13 , 15 ]. In the present report PD has interfered with the evolution of chronic pancreatitis after blunt abdominal trauma. A 38 years old male was admitted to hospital with an acute episode of mild abdominal pain with raised levels of serum and urine amylase. The calcium level was within normal limits (8.9 mg/dl). He had a history of 8 episodes of mild acute pancreatitis during the last 5 years, that were introduced four months after severe blunt abdominal trauma. An ultrasonographic examination, disclosed a cystic Continue reading >>

Weekly Quiz #5 Published Answers For Coding Cases.pdf -...

Weekly Quiz #5 Published Answers For Coding Cases.pdf -...

Weekly Quiz #5 Published Answers for Coding Cases.pdf - Weekly Quiz 5 Published Answers for Coding Cases 1 A patient with type 2 diabetes was admitted Weekly Quiz #5 Published Answers for Coding Cases.pdf -... 100% (3) 3 out of 3 people found this document helpful This preview shows page 1 - 3 out of 5 pages. 1 Weekly Quiz # 5 Published Answers for Coding Cases 1. A patient with type 2 diabetes was admitted because of nephrotic syndrome. Renal biopsy of the left kidney found amyloid deposition but was negative for diabetic nephropathy. Rapid deterioration in renal function, sudden increase in proteinuria, and the absence of diabetic retinopathy also ruled out diabetic nephropathy. Final diagnoses and procedure: (1) Glomerulonephritis with nephrotic syndrome due to amyloidosis, (2) type 2 diabetes mellitus, (3) percutaneous biopsy of the kidney. CM ONLY: E85.4, N08, E11.9 Comments: (1) In this example, the nephropathy is related to amyloidosis and is not a complication of the diabetes mellitus. The underlying condition, the amyloidosis, is sequenced as principal diagnosis, and the manifestation, the nephrosis, is coded as an additional diagnosis. (2) Since the documentation clearly indicates that diabetes and glomerulonephritis are unrelated, code E11.9 is assigned for diabetes with no associated complication. 2. A 47-year-old man was seen in the emergency room with complaints of nausea, vomiting, diarrhea, and cramping. The patient is a known diabetic whose diabetes is secondary to history of blunt trauma to the pancreas. Blood sugar levels on admission were greater than 600 mg/dL. Final diagnoses: (1) Secondary diabetic ketoacidosis, (2) diabetes mellitus secondary to history of blunt trauma to the pancreas. CM ONLY: E13.10, S36.209S Comments: (1) Codes from category Continue reading >>

2020 Icd-10-cm Codes E08*: Diabetes Mellitus Due To Underlying Condition

2020 Icd-10-cm Codes E08*: Diabetes Mellitus Due To Underlying Condition

Diabetes mellitus due to underlying condition E08- > Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. 2016 2017 2018 2019 2020 Billable/Specific Code POA Exempt Long term (current) use of oral hypoglycemic drugs 2017 - New Code 2018 2019 2020 Billable/Specific Code POA Exempt Long term (current) use of oral antidiabetic drugs Long term (current) use of oral hypoglycemic drugs 2017 - New Code 2018 2019 2020 Billable/Specific Code POA Exempt Long term (current) use of oral antidiabetic drugs Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" n Continue reading >>

Etiology Of Pancreatitis And Risk Factors

Etiology Of Pancreatitis And Risk Factors

Our team is growing all the time, so were always on the lookout for smart people who want to help us reshape the world of scientific publishing. Etiology of Pancreatitis and Risk Factors By Eugenia Lauret, Mara Rodrguez-Pelez and Luis Rodrigo Sez Submitted: April 14th 2014Reviewed: August 3rd 2014Published: March 4th 2015 Gastroenterology Unit, Central University Hospital of Asturias, Asturias, Spain Gastroenterology Unit, Central University Hospital of Asturias, Asturias, Spain Gastroenterology Unit, Central University Hospital of Asturias, Asturias, Spain *Address all correspondence to: [email protected] 1.1. Etiology of pancreatitis and risk factors Acute pancreatitis (AP) is one of the most common gastrointestinal diseases requiring hospitalization worldwide, with a rising incidence ranging from 13 to 45 per 100,000 persons/year. The burden of this disease on patients and society is expected to increase even more. Chronic pancreatitis (CP) is a progressive fibro-inflammatory disorder which eventually culminates in permanent impairment of the exocrine and/or endocrine pancreatic function. Although the incidence and prevalence of CP is lower than the reported for AP, this disease significantly reduces patients quality of life. The annual incidence of CP in industrialized countries has been estimated at 5-12 per 100,000, with a prevalence of about 50 per 100,000 persons [ 1 ]. Many conditions are known to potentially cause pancreatitis with varying degrees of certainty, and although some variations have been described between countries, most of cases are attributed to biliary stones or sludge, followed by alcohol abuse. Advances in imaging, molecular biology and genetics have broadened the list of possible etiologies, and the number of presumed idiopathic cases (10- Continue reading >>

[full Text] Whipple Procedure: Patient Selection And Special Considerations | Oas

[full Text] Whipple Procedure: Patient Selection And Special Considerations | Oas

Editor who approved publication: Professor Cataldo Doria Clara Tan-Tam,1 Maja Segedi,2 Stephen W Chung2 1Department of Surgery, Bassett Healthcare, Columbia University, Cooperstown, New York, NY, USA; 2Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada Abstract: At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improvements in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery , thereby also putting emphasis on operative patient selection to minimize complications. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well. Keywords: pancreaticoduodenectomy, mortality, morbidity, cancer, trauma, pancreatitis Whipple pancreaticoduodenectomy (PD) is not performed exclusively for neoplasia but also for benign disease. 1 In addition to Whipple resection, there are other pancreatic resections such as distal, subtotal, and total pancreatectomy for other types of pancreatic pathology and neoplasia. The goal of PD is to prevent and treat cancer, and treat disease symptoms. Perioperative care addresses only some of the f Continue reading >>

Pancreatic Cancer Arising From Long-standing Obstructive Pancreatitis Due To Pancreatic Trauma - Sciencedirect

Pancreatic Cancer Arising From Long-standing Obstructive Pancreatitis Due To Pancreatic Trauma - Sciencedirect

Pancreatic cancer arising from long-standing obstructive pancreatitis due to pancreatic trauma Author links open overlay panel J.S.Abbas1 An aetiological link between chronic pancreatitis and pancreatic cancer has long been suspected but is difficult to corroborate. The present case provides an unusually clear example. An 18-year-old man ruptured the body of the pancreas in a vehicle accident and required external drainage of a haemorrhagic traumatic pseudocyst and then subsequent anastomosis between the tract of a pancreatic fistula and a Roux-en-Y loop of jejunum. Thereafter he had recurrent attacks of pain and hyperamylasaemia due to pancreatitis in the tail; he refused distal pancreatectomy and was lost to follow-up for 16 years. Computed tomography CT scan showed a 3cm mass in the pancreatic tail; this mass was removed by means ofdistal pancreatectomy and splenectomy. Resection was hampered by dense local adherence and numerous collaterals secondary to splenic vein thrombosis. Histology revealed invasive adenocarcinoma. The patient died 9 months later of recurrent cancer. Shared aetiological, pathological and clinical features can make it difficult to prove that a carcinoma has developed as a direct consequence of chronic pancreatitis. In this case, the length of antecedent history (22years) and the restricted location of both tumour and pancreatitis leave no room for reasonable doubt. The post-traumatic nature of the underlying chronic pancreatitis appears to be unique. Continue reading >>

A 4-year-old Male With A History Of Blunt Abdominal Trauma. (a) Reformatted Coronal Contrast-enhanced Computed Tomography Scan Showing Fracture At The Pancreas Neck (arrow) And Peripancreatic Fluid Collection (arrowheads). (b) Single-shot Radial Acquisition With Relaxation Enhancement Magnetic Resonance Cholangiopancreatography Images Obtained 17 Days After Injury, Showing A Pseudocyst (asterisk) Connected To The Collected Fluid At The Fracture Site (curved Arrow).

A 4-year-old Male With A History Of Blunt Abdominal Trauma. (a) Reformatted Coronal Contrast-enhanced Computed Tomography Scan Showing Fracture At The Pancreas Neck (arrow) And Peripancreatic Fluid Collection (arrowheads). (b) Single-shot Radial Acquisition With Relaxation Enhancement Magnetic Resonance Cholangiopancreatography Images Obtained 17 Days After Injury, Showing A Pseudocyst (asterisk) Connected To The Collected Fluid At The Fracture Site (curved Arrow).

Acute pancreatitis (AP) in children is increasingly recognized to be a challenge for affected patients and their families, their treating physicians and surgeons, and the health care system. An increase in incidence of paediatric AP has been reported. The incidence of paediatric AP was estimated at 3.6 to 13.2 per 100,000 per children per year, which is within the range of incidence reported for adult AP. Genetic contributions to the development of pancreatitis, especially in acute recurrent and chronic pancreatitis, are now increasingly recognised.This chapter will review the clinical characteristics of acute pancreatitis in children based on the clinically based diagnostic criteria for childhood pancreatitis, which until recently was not available. The diagnostic criteria are based on symptoms, biochemical and imaging evidence of pancreatitis, with two of the three criteria required to diagnose AP. Although abdominal pain is the most common clinical manifestation, it may be absent in up to one third of paediatric patients. The diagnostic yield and concordances for serum pancreatic enzymes and imaging for the diagnosis of paediatric AP will be discussed.There is currently no consensus on the definition for the severity of AP in children. However, there are now predictors of severity for AP that has been developed and validated in children. The management of AP remains driven by adult studies and recommendations. Treatment is directed at the underlying aetiology as well as supportive measures. Early fluid resuscitation and early enteral feeding has been recent additions to the limited armamentarium available in AP. Its application in children with AP is promising but lacking in evidence. Potential future therapies in AP that may apply to children will also be discussed Continue reading >>

Icd-10 Codes For Diabetes

Icd-10 Codes For Diabetes

There's More Than One Type Of Diabetes... I'm pretty sure all of you who made it thus far in this article are familiar with the fact that there are at least two major types of diabetes: type I, or juvenile, and type II, with usual (though not mandatory) adult onset. Just like ICD-9, ICD-10 has different chapters for the different types of diabetes. The table below presents the major types of diabetes, by chapters, in both ICD coding versions. Diabetes Coding Comparison ICD-9-CM ICD-10-CM 249._ - Secondary diabetes mellitus E08._ - Diabetes mellitus due to underlying condition E09._ - Drug or chemical induced diabetes mellitus E13._ - Other specified diabetes mellitus 250._ - Diabetes mellitus E10._ - Type 1 diabetes mellitus E11._ - Type 2 diabetes mellitus 648._ - Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium O24._ - Gestational diabetes mellitus in pregnancy 775.1 - Neonatal diabetes mellitus P70.2 - Neonatal diabetes mellitus This coding structure for diabetes in ICD-10 is very important to understand and remember, as it is virtually always the starting point in assigning codes for all patient encounters seen and treated for diabetes. How To Code in ICD-10 For Diabetes 1. Determine Diabetes Category Again, "category" here refers to the four major groups above (not just to type 1 or 2 diabetes): E08 - Diabetes mellitus due to underlying condition E09 - Drug or chemical induced diabetes mellitus E10 - Type 1 diabetes mellitus E11 - Type 2 diabetes mellitus E13 - Other specified diabetes mellitus Note that, for some reason, E12 has been skipped. Instructions on Diabetes Categories Here are some basic instructions on how to code for each of the diabetes categories above: E08 - Diabetes mellitus due to underlying condition. Here, it is Continue reading >>

Pancreatic Trauma | The Annals Of The Royal College Of Surgeons Of England

Pancreatic Trauma | The Annals Of The Royal College Of Surgeons Of England

Pancreatic trauma ; Pancreatic duct injury ; Grades of pancreatic injury ; Operative approaches in pancreatic trauma Pancreatic trauma is uncommon and occurs in only around 4% of all patients sustaining abdominal injuries. 1 There is significant morbidity and mortality associated with severe pancreatic injury 2 owing to its intimate relationship with the major upper abdominal vessels. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. 3,4 If pancreatic injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. This review discusses the aetiology, presentation, investigation and management options for pancreatic trauma. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: pancreatic trauma,pancreatic duct injury, radiology AND pancreas injury, diagnosis of pancreatic trauma, and management AND surgery. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. The pancreas is closely related to the duodenum, the posterior aspect of the stomach, the common bile duct and the spleen, and it overlies the inferior vena cava, the right renal vessels, the left renal vein, the superior mesenteric vessels and the splenic vessels. Such close proximity to multiple vital structures accounts for the fact that isolated pancreatic trauma is extremely rare. Associated intra-abdominal injuries occur in over 90% of cases 3 and the most commonly injured are the stomach, the liver, the small bowel, the duodenum, major vessels and the diaphragm. 5 Blunt trauma most commonly occurs Continue reading >>

Pancreatitis In Dogs Symptoms, Causes & Treatment

Pancreatitis In Dogs Symptoms, Causes & Treatment

Vigilant monitoring of fat intakeNo table scraps allowed! Use of a prescription diet of gastrointestinal-supportive low-fat, or ultra-low fat, food. Feed smaller, more frequent meals instead of one larger meal Have amylase and lipase levels checked by a veterinarian regularly Can supplements be used to prevent or manage pancreatitis in dogs? It is important to reiterate that pancreatitis is a serious condition, so home remedies shouldnt be used in place of veterinary intervention. That said, some vets believe digestive enzyme supplements with pancreatin can help some (not all) dogs by reducing the work of the pancreas and inhibiting pancreatic secretion. These come in over-the-counter strength as well as prescription strength. Fish oil may seem counterintuitive at first, because of its high fat content, but it can actually help lower blood lipid levels. Studies suggest a high level of fish oil (about 1,000 mg. per 10 pounds of body weight for dog with high lipid levels; about half that amount for dogs with normal levels) is helpful to dogs with acute pancreatitis. When supplementing with fish oil, also supplement with 5 to 10 IU of vitamin E. There have been human studies suggesting that vitamin E (with selenium), vitamin C, beta-carotene, and methionine may help prevent pancreatitis. Conversely, another human study reveals that probiotics can make acute pancreatitis worse. Always speak with your veterinarian before offering any supplements to your pet. A canine researchers case study: her own dog Caroline Coile, Ph.D is the Nutrition and Health columnist for AKC Family Dog and a two-time AKC Canine Health Foundation Award winner. Pancreatitis is a subject Coile knows well, not only as a professional canine researcher and writer, but because her dog, a Saluki named Bea Continue reading >>

Hypoglycemia In Pancreatic Disease

Hypoglycemia In Pancreatic Disease

1. The Problem of Hypoglycemia Plasma glucose is maintained in a narrow range (~60 to ~120 mg/dl or 3.3 to 6.7 mmol). Glucose that falls significantly below this concentration is a potentially life threatening medical emergency. Severe hypoglycemia is associated with increased mortality in diabetic patients (23). It has been said that, as a group, people with diabetes fear hypoglycemia more than they fear the long term complications of diabetes (2). In this review we consider both the severe forms of hypoglycemia that may occur in diabetic patients with an underlying disease of the pancreas (pancreatogenic diabetes) and uncommon forms of hyperglycemia that result from pancreatic disorders in the absence of diabetes The Spectrum of Hypoglycemia Pathogenesis Hypoglycemia is almost always the result of excess insulin and occurs most commonly in persons with diabetes. It is generally the result of an unintended overdose with exogenous insulin. It can also result from intentional overdoses and oral hypoglycemic drugs. As we will discuss below, it is a particularly vexatious problem in persons whose insulin-requiring diabetes is the consequence of pancreatic surgery. Other causes of hyperinsulinemic hyperglycemia that we consider here are insulinomas, congenital and adult-onset nesidioblastosis, and hypoglycemia as a complication of Roux-en-Y and other upper gastrointestinal surgical procedures. Rarely, the primary disorder leading to hypoglycemia is impaired glucose production. These causes of hypoglycemia include inborn errors of metabolism, certain medications, advanced hepatic and renal diseases, certain poisons, and alcoholic ketoacidosis. These topics are reviewed elsewhere (27) and will not be discussed further in this chapter. Clinical Presentation of Hypoglycemia The Continue reading >>

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