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Is Ketoacidosis Hereditary

If You Have Gallstones Is Removing The Gallbladder Required?

If You Have Gallstones Is Removing The Gallbladder Required?

A2A: Cholecystectomy (removal of the gallbladder) is not indicated in most patients with asymptomatic (silent) gallstones, because only 2-3% of these patients go on to become symptomatic each year. For an accurate determination of the indications for elective cholecystectomy, the risk posed by the operation (with individual patient age comorbid factors taken into account) must be weighed against the risk of complications and death if the operation is not done. Updated: Apr 14, 2016 Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD Practice Essentials Cholelithiasis involves the presence of gallstones (see the image below), which are concretions that form in the biliary tract, usually in the gallbladder. Choledocholithiasis refers to the presence of 1 or more gallstones in the common bile duct (CBD). Treatment of gallstones depends on the stage of disease. Magnetic resonance cholangiopancreatography (MRCP) showing 5 gallstones in the common bile duct (arrows). In this image, bile in the duct appears white; stones appear as dark-filling defects. Similar images can be obtained by taking plain radiographs after injection of radiocontrast material in the common bile duct, either endoscopically (endoscopic retrograde cholangiography) or percutaneously under fluoroscopic guidance (percutaneous transhepatic cholangiography), but these approaches are more invasive. Signs and symptoms Gallstone disease may be thought of as having the following 4 stages: Lithogenic state, in which conditions favor gallstone formation Asymptomatic gallstones Symptomatic gallstones, characterized by episodes of biliary colic Complicated cholelithiasis Symptoms and complications result from effects occurring within the gallbladder or from stones that escape the gallbladder to Continue reading >>

New Insights Into The Management Of Diabetic Ketoacidosis - Wsava2009 - Vin

New Insights Into The Management Of Diabetic Ketoacidosis - Wsava2009 - Vin

The diagnosis of diabetic ketoacidosis (DKA) in the ill-appearing diabetic dog is usually straightforward. Dogs with DKA usually present with dramatic clinical manifestations, such as anorexia, vomiting, and lethargy. Within such a setting, detection of ketonuria can rapidly confirm the suspicion of DKA, but it has few implications in the subsequent approach. One can estimate ketonemia by applying a drop of serum or plasma on the appropriate reagent of the urine test strip, but this test only detects acetoacetate and is a semiquantitative test. The measurement of plasma beta-hydroxybutyrate (β-OHB) on admission can provide additional information. Based on a previous study, dogs with plasma β-OHB >2.0 mmol/L should receive ambulatory monitoring and treatment, until the results of additional tests. If plasma β-OHB is >3.8 mmol/L the diagnosis of DKA is confirmed and intensive care is warranted.1 Coincidentally, a recent study in human beings with DKA, suggested that the same cutoff value of plasma β-OHB should be used for the diagnosis of DKA, using a portable meter (MediSense Optium, Abbott Laboratories).2 This device has been validated for the use in dogs.3 Evaluation of blood gases and pH is still needed. In a study of our group (unpublished data), mixed acid-base disorders were common, chiefly high anion gap acidosis and concurrent respiratory alkalosis, and hyperchloremic acidosis with moderated to marked increases in serum B-OHB. The implications of these findings are unknown, but in human patients with DKA, both conditions can possibly slower the recovery from metabolic acidosis. Because respiratory alkalosis is the expected physiologic response to metabolic acidosis, this mixed acid-base disorder may be difficult to recognize clinically, and the diagnosis can Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, specialized cells in the pancreas called beta cells stop producing insulin. Insulin controls how much glucose (a type of sugar) is passed from the blood into cells for conversion to energy. Lack of insulin results in the inability to use glucose for energy or to control the amount of sugar in the blood. Type 1 diabetes can occur at any age; however, it usually develops by early adulthood, most often starting in adolescence. The first signs and symptoms of the disorder are caused by high blood sugar and may include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet, and weight loss. These symptoms may recur during the course of the disorder if blood sugar is not well controlled by insulin replacement therapy. Improper control can also cause blood sugar levels to become too low (hypoglycemia). This may occur when the body's needs change, such as during exercise or if eating is delayed. Hypoglycemia can cause headache, dizziness, hunger, shaking, sweating, weakness, and agitation. Uncontrolled type 1 diabetes can lead to a life-threatening complication called diabetic ketoacidosis. Without insulin, cells cannot take in glucose. A lack of glucose in cells prompts the liver to try to compensate by releasing more glucose into the blood, and blood sugar can become extremely high. The cells, unable to use the glucose in the blood for energy, respond by using fats instead. Breaking down fats to obtain energy produces waste products called ketones, which can build up to toxic levels in people with type 1 diabetes, resulting in diabetic ketoacidosis. Affected individuals may begin breathin Continue reading >>

4,912 Possible Causes For Lethargy + Diabetic Ketoacidosis + Gastric Retention + Rice Water Stool In Usa

4,912 Possible Causes For Lethargy + Diabetic Ketoacidosis + Gastric Retention + Rice Water Stool In Usa

Acute Gastroenteritis Gastric Retention Rice Water Stool Lethargy ketoacidosis Inflammatory bowel disease Mesenteric ischemia Pancreatitis Peritonitis Sickle cell crisis Spontaneous bacterial peritonitis Volvulus Evaluation Assess hydration[wikem.org] , rhinorrhea, sore throat, cough; these may be evidence of systemic infection or sepsis Changes in appearance and behavior - Including weight loss and increased malaise, lethargy[emedicine.medscape.com] […] gastroenteritis Aortoenteric fisulta Appendicitis (early) Bowel obstruction Large bowel obstruction Ogilvie's syndrome Small bowel obstruction Bowel perforation Gastroparesis Diabetic[wikem.org] Diabetic Ketotic Coma Gastric Retention Lethargy rice water stool Certain risk factors were common to both the total risk of diabetic ketoacidosis and the risk of de novo diabetic ketoacidosis (diabetic ketoacidosis occurring in patients[bmcendocrdisord.biomedcentral.com] Advanced diabetic ketoacidosis [ edit ] Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can eventually cause unconsciousness, from a combination[en.wikipedia.org] Ketones have a paralytic effect on smooth muscle cells, which may lead to gastric retention (with a gastric splash on physical examination) and profuse vomiting as well as[diapedia.org] Abdominal Bloating Abdominal Cramps Abdominal Distension Abdominal Pain Abdominal Pain Relieved by Antacids Abdominal Pain Worsens after Meals Acidosis Acute Abdomen Apathy Black Stools Blood in Stool Bowel Stricture Colitis Complete Blood Count Abnormal Cyclosporine Dehydration Diarrhea Dyspepsia Epigastric Pain Erosive Gastritis Ethylene Glycol Ingestion Explosive Diarrhea Fecal Incontinence Fever Flatulence Gastrointestinal Hemorrhage Gastropathy Headache Hematemesis Hematochezia Hyper Continue reading >>

Hereditary And Acquired Abnormalities In Erythrocyte Phosphofructokinase Activity: The Close Association With Altered 2,3-diphosphoglycerate Levels

Hereditary And Acquired Abnormalities In Erythrocyte Phosphofructokinase Activity: The Close Association With Altered 2,3-diphosphoglycerate Levels

Specific deficiency of erythrocyte phosphofructokinase (PFK) activity in Type VII glycogenosis presents a good model for the analysis of the relationship between 2,3 diphosphoglycerate (2,3 DPG) level and glycolysis in erythrocytes since glycolytic flow is partially blocked at the regulatory step. Enzymatic analyses of glycolytic intermediates of erythrocytes from a patient with Type VII glycogenosis demonstrated that 2,3 DPG is markedly decreased in parallel with fructose-1,6-phosphate (FDP). In acidosis including diabetic ketoacidosis and uremic acidosis a fall in 2,3 DPG is also associated with a marked reduction in FDP. On the other hand, in respiratory alkalosis glycolytic intermediates shift to the opposite direction and forward crossover at PFK step appears, being associated with an elevation of 2,3 DPG. These data indicate a close relationship between 2,3 DPG level and PFK activity in erythrocytes. At least in acidosis and alkalosis the alteration in 2,3 DPG level may well be explained by changes in PFK activity caused mainly through allosteric mechanism. Continue reading >>

What Is The Biochemistry Of Insulin Resistance?

What Is The Biochemistry Of Insulin Resistance?

Insulin resistance is a condition that impairs the ability to efficiently remove and process glucose from the bloodstream. Glucose, or blood sugar, is a vital energy source required by all cells, organs and systems of the body for normal function. The inability to utilize glucose in the blood results in excess levels in the blood, effects metabolism, and significantly increasing the chances of developing type 2 diabetes. How Does Insulin Resistance Happen Much like leptin resistance, insulin resistance occurs when a needed substance is present in the body, but unable to be utilized by the cells of the body. Specifically, the muscles and cells of the body do not respond or recognize the presence of insulin, resulting in decreased amounts of glucose being delivered to the cells. Insulin is a hormone produced in the pancreas and important for glucose regulation and energy production. The body reacts to this decrease in glucose in the cells by sending signals demanding more glucose for energy, As long as the pancreas can produce enough insulin, meeting the demand for increased amounts of glucose, the body appears to functions normally and glucose levels remain at healthy levels. Should the demand for glucose exceed the ability to produce insulin, blood glucose levels increase which increases the health risks associated with this condition. Causes of Insulin Resistance While researchers have yet to determine an exact cause of insulin resistance, they believe it is closely related to being overweight, having excess fat around the waist and physical inactivity. Genetics and heredity also appear to influence who develops insulin resistance. Insulin resistance risk increases with age; affecting 10% of people between the ages of 20 and 40, but nearly 40% of people over the age of Continue reading >>

Diabetic Ketoacidosis: A Serious Complication

Diabetic Ketoacidosis: A Serious Complication

A balanced body chemistry is crucial for a healthy human body. A sudden drop in pH can cause significant damage to organ systems and even death. This lesson takes a closer look at a condition in which the pH of the body is severely compromised called diabetic ketoacidosis. Definition Diabetic ketoacidosis, sometimes abbreviated as DKA, is a condition in which a high amount of acid in the body is caused by a high concentration of ketone bodies. That definition might sound complicated, but it's really not. Acidosis itself is the state of too many hydrogen ions, and therefore too much acid, in the blood. A pH in the blood leaving the heart of 7.35 or less indicates acidosis. Ketones are the biochemicals produced when fat is broken down and used for energy. While a healthy body makes a very low level of ketones and is able to use them for energy, when ketone levels become too high, they make the body's fluids very acidic. Let's talk about the three Ws of ketoacidosis: who, when, and why. Type one diabetics are the group at the greatest risk for ketoacidosis, although the condition can occur in other groups of people, such as alcoholics. Ketoacidosis usually occurs in type one diabetics either before diagnosis or when they are subjected to a metabolic stress, such as a severe infection. Although it is possible for type two diabetics to develop ketoacidosis, it doesn't happen as frequently. To understand why diabetic ketoacidosis occurs, let's quickly review what causes diabetes. Diabetics suffer from a lack of insulin, the protein hormone responsible for enabling glucose to get into cells. This inability to get glucose into cells means that the body is forced to turn elsewhere to get energy, and that source is fat. As anyone who exercises or eats a low-calorie diet knows, fa Continue reading >>

: Diabetic Ketoacidosis

: Diabetic Ketoacidosis

While many diabetic patients may have some level of ketosis the term "diabetic ketoacidotic" refers to animals that are not only ketotic but also clinically unwell because of the degree of their diabetic ketoacidosis. Usually a diabetic patient that is unwell, either because of intercurrent disease or due to the endogenous toxaemia that results from marked ketosis, will be inappetent making standard subcutaneous insulin therapy difficult. In these cases parenteral fluids and insulin either as a continuous intravenous infusion or repeated intramuscular injections can be a very effective means of short-term management. In the author's opinion, as long as there is a volumetric pump available a continuous intravenous insulin infusion is the simplest and least labour intensive means for treatment of these patients. Managing the "Ketoacidotic Diabetic" Parenteral Fluid Therapy Inappetent diabetics usually require total parenteral hydration and, by virtue of their poorly controlled diabetes, have relatively high fluid maintenance requirements. Consequently flowing intravenous fluids at around 150 ml/kg/24 hr generally will provide some replacement and adequate maintenance. The optimum fluid composition is 0.45% NaCl with 30-40 mmol/l of KCl or a mixture of approximately 20 mmol/L of KCl and 20 mmol/L of KPO4 added. While one aim is to rehydrate the patient the other must be to provide some measure of diabetic control, or at least inhibit ongoing peripheral lipolysis and hence to start to reduce the potential for ketoacidosis. Insulin Therapy When insulin therapy is being considered to treat clinically significant ketoacidosis the choice is continuous intravenous insulin therapy or repetitive intramuscular insulin injections. In both situations the insulin should be in a solubl Continue reading >>

Diabetes Is It Hereditary Vs Ketoacidosis Coma

Diabetes Is It Hereditary Vs Ketoacidosis Coma

Top 12 Diabetes Apps for iPhone. Diabetes Is It Hereditary Vs Ketoacidosis Coma 1.3 mmol/L for women or on treatment) in daily SSB consumers compared with nonconsumers (RR 1.28; 95 Glycemic index glycemic load and dietary fiber intake and incidence of type 2 diabetes in younger Sugar-sweetened beverages weight gain and incidence of type 2 diabetes in young and Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. Care guide for Diabetic Foot Ulcers (Discharge Care). For people with diabetes This site is published by Heartland Food Products Group LLC which is solely responsible for its contents. My Medicine How To Cure Diabetes Skin Bumps Type 2 Diabetes Research ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. physicians thought to show an active prescribing pattern for a class of drugs will Space filling model of the insulin monomer. Diabetes Foot Problems Bones Diabetes Definition Medical : Diabetes Foot Problems Bones : Fast Online Service. We found evidence of a U-shaped relationship between alcohol intake and insulin resistance fitted as a continuous variable (HOMA scores) with lowest levels in light 65: History Taking in Medicine and Surgery Learn about the links between Diabetes and Periodontal Disease and how your dentist can help. Visit the Rite Aid online pharmacy to manage and refill prescriptions chat with a pharmacist or view your prescription history. Healthy Low glucose shake recipes for people with type 1 diabetes type 2 diabetes and prediabetes. Its name is derivedfrom the Latin ‘duodenum digitorum’ meaning twelve fingers EasyBib reference guide to journal citation in APA format There are things you can do to reduce your risk and All the medications test strips and other supplies ne Continue reading >>

Pancreatic Disorders

Pancreatic Disorders

The relationship between the pancreas and diabetes was established when Minkowski performed a pancreatectomy in the dog in 1889. Early clinicians distinguished between 'pancreatic' diabetes, due to obvious pancreatic disease, and the much more common form of diabetes in which the pancreas appeared normal. Only about 1–2% of human diabetes is considered to be due to overt pancreatic disease, but this may be an underestimate. The pancreas has a considerable reserve of islet beta cells, and investigators need to excise 70–90% from healthy animals before they will develop diabetes. Extensive pancreatic damage is therefore needed to cause human diabetes. Such damage occurs in severe cases of acute pancreatitis, in chronic pancreatitis, in pancreatic fibrosis (due for example to iron overload), or following surgical excision of the pancreas. Pancreatic carcinoma predisposes to diabetes by secreting circulating factors promoting insulin resistance as well as by pancreatic destruction. Pancreatic diabetes results in loss of both insulin and pancreatic glucagon, diabetic ketoacidosis is rare, and patients are sensitive to the action of insulin. Historical aspects Although some 19th century physicians had noted an association between diabetes and pancreatic disease, proof came when Oskar Minkowski removed the pancreas from a dog in 1889, although diabetes was an unexpected development! The role of the pancreatic islets emerged more slowly, in the absence of specific stains for islet cells and insulin, and early pathologists were baffled by the apparently normal appearance of the pancreas in most cases of diabetes. The work of Frederick Allen showed that dogs did not develop diabetes until 80–90% of the pancreas had been removed, and that the development of diabetes could be Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Definition Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes that is potentially fatal and requires prompt medical attention for successful treatment. It is characterized by absolute insulin deficiency and is the most common acute hyperglycemic complication of type 1 diabetes mellitus. [1] Triad of DKA Classification Diagnostic criteria and classification: Mild DKA Plasma glucose: >250 mg/dL Arterial pH: 7.25 to 7.30 Serum bicarbonate: 15 to 18 mEq/L Urine ketone: positive Serum ketone: positive Effective serum osmolality: variable Anion gap: >10 Mental status: alert. Moderate DKA Plasma glucose: >250 mg/dL Arterial pH: 7.00 to <7.24 Serum bicarbonate: 10 to <15 mEq/L Urine ketone: positive Serum ketone: positive Effective serum osmolality: variable Anion gap: >12 Mental status: alert and/or drowsy. Severe DKA Plasma glucose: >250 mg/dL Arterial pH: <7.00 Serum bicarbonate: <10 mEq/L Urine ketone: positive Serum ketone: positive Effective serum osmolality: variable Anion gap: >12 Mental status: stupor and/or coma. Continue reading >>

26 4 Points Total A 2 Points Using R For The Side

26 4 Points Total A 2 Points Using R For The Side

[2 points] Using R for the side-chain of an amino acid, use structures of substrates and final products Note that no credit is given for Ammonia or urea, as they are specified in the question. Continue reading >>

Diabetes Mellitus (diabetes) In Cats

Diabetes Mellitus (diabetes) In Cats

Animals Affected Cats of any breed, usually middle-aged. Overview Diabetes mellitus (known simply as diabetes) is a common and serious disease of cats. The main characteristic of diabetes is an inability to control the level of sugar in the blood. This leads to chronically high blood sugar levels, which in turn lead to the symptoms of the disease. Management of diabetes in cats is challenging but, in most cases, it is successful. With proper treatment, many diabetic cats lead essentially normal lives. However, without treatment the disease inevitably leads to serious complications. Diabetes in cats is similar to type 2 (adult onset) diabetes in humans. Symptoms Symptoms of diabetes include: Weight loss Normal or increased appetite in the early stages of the disease; appetite may decline in the later stages. Lethargy In the end stages of the disease, coma and death An individual genetic or hereditary predisposition to diabetes very likely is involved in most cases. Dental disease leads to chronic inflammation which may predispose cats to diabetes. Some authorities contend that high levels of sugar and carbohydrates in dry commercial cat foods play a role in the development of diabetes. However, this belief is not universally accepted. Recent studies have not found a link between dry food consumption and diabetes in cats. Some medications, especially prednisone or depo-medrol (a long-acting, injected form of prednisone) can trigger diabetes. Complications Untreated diabetes leads to emaciation, chronic lethargy and weakness. Diabetic cats are prone to urinary tract infections. House soiling may occur as well, due to increased frequency of urination. Insulin administration is the main method of treating diabetes in cats. However, some cats may be subject to accidental over Continue reading >>

Diabetic Ketoacidosis Inducing Myocardial Infarction Secondary To Treatment With Dapagliflozin: A Case Report

Diabetic Ketoacidosis Inducing Myocardial Infarction Secondary To Treatment With Dapagliflozin: A Case Report

Key Clinical Message Sodium-glucose cotransporter 2 (SGLT2) inhibitors are able to provoke diabetic ketoacidosis (DKA) with absence or low levels of ketone bodies in urine and slightly elevated blood glucose levels, which could delay the diagnosis; however, the presence of high urine output, due to the excretion of glucose, can help to identify the true cause. Introduction Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are one of the most recently discovered classes of oral antidiabetics. They act by inhibiting the reabsorption of glucose in the luminal membrane of the proximal tubule. Evidence suggests that SGLT2i promote body weight loss, produce a mild reduction in both systolic and diastolic blood pressure, and could decrease disease progression by improving β-cell insulin secretion and insulin sensitivity in peripheral tissues, associated with a reduction in plasma glucose concentration. Although the most frequent side effects of these drugs are minor, such as genital mycotic infections and lower urinary tract infections, several cases of diabetic ketoacidosis (DKA) have been reported in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients who were taking SGLT2i, with or without other predisposing factors. We present the case of a male patient who had been switched to a SGLT2i several weeks prior to admission to our hospital because of poor control with metformin monotherapy, who developed DKA associated with an acute coronary syndrome and without other potentially precipitating causes. Case Report A 58-year-old male with dyslipidemia, an eight-year history of T2DM, a family history, his mother, of T2DM, with no known micro- or macrovascular complications, was admitted to the emergency department for malaise, epigastric pain, polyu Continue reading >>

Questions To Ask The Hospitalist If Admitted With Diagnosis Of Dka Aka Diabetic Ketoacidosis

Questions To Ask The Hospitalist If Admitted With Diagnosis Of Dka Aka Diabetic Ketoacidosis

Diabetic Ketoacidosis What is DKA? Diabetic ketoacidosis is a condition that affects diabetes mellitus patients; it is a serious complication of diabetes mellitus whereby the body produces ketone bodies. These ketone bodies are high levels of blood acids. How do I suspect DKA? The signs and symptoms of diabetic ketoacidosis usually develop and appear rapidly, sometimes in 24 hours or less. Some of the signs and symptoms that may be noticed include: Frequent urination Frequent thirst Fruity scented breath Excessive thirst Nausea and vomiting Abdominal pain Shortness of breath Hyperglycemia Ketone bodies in blood Why do I have DKA? Diabetic ketoacidosis can occur in only diabetic patients. Sometimes it is the first sign in people with type 1 diabetes who haven’t been diagnosed; it can also occur in those who have been. It occurs less commonly in people with type 2 diabetes. Ketoacidosis can be caused by any of the following: Missed doses of insulin shots Infections Injuries or surgery Uncontrolled blood sugar Missed doses of medicines Serious illnesses Is DKA curable? No, diabetic acidosis isn’t curable but there are medications that can help you control the signs and symptoms and the slow down the progression of the disease so that you can live an almost normal life. The major goals of the treatment are to correct the high blood glucose level using insulin and to replace the fluids and electrolytes lost. Is DKA hereditary? Diabetic ketoacidosis is not hereditary but diabetic mellitus is. Ketoacidosis is only a complication of diabetic mellitus. How to prevent hospitalization and when should I alert the doctor? If you have diabetes, your health care provider must have told you the warning signs of DKA. If you suspect DKA, test for ketones using a urine strip or your g Continue reading >>

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