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Clinical Signs Of Diabetes Mellitus In Dogs And Cats

Clinical Signs Of Diabetes Mellitus In Dogs And Cats

Clinical signs are useful in the diagnosis and monitoring of canine and feline diabetes. Other laboratory tests are also necessary for diagnosis of Diabetes mellitus and the monitoring of treated diabetic pets. There are three distinct clinical pictures in diabetes mellitus: Uncomplicated diabetes mellitus The classical signs are polyuria,polydipsia, polyphagia, cachexia and increased susceptibility to infections (e.g. urinary tract infections). In long term diabetes complications due to protein glycosylation can be seen: cataracts (mainly in dogs) and peripheral neuropathy (mainly in cats). Diabetic ketoacidosis DKA develops due to long standing undiagnosed diabetes mellitus, insufficient insulin dose in treated diabetics and impaired insulin action and/or resistance, caused by obesity, concurrent illness or drugs. This is the cause of more than two thirds of cases of DKA. Due to the lack of insulin, glucose cannot be used as an energy source. Fats are broken down to provide energy. During lipolysis, high levels of ketones are produced. Ketosis and acidosis develop and are accompanied by electrolyte imbalances. Ketosis causes anorexia, nausea and lethargy. Treatment DKA is an emergency and treatment must be started as soon as possible. The goals of treatment are to correct fluid deficits, acid-base balance and electrolyte balance, lower blood glucose and ketone concentrations and recognize and correct underlying and precipitating factors. Therapy includes intravenous fluid therapy with isotonic fluids, e.g. 0.9% saline, and intravenous administration of rapid-acting insulin. If possible the electrolyte concentrations and acid-base balance should be measured and corrected. Caninsulin is an intermediate-acting insulin and is not suitable for intravenous administration. W Continue reading >>

Eating Disorders Signs And Symptoms

Eating Disorders Signs And Symptoms

Although eating disorders are most common among female adolescents and young adults, they can affect any age, or gender. According to the National Eating Disorder Association, 20 million women and 10 million men will suffer from an eating disorder in their lifetime. There are several different types of eating disorders including, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating disorder, etc. Although each is unique and characterized by different symptoms, they are all associated with extreme emotions, beliefs, and behaviors related to weight and food. Anorexia Nervosa: 90-95% of individuals with Anorexia Nervosa are female, and it is one of the most common mental health diagnoses in young women. Most individuals with this illness fail to recognize the seriousness of the illness. Health consequences include dehydration, muscle loss, overall weakness, abnormally low heart rate and blood pressure resulting in increased risk of heart failure, eventual loss of bone density, and possible kidney damage. Anorexia Nervosa can be life threating. The signs and symptoms include: Self-esteem issues related to body image Inadequate food intake and an extreme low body weight Extreme fear or anxiety of weight gain or becoming “fat” An obsession with weight, food, calories, and/or dieting Denial of hunger or consistent excuses to avoid meal times or situations involving food Purging (vomiting or laxative use) to further avoid weight loss may be accompanied with Anorexia. Bulimia Nervosa: Bulimia Nervosa affects 1-2% of adolescent girls and young women. Although most patients with Bulimia are female, 20% are male. Individuals with Bulimia Nervosa don’t appear extremely underweight, and often appear to be average weight. The constant cycle of binging (overeating) and purging (vo Continue reading >>

How To Identify Ketosis

How To Identify Ketosis

Expert Reviewed Ketosis is a normal metabolic process by which your body breaks down stored fat for energy, which can also result in a dangerous buildup of ketones in the body called ketoacidosis.[1] Ketosis is often the product of a low-carbohydrate diet that people use to lose weight and gain muscle or it can also be a product of malnutrition. Although the long-term risks of ketosis are not clear, there is some evidence that it can increase your risk of heart disease and certain cancers.[2] By recognizing the signs of ketosis, you can help minimize your risk for developing ketoacidosis.[3] Continue reading >>

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

Severe Diabetic Ketoacidosis In Combination With Starvation And Anorexia Nervosa At Onset Of Type 1 Diabetes: A Case Report

Go to: A 53-year-old woman with a history of AN since adolescence was admitted to the psychiatric clinic at the Uppsala University Hospital due to psychotic behaviour and inability to take care of herself. There were reports of paranoid schizophrenia and personality disorders, but her contacts with the psychiatric clinic were sparse, and she used no medications. According to her relatives she had isolated herself the last two weeks, and over the last two months she had barely been eating at all. Twenty-four hours after admission to the psychiatric clinic she was admitted to the clinic of internal medicine and presented at the emergency room (ER) in a cachectic state with hypothermia (32.6°C). Her mental status was altered (reaction level scale 2), and she barely responded to questions, being close to stupor. There were clinical signs of severe dehydration and muscle atrophy. Her breathing was shallow with 30 bpm, whereas blood pressure and pulse rate were normal, 110/60 mmHg and 77 bpm (see Table I for a summary of the initial physical examination). She denied alcohol and any substance abuse. An initial arterial blood gas analysis displayed pH 6.895, pCO2 0.93 kPa, pO2 22 kPa, and P-glucose 40.6 mmol/L. There were no signs of infection, and electrolytes were normal (see Table II for a summary of laboratory screening). She was immediately admitted to the intensive care unit (ICU), where rehydration was initiated with warm fluid combined with re-warming with heated blankets. Bicarbonate (100 mL) was administered i.v. in order to reverse acidosis; pH increased to 7.1, and blood glucose decreased to 35 mmol/L. Six hours after ICU admission insulin infusion was started with initially 0.5 IU/h (0.0128 IU/kg) combined with 5 mmol potassium/h. The patient's pH was normalized 1 Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Also known as: DKA Severe diabetic ketoacidosis is a medical emergency and requires prompt treatment to correct dehydration, electrolyte disturbances and acidosis. It is a complication of insulin dependent Diabetes Mellitus. DKA is the result of marked insulin deficiency, and ketonaemia and ketoacidosis occur approximately 15 days after insulin concentrations are suppressed to fasting levels. Marked insulin suppression occurs on average 4 days after fasting glucose levels reach 30mmol/L. Many cats with DKA have other intercurrent conditions which may precipitate the condition including: infection, pancreatitis or renal insufficiency. Pathophysiology Insulin deficiency leads to increased breakdown of fat that releases fatty acids into the circulation. Free fatty acids are oxidised in the liver to ketones that are used by many tissues as an energy source instead of glucose. This occurs when intracellular levels of glucose are insufficient for energy metabolism as a result of severe insulin deficiency. In the liver, instead of being converted to triglycerides, free fatty acids are oxidised to acetoacetate, which is converted to hydroxybutyrate or acetone. Ketones are acids that cause central nervous system depression and act in the chemoreceptor trigger zone to cause nausea, vomiting and anorexia. They also accelerate osmotic water loss in the urine. Dehydration results from inadequate fluid intake in the face of accelerated water loss due to glucosuria and ketonuria. Dehydration and subsequent reduced tissue perfusion compounds the acidosis through lactic acid production. There is whole body loss of electrolytes including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound p Continue reading >>

Ketoacidosis Caused By Anorexia Nervosa

Ketoacidosis Caused By Anorexia Nervosa

Please log in to add your comment. Transcript of Ketoacidosis caused by Anorexia Nervosa Ketoacidosis caused by Anorexia Nervosa Resources Symptoms Weakness, Tiredness Nasuea Shortness of Breath Vomiting High Blood Sugar, Rapid Pulse Low Blood Pressure Extreme Thirst Frequent Urination Leg Cramps Treatment Take in lots of Fluids Take in lots of Electrolytes Insulin treatment to lower high blood sugar levels How It Relates To Other Body Systems Ketoacidosis keeps blood sugar high, leading to nerve, blood vessel and kidney damage, as well as worsening pancreatic damage which in turn makes the condition more severe. What Further Tests are Needed Electrolyte test: Potassium, sodium, blood urea, serum, Ketone levels and kidney function markers along with an arterial blood gas sample are the electrolyte tests for ketoacidosis. • Other tests may be used to check underlying conditions , based on the history and physical examination findings. These may include chest x-ray, urine analysis and possible scan of brain Urinalysis and Connection to results Ketones are detected in the blood using urinalysis Ketones build up when the body needs to break down fats and fatty acids to use as fuel. This is most likely to occur when the body does not get enough sugar or carbohydrates, because of Anorexia Nervosa. Full transcript Continue reading >>

Cough & Poor Appetite Are Symptoms Of Which Disease?

Cough & Poor Appetite Are Symptoms Of Which Disease?

Cough, Decreased appetite, Fatigue and Weight loss (unintentional) There are 143 conditions associated with cough, decreased appetite, fatigue and weight loss (unintentional). The links below will provide you with more detailed information on these medical conditions from the WebMD Symptom Checker and help provide a better understanding of causes and treatment of these related conditions. Continue reading >>

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(invokanaâ–¼ (canagliflozin), Vokanametâ–¼ (canagliflozin / Metformin), Forxigaâ–¼ (dapagliflozin), Xigduoâ–¼ (dapagliflozin / Metformin),

DHPC agreed by CHMP on 25 February 2016 *JARDIANCE and SYNJARDY are co-promoted by Boehringer Ingelheim Limited and Eli Lilly and Company Limited Direct Healthcare Professional Communication Updated advice on the risk of diabetic ketoacidosis during treatment with SGLT2 inhibitors (INVOKANA▼ (canagliflozin), VOKANAMET▼ (canagliflozin / metformin), FORXIGA▼ (dapagliflozin), XIGDUO▼ (dapagliflozin / metformin), JARDIANCE▼* (empagliflozin), SYNJARDY▼* (empagliflozin / metformin)) Dear Healthcare Professional, In agreement with the European Medicines Agency (EMA) and Health Products Regulatory Authority (HPRA), Janssen-Cilag Limited, AstraZeneca Limited and Boehringer Ingelheim Limited would like to inform you of the latest recommendations regarding the risk of diabetic ketoacidosis (DKA) during treatment with SGLT2 inhibitors (canagliflozin, dapagliflozin or empagliflozin). This follows on the outcome of an evaluation by the EMA of the risk of diabetic ketoacidosis during treatment with SGLT2 inhibitors. Rare but serious, sometimes life-threatening and fatal cases of diabetic ketoacidosis have been reported in patients on SGLT2 inhibitor treatment for type 2 diabetes. In a number of these reports, the presentation of the condition was atypical with only moderately increased blood glucose levels observed. Such atypical presentation of diabetic ketoacidosis in patients with diabetes could delay diagnosis and treatment. Summary of updated advice • The risk of diabetic ketoacidosis must be considered in the event of non-specific symptoms such as nausea, vomiting, anorexia, abdominal pain, excessive thirst, difficulty breathing, confusion, unusual fatigue or sleepiness. Prescribers should inform patients of signs and symptoms of metabol Continue reading >>

Symptoms And Symptom Management

Symptoms And Symptom Management

Many physical and psychological symptoms accompany the end of life. In one study, 1,000 cancer patients had a median of eleven symptoms during the terminal phase of illness, many of which affect the patient's quality of life. Assessment and management of common symptoms are thus integral to a balanced approach to end-of-life care. Because of the multidimensional nature of many symptoms, an interdisciplinary team approach to assessment and management is essential. Such an interdisciplinary team calls for the expertise of nurses, physicians, social workers, nursing assistants, spiritual care providers, and expressive therapists. Prevalence and Relevance of Symptoms Pharmacological and nonpharmacological efforts to alleviate the symptoms seek to accommodate the patient's desires. For example, if a patient has requested to be as alert as possible until death, and if the same patient needs an antiemetic agent to control nausea and vomiting, the common side effect of sedation represents an unacceptable tradeoff to the patient. If, on the other hand, the patient desires total control of the nausea and vomiting, even at the expense of alertness, such medication would be appropriate. The goal of symptom management is quality of life. Fatigue. Fatigue is the most prevalent end-of-life symptom, second only to pain. In a study by Conill, fatigue was present in 80 percent of 176 palliative care patients. There is not a universal definition of fatigue. Patients often speak of weakness, easy tiring, or inability to perform the activities of daily living. According to death experts Linda Tyler and Arthur Lipman, fatigue is a multifaceted symptom. Tyler and Lipman identify the following causes of fatigue: anemia, pain, depression, insomnia, dehydration, metabolic disease process, and si Continue reading >>

Diabetic Ketoacidosis Clinical Presentation

Diabetic Ketoacidosis Clinical Presentation

History Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early symptoms of diabetic ketoacidosis (DKA). Malaise, generalized weakness, and fatigability also can present as symptoms of DKA. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. A history of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes. Patients may present with a history of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons. Decreased perspiration is another possible symptom of DKA. Altered consciousness in the form of mild disorientation or confusion can occur. Although frank coma is uncommon, it may occur when the condition is neglected or if dehydration or acidosis is severe. Among the symptoms of DKA associated with possible intercurrent infection are fever, dysuria, coughing, malaise, chills, chest pain, shortness of breath, and arthralgia. Acute chest pain or palpitation may occur in association with myocardial infarction. Painless infarction is not uncommon in patients with diabetes and should always be suspected in elderly patients. A study by Crossen et al indicated that in children with type 1 diabetes, those who have had a recent emergency department visit and have undergone a long period without visiting an endocrinologist are more likely to develop DKA. The study included 5263 pediatric patients with type 1 diabetes. [15] Continue reading >>

Chapter 24: Diabetic Ketoacidosis And Hyperosmolar Coma

Chapter 24: Diabetic Ketoacidosis And Hyperosmolar Coma

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute complications of diabetes mellitus (DM). DKA is seen primarily in individuals with type 1 DM and HHS in individuals with type 2 DM. Both disorders are associated with absolute or relative insulin deficiency, volume depletion, and altered mental status. The metabolic similarities and differences in DKA and HHS are summarized in Table 24-1. DKA results from insulin deficiency with a relative or absolute increase in glucagon and may be caused by inadequate insulin administration, infection (pneumonia, urinary tract infection, gastroenteritis, sepsis), infarction (cerebral, coronary, mesenteric, peripheral), surgery, trauma, drugs (cocaine), or pregnancy. A common precipitating scenario is the pt with type 1 DM who erroneously stops administering insulin because of anorexia/lack of food intake caused by a minor illness, followed by lipolysis and progressive ketosis leading to DKA. The initial symptoms of DKA include anorexia, nausea, vomiting, polyuria, and thirst. Abdominal pain, altered mental function, or frank coma may ensue. Classic signs of DKA include Kussmaul respirations and an acetone odor on the pt's breath. Volume depletion can lead to dry mucous membranes, tachycardia, and hypotension. Fever and abdominal tenderness may also be present. Laboratory evaluation reveals hyperglycemia, ketosis (β-hydroxybutyrate > acetoacetate), and metabolic acidosis (arterial pH 6.8–7.3) with an increased anion gap (Table 24-1). The fluid deficit is often 3–5 L and can be greater. Despite a total-body potassium deficit, the serum potassium at presentation may be normal or mildly high as a result of acidosis. Similarly, phosphate may be normal at presentation despite total body phosphate depletion Continue reading >>

Eating Disorders In Type 1 Diabetes: Risks And Recommendations

Eating Disorders In Type 1 Diabetes: Risks And Recommendations

Girls and women with type 1 diabetes (T1DM) are almost 2.5 times as likely to develop an eating disorder as those without diabetes(1). In order to understand why this might be, one must first understand the complexity of T1DM and the unique symptom of insulin restriction. Recently, this phenomenon has been referred to as “diabulimia” in both the popular press and by those who are struggling themselves. I have a love-hate relationship with the term. My love comes from the knowledge that having a name has given women who struggle an actual voice. They have something to call it and something to describe. Also, if something has a name, then they can’t be the only ones with the problem. This awareness is a huge step forward as it brings with it the possibility of decreasing shame and possible secrecy. My hate, which is too strong a word, comes from several angles. First, the “bulimia” part of the word runs the risk of implying that only people who binge have this problem. What I’ve seen in my practice is that eating disorders of all kinds occur in the context of T1DM. I think of them as falling on a continuum—people can exclusively restrict food and calories, they can restrict both food and insulin, they can eat normally and restrict insulin, they can binge and restrict insulin, they can use other means of purging, or they can binge without purging. This leads to my second problem with the term, which is that it seems to oversimplify the problem taking all these nuances and fitting them into one entity. The reality is that all eating disorders in the context of T1DM are complex, tormenting, and dangerous and all deserve access to appropriate treatment. With that said, the remainder of this article will focus on the problem of insulin restriction, since up to 30 Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Diagnosis

Diagnosis

Print If your doctor suspects that you have anorexia nervosa, he or she will typically run several tests and exams to help pinpoint a diagnosis, rule out medical causes for the weight loss, and check for any related complications. These exams and tests generally include: Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; checking your skin and nails for problems; listening to your heart and lungs; and examining your abdomen. Lab tests. These may include a complete blood count (CBC) and more specialized blood tests to check electrolytes and protein as well as functioning of your liver, kidney and thyroid. A urinalysis also may be done. Psychological evaluation. A doctor or mental health provider will likely ask about your thoughts, feelings and eating habits. You may also be asked to complete psychological self-assessment questionnaires. Other studies. X-rays may be taken to check your bone density, check for stress fractures or broken bones, or check for pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements. Diagnostic criteria for anorexia The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. DSM-5 diagnostic criteria for anorexia include: Restricting food intake — eating less than needed to maintain a body weight that's at or above the minimum normal weight for your age and height Fear of gaining weight — intense fear of gaining wei Continue reading >>

Dying To Be Thin: The Long Term Health Risks Of Anorexia

Dying To Be Thin: The Long Term Health Risks Of Anorexia

How the Complications That Accompany Anorexia Attack the Body Anorexia Nervosa’s impact on a person’s health can be brutal. Even before the physical effects of this eating disorder become apparent, it begins to attack nearly every system in the human body. Like an aggressive form of cancer, it won’t stop until it wins. The disease has the highest mortality rate of all mental health disorders. As many as 20 percent of the people who suffer from anorexia will eventually die from it. And the longer a person suffers from anorexia, the greater their risk of dying becomes. Because some of the complications that come with anorexia can last a lifetime, the timeline for detection, intervention, and treatment can be crucial for recovery. The Complications of Anorexia Anorexia Nervosa is taken very seriously in the mental health community because the damage it inflicts extends to nearly every part of the body. These effects can range from minor infections and poor general health to serious life threatening medical problems. Because it often strikes young people, some of these conditions may carry over into adulthood and last an entire lifetime. “A lot of people -parents, and even some doctors- think that medical complications of anorexia only happen when you’re so thin you’re wasting away,” Rebecka Peebles, MD, a specialist in adolescent medicine at the Lucile Packard Children’s Hospital, told WebMD: “Practitioners need to understand that a good therapist is only part of the treatment for anorexia and other eating disorders, and that these patients need treatment from a medical doctor as well.” Psychological Effects Adolescents and teens with anorexia have a high risk for other mental disorders such as anxiety and depression. Patients who suffer from anorexia a Continue reading >>

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