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Starvation Ketoacidosis Medscape

Starvation-induced True Diabetic Euglycemic Ketoacidosis In Severe Depression

Starvation-induced True Diabetic Euglycemic Ketoacidosis In Severe Depression

Go to: A 34-year-old man with a 19-year history of type 1 diabetes presented as an emergency with a 4-day history of nausea, vomiting, and flu-like symptoms. He was on a basal bolus insulin regime comprising 8 units of bolus insulin lispro injected at mealtimes and 12 units of basal isophane insulin at bedtime, but did not monitor capillary blood glucose levels. He did however empirically increase his insulin doses during times of illness and had increased his isophane insulin to 15 units during the 3 days prior to presentation. He had only one prior hospital admission, which occurred 6 years previously and was due to an episode of DKA precipitated by gastroenteritis. He was single, unemployed, did not drink alcohol, had no previous psychiatric history, no family history of diabetes or other medical conditions, and lived in a hostel. He had a record of poor clinic attendances and a history of long-term cannabis use. He denied any salicylate consumption, but admitted to some weight loss; however, he was unable to quantify this. His body mass index (BMI) was 19 kg/m2, and he looked unkempt. Physical examination revealed a temperature of 36.4°C (97.5°F), heart rate of 106 beats per minute, supine blood pressure of 131/85 mmHg, and sitting blood pressure of 122/80 mmHg. He had a respiratory rate of 30 breaths per minute, and his oxygen saturation using a pulsoximeter was 99% on room air. He appeared clinically dehydrated with dry oral mucosa, but cardiovascular, respiratory, abdominal, and neurological examinations were otherwise normal. Diabetic ketoacidosis (DKA) was suspected; metabolic acidosis was confirmed with a pH of 7.3, bicarbonate concentration of 10 mEq/l, and an elevated anion gap of 29 mEq/l [sodium = 134 mEq/l, potassium = 5.7 mEq/l, chloride = 101 mEq/l, b Continue reading >>

Shock: Symptoms, Causes & Treatment Of Trauma

Shock: Symptoms, Causes & Treatment Of Trauma

The word shock is used differently by the medical community and the general public. The connotation by the public is an intense emotional reaction to a stressful situation or bad news. The medical definition of shock is much different. Medically, shock is defined as a condition where the tissues in the body don't receive enough oxygen and nutrients to allow the cells to function. This ultimately leads to cellular death, progressing to organ failure, and finally, if untreated, whole body failure and death. Cells need two things to function: oxygen and glucose. This allows the cells to generate energy and do their specific jobs. Oxygen in the air enters the body through the lungs . Oxygen molecules cross from the air sacs of the lungs into the smallest blood vessels, the capillaries, and are picked up by red blood cells and attached to hemoglobin molecules. The red blood cells are pushed through the body by the actions of the pumping heart and deliver the oxygen to cells in all the tissues of the body. The hemoglobin then picks up carbon dioxide, the waste product of metabolism , which it is then taken back to the lungs and breathed out into the air. The whole cycle begins again. Glucose is generated in the body from the foods we eat. Glucose travels in the blood stream and uses an insulin molecule to "open the door," where it then enters the cell to provide energy for cellular metabolism . If cells are deprived of oxygen, instead of using aerobic (with oxygen) metabolism to function, the cells use the anaerobic (without oxygen) pathway to produce energy. Unfortunately, lactic acid is formed as a by-product of anaerobic metabolism. This acid changes the acid-base balance in the blood, making it more acidic, and can lead to a situation in which cells begin to leak toxic c Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Background In 1940, Dillon and colleagues first described alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration. [1, 2] Although AKA most commonly occurs in adults with alcoholism, it has been reported in less-experienced drinkers of all ages. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting. [3, 4, 5] A concomitant metabolic alkalosis is common, secondary to vomiting and volume depletion (see Workup). [6] Treatment of AKA is directed toward reversing the 3 major pathophysiologic causes of the syndrome, which are: This goal can usually be achieved through the administration of dextrose and saline solutions (see Treatment). Continue reading >>

What Is Ketosis?

What Is Ketosis?

"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>

Blog - Clen Fat Burner

Blog - Clen Fat Burner

Clenbuterol abuse as a diet drug gained popularity a few years ago. Its side effects caused it to become a banned substance. In this interview with Medscape and Drs. McKeever and Hoffman, they break down the dangers of using Clenbuterol to gain muscle and lose weight. The original article can be found at MedScape.com To Dope or Not to Dope: Abuse of Clenbuterol as a Diet Drug: An Expert Interview With Drs. Ken McKeever and Hoffman Use and abuse. Misuse and overuse. These are topics that we have explored before in our To Dope or Not to Dope columns. Previously, we discussed the role of the team physician and why elite athletes may choose to use performance-enhancing drugs. In this column, we talk about the use of performance-enhancing drugs by the everyday weekend warrior. Clenbuterol has received substantial attention by the lay media as a miracle diet drug with only perfunctory regard to the dangers of its unsupervised use. When used appropriately under the supervision of a physician or veterinarian, clenbuterol can alleviate respiratory distress in horses and may have potential therapeutic benefits in human heart failure. However, off-label unsupervised overuse of the drug can be fraught with dangers and side effects. These interviews deal with the potential abuse of clenbuterol as an unlicensed diet drug, not its legitimate physician-supervised usages. Medscape: Clenbuterol is getting a lot of press these days for misuse by weight lifters and dieters. Could you tell Medscape readers about its legitimate uses in the United States? Dr. McKeever: Clenbuterol was approved 6 or 7 years ago for use in treating respiratory disease in horses. Its very similar to the bronchodilator albuterol, and is the only beta-2 agonist that has been licensed for use in treating respirato Continue reading >>

Invokana Lawsuit

Invokana Lawsuit

The Food and Drug Administration has recently issued a Black Box warning about Invokana and the risk of amputation. Other safety concerns have been raised over serious side effects such as severe urinary tract infection, kidney failure and heart attack. If you or a loved one have been harmed after taking Invokana, you may be eligible to file an Invokana lawsuit. Should I talk to a lawyer about the experience I had with the drug Invokana? If you or a loved one used the type 2 diabetes medication Invokana, you might be eligible for financial compensation. Some Invokana users have required amputation of the leg, foot or toe after using the drug. Others have developed diabetic ketoacidosis or suffered other side effects such as severe kidney infection, heart attack or stroke after taking Invokana. Invokana (canagliflozin) is an SGLT2 inhibitor, which is a type of medication that works by lowering blood glucose levels. It does this by encouraging higher amounts of sugar to be released through urine. Though the medication does help control blood sugar levels, it triggers a number of other side effects, many of which are severe. Some Invokana users experienced cardiovascular issues including heart attacks and strokes, as well as diabetic ketoacidosis and kidney health issues. Final results from two clinical studies, CANVAS and CANVAS-R have shown that use of Invokana may double the risk for limb amputation and have prompted the FDA to release a black box warning about the risk. For some, the use of Invokana triggered side effects so severe they needed hospitalization. Others suffered permanent disability. In response to these devastating medical emergencies, many Invokana users have opted to take legal action against the makers of the drug. Both Janssen Pharmaceuticals and its Continue reading >>

Why Ditch The Infant Cereals?

Why Ditch The Infant Cereals?

nutritional philosophy, tradition has weight. After all, weve survived anywhere from 7,000 to 77,000 generations on this planet (depending on whose science you believe). If we didnt know how to adequately nourish our children all that time, how did we even get here? And guess what? Traditional cultures didnt (and dont) feed their young babies infant cereal. Among the few cultures who fed their babies a gruel of grains, their practice radically differed from what we do today. First, they only introduced the gruel after the baby was more than a year old. And second, they ensured that the gruel was mildly fermented by soaking the grains for 24 hours or more. In order to digest grains, your body needs to make use of an enzyme called amylase. Amylase is the enzyme responsible for splitting starches. And, guess what? Babies dont make amylase in large enough quantities to digest grains until after they are a year old at the earliest. Sometimes it can take up to two years. You see, newborns dont produce amylase at all. Salivary amylase makes a small appearance at about 6 months old, but pancreatic amylase (what you need to actually digest grains) is not produced until molar teeth are fully developed! First molars usually dont show up until 13-19 months old, on average. Undigested grains wreak havoc on your babys intestinal lining. It can throw off the balance of bacteria in their gut and lead to lots of complications as they age including: food allergies, behavioral problems, mood issues, and more. What does this mean? Dont feed your baby grains (or even highly starchy foods), until all of their first molars have emerged. This means no rice cereals, no Cheerios, no Goldfish, no oatmeal, no infant crackers. It means that when you sit down with them at a restaurant, you shouldnt Continue reading >>

The Lowly Urinalysis: How To Avoid Common Pitfalls

The Lowly Urinalysis: How To Avoid Common Pitfalls

You are at: Home More Departments Clinical Focus The Lowly Urinalysis: How to Avoid Common Pitfalls The Lowly Urinalysis: How to Avoid Common Pitfalls You may think you know everything about the humble pee test, but there are subtleties you might be missing. A 53-year-old female presents with malodorous urine. She denies dysuria, urgency, incontinence, and frequency, but she is concerned for UTI. She had one UTI several years ago, but at that time had dysuria and urgency. A urinalysis sent from triage demonstrates 3 WBCs, trace LE, and 2 squamous cells, but nitrites are negative. A diagnosis of UTI is made. Is this the right call? URINALYSIS/URINE DIPSTICK AND ITS COMPONENTS Urinalysis and urine dipstick are commonly ordered tests in the ED and can be useful in many clinical conditions, including urolithiasis and urinary tract infection (UTI). [1-5] Where can we go wrong? You may think you know how to interpret these tests, but there are several subtleties. In this article well evaluate several components, including bedside analysis, dipstick, and pitfalls in analysis (especially in UTI). The most common collection method is midstream cleancatch into a clean dry container, while others include urethral catheterization or suprapubic aspiration. [2,3,6,7] Though external cleaning is usually recommended for midstream collection, it really does not have proven benefit in decreasing contamination. [1,3] One study found contamination rates were similar between those with and without cleansing. [6] Even with external cleansing, close to 30% of samples are contaminated. [6] Once urine is collected, it should be rapidly analyzed, as bacteria can proliferate in warm urine. If the sample cannot be analyzed quickly, refrigeration is recommended. A delay of two hours or more can pr Continue reading >>

Euglycaemic Ketoacidosis In A Non-diabetic Primigravida Following An Appendicectomy

Euglycaemic Ketoacidosis In A Non-diabetic Primigravida Following An Appendicectomy

Pregnancy creates significant alterations in energy metabolism which itself is a physiological adaptation to provide continuous flow of energy metabolites to the foetus. The state of insulin resistance created by hormonal changes in pregnancy enables free flow of glucose to the foetus and allows its absorption through facilitated diffusion. As glucose is preferentially available for the foetus, maternal fasting glucose level would be less than that of a non-pregnant state and in contrast plasma ketones and free fatty acids levels are elevated, resulting in a state of accelerated starvation. These metabolic alterations place a pregnant woman at a higher risk of developing euglycaemic ketoacidosis when allowed to fast for prolonged periods due to medical, surgical and psychological reasons. We report a rare case of euglycaemic ketoacidosis causing severe increased anion gap metabolic acidosis in a non-diabetic mother following surgery for appendicitis at a gestation of 27 weeks. Euglycaemic ketoacidosis is a condition characterized by accelerated ketogenesis in cellular level in spite of adequate supply of glucose for energy metabolism, in contrast to diabetic ketoacidosis where there is intracellular glucose depletion resulting in accelerated ketogenesis providing keto acids as an alternative energy metabolite. The hormonal changes that occur in pregnancy create a state of insulin resistance allowing free flow of glucose to the foetus. Thus, prolonged starvation in a pregnant woman will place her at high risk of starvation ketosis. We describe a 27-year-old non-diabetic primigravida woman who presented with increased anion gap metabolic acidosis secondary to starvation ketoacidosis following prolonged fasting and vomiting due to appendicitis. A 27-year-old primigravida w Continue reading >>

Mcq Masterset Krom Flashcards | Quizlet

Mcq Masterset Krom Flashcards | Quizlet

- Renal effects - mild proteinuuria & HTN - Widespread - RA, cancer, B cell lymphoma, Crohn's, anti-platelet, MS, psoriasis, severe allergic asthma, osteoporosis,organ transplant, ank spond, nocturnal haematuria, pain (bony) 8 hrs after 1 dose, 14 after multiple- doubles in severe renal impairment; steady state reached at 3 days. Dose dep in crease in aPTT & PT, thrombin time but wide variation. Normal thrombin clotting time exclude clinical effect. Fentanyl Patch - What is time to reach peak concentration? Transdermal drug delivery system, duration 72 hrs. Rectangular patch, rounded corners with backing layer and fentanyl containing silicone layer. Strengths dep on area. 12.5mcg/25/50/75/100 per hour. After initial patch application serum levels increase until 12-24hrs then remain stable until 72 hrs. (Model suggests adding a new patch after 24 hrs will increase levels still) Mean half life after 72hr patch is 24 hrs (IV doses 3-12 hrs; slower transdermally due to ongoing slow absorption from skin)) Most common cause of epidural catheter related infection Staph aureus - as per Oxford Handbook & google search A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizur and losing consciousness. Which drug should NOT be given Porphyria = group of disease with enzyme defect in harm synthesis leading to accumulation of porphyrins. Porphyrins (purple) are organic substances with particular sturcuture; porphyrins with iron called harm. There are hepatic & erythoropoietic types of porphyria. Only the heaptic types affect anaesthesia - Acute intermittent porphyrins - common & variaegate & heridatory coroporphyria. Issue - Anaesthetic drugs + peri-op stress Continue reading >>

Symptoms Of Diabetic Ketoacidosis

Symptoms Of Diabetic Ketoacidosis

Diabetic ketoacidosis, or simply DKA, is one of the complications of diabetes mellitus. It occurs suddenly, is severe and can be life-threatening if neglected. The diabetic ketoacidosis is a complex metabolic state comprising of increased blood glucose levels (hyperglycemia), increased production and presence of ketone acids in the blood (ketonemia) and acidic changes in the internal environment of the body (acidosis). These changes together constitute the diabetic ketoacidosis. Diabetic ketoacidosis is more common in persons with type – 1 as compared to type – 2 diabetes mellitus. Sometimes, it may be the first sign of diabetes mellitus in patients with no previous diagnosis of diabetes. In normal individuals, insulin hormone is produced and secreted by an organ called pancreas. Insulin is necessary for the entry of blood glucose into our cells. Insulin works like a key and unlocks the cellular gates to help glucose enter the cells. The cells use entered glucose to produce energy. In type – 1 diabetes mellitus, the pancreatic cells producing insulin are destroyed. This lack of insulin prevents the entry of blood glucose into our cells as the cellular gates are closed, increasing the blood glucose levels (hyperglycemia). Our body cells starve and cannot utilize glucose for energy despite increased amounts of glucose in our blood. In this starving state, our body burns fats and produces ketones for energy purposes. Ketones have an advantage that they do not need insulin to enter into cells but the ketones also have a disadvantage that they are acidic in nature and when produced in excessive amounts, they change our body environment and make it acidic, which can be life-threatening. The patients often develop ketoacidosis when: They have missed their insulin doses T 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 >>

Emdocs Foam Em Rss - Page 129

Emdocs Foam Em Rss - Page 129

Author: James L Webb, MD (Internal Medicine, SAUSHEC, USAF) and Brit Long, MD (@long_brit) // Edited by: Erica Simon, DO, MHA (@E_M_Simon) & Alex Koyfman, MD (@EMHighAK) A 20 year-old female presents to the ED after a witnessed fall. According to bystanders, the young woman was walking towards a gym treadmill when she collapsed to the floor below, convulsing for approximately1-2 minutes. Upon EMS arrival VS were within normal limits, GCS was noted as 14 (confusion, orientation only to self), EKG revealed NSR, and accucheck demonstrated a blood glucose of 134. Intravenous access was obtained en route to your facility. As you interview and examine the patient, you note ABCs intact, a GCS of 15, an ample history remarkable only for report of a rising feeling in the abdomen prior to the event, and a secondary survey without obvious signs of trauma. ED evaluation, to include a CBC, CMP, EKG, and non-contrasted head CT are all within normal limits. Urine Hcg is negative. Was this a seizure? Whats the appropriate patient disposition? If youve got questions, weve got important details on seizures and their mimics. Current data indicate that nearly 2 million U.S. residents are affected by Epilepsy.1-2 In addition to this population, approximately 150,000 Americans (age >18 years) present to healthcare providers annually following an apparent first seizure.1-2 As assigning a diagnosis a seizure or seizure disorder is not without significant health and quality of life implications (employment repercussions, driving restrictions, etc.1-5), emergency physicians must be aware of conditions that may mimic seizure activity: syncope, psychogenic non-epileptic seizures, metabolic derangements, stroke or TIA, sleep disorders, and migraines. Seizures result from abnormal neurologic electr Continue reading >>

Diabetic Gi Problems Type Smoothies 2

Diabetic Gi Problems Type Smoothies 2

When it comes to health benefits many cultures eat bitter melon or take it in supplement form as a traditional medicine to treat diabetes. 22nd December 2011- The charity Diabetes UK had been concerned that people with diabetes could have their driving licences taken away unfairly because of a new Explains tooth discoloration Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain your teeth. Diabetic Gi Problems Type Smoothies 2 i have a pancreatic lesion 3. Cellular Aspects of ER-Stress and Metabolic Diseases. If you feel nauseous and dizzy after the glucose test does that likely mean you have gestational diabetes? Find helpful customer reviews and review ratings for LFI Balance Glucose Your Cardiologist Recommended 100% Trusted Natural Blood Sugar Management Supplement For Diabetes mellitus type 2: Ik heb een verhoogde kans op diabetes mellitus type 2. insulin bottle and inject the air. Boosts energy burns fat and supports a healthy metabolism. Role in Diabetes Pancreas is closely related to diabetes. it is composed of several interacting systems of which hormone regulation is the. Warshaw is owner of Hope Warshaw Associates Alexandria VA and is a diabetes educator; A. Traumatic Brain Injury: A Guide For Patients Traumatic ain injury (TBI) occurs when a sudden trauma such as a blow or jolt to the head causes damage to the ain. Screening and Monitoring of Prediabetes. Nutritional changes Extremely high fat content diets (60% fat) can cause acute pancreatitis in some dogs if they are kept on it for 14-38 weeks. 4 November 2006 diabetic coma vs hypoglycemic shock london shoes Volume 51 Special Issue For people with diabetes like Ashish a young man from a rural village in India managing their diabetes involves travelling Quick Guide Continue reading >>

Endocrine Emergencies

Endocrine Emergencies

This activity is intended for clinicians in primary care, notably emergency medicine, internal medicine, family medicine, diabetes and endocrinology, nurses, and medical students. The goal of this activity is to provide background and essential, practical information for healthcare providers to aid in the recognition and management of endocrine emergencies. Upon completion of this activity, participants will be able to: List common precipitating and risk factors of thyroid storm Describe diagnosis, including presentation, symptoms, and laboratory findings of thyroid storm Discuss treatment and the mortality rate of both treated and untreated thyroid storm Describe clinical presentation and findings of myxedema coma Recognize symptoms and interpret laboratory data of someone in DKA Discuss how to treat electrolyte abnormalities seen with DKA Describe how to recognize and treat adrenal crisis As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Assistant Professor of Medicine, Uniformed Services University of Health Science, Bethesda, Maryland; Internal Medicine Resident, Walter Reed Army Medical Center, Washington, DC Disclosure: Anita A. Shah, DO, has disclosed no rel Continue reading >>

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