Snake envenomation can cause both acute and chronic complications. Acute complications include tissue necrosis, compartment syndrome, acute kidney injury, hypotension, neuroparalysis, and hemorrhagic abnormalities. Chronic complications involve persistent renal dysfunction, chronic panhypopituitarism, chronic neurological deficits, and malignant transformation of ulcers resulting in disability. Prompt administration of antivenom within the crucial window can help prevent many of these long-term complications.
This slide discusses the presentation and management of six Oncological Emergencies: Hypercalcemia, Tumor lysis syndrome, Spinal cord compression, Superior vena cava obstruction, SIADH, Disseminated intravascular coagulation.
This slide discusses the presentation and management of six Oncological Emergencies: Hypercalcemia, Tumor lysis syndrome, Spinal cord compression, Superior vena cava obstruction, SIADH, Disseminated intravascular coagulation.
Epidemiology of Acute Kidney Injury (AKI)
By Dr. Usama Ragab
Lecturer of Internal Medicine
I have discussed the epidemiology, etiology of acute kidney injury
Topics Covered:
Basic kidney physiology (just enumeration).
Manifestations of renal impairment.
AKI vs. CRF , definitions, causes and their classifications (in brief) .
Clinical evaluation of a case of renal failure.
indications for renal replacement therapy.
Approach for real-Life patient with renal impairment: group-case discussion.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Epidemiology of Acute Kidney Injury (AKI)
By Dr. Usama Ragab
Lecturer of Internal Medicine
I have discussed the epidemiology, etiology of acute kidney injury
Topics Covered:
Basic kidney physiology (just enumeration).
Manifestations of renal impairment.
AKI vs. CRF , definitions, causes and their classifications (in brief) .
Clinical evaluation of a case of renal failure.
indications for renal replacement therapy.
Approach for real-Life patient with renal impairment: group-case discussion.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. INTRODUCTION
Of the 1·8 million people envenomed by snakes every year, up to 125 000
die, while hundreds of thousands survive only to suffer with life‐changing
long‐term morbidity.
Consequently, snakebite is one of the world's most severe neglected tropical
diseases.
Every hour wasted between bite and antivenom administration is strongly
associated with sharp increases in mortality and the development of chronic or
permanent sequelae including amputation, disfigurement, PTSD, blindness, kidney
injury, infections, and partial or complete loss of function of the bitten limb
3.
4. ACUTE/ LIFE THREATENING COMPLICATIONS
Tissue necrosis and Compartment syndrome
Acute Kidney Injury
Hypotension due to hypovolaemia or direct vasodilatation or direct
cardiotoxicity
Neuroparalysis
Hemostatic abnormalities (VICC, DIC)
Pituitary Insufficiency, neurological deficit (ADEMS, GBS)Rarely
6. TISSUE NECROSIS AND COMPARTMENT
SYNDROME
Local tissue necrosis results from the direct action of
myotoxins and cytotoxins,
Ischaemia caused by thrombosis,
compression of blood vessels by first-aid methods such as tight
tourniquets or
Swelling of envenomed muscle within such tight fascial
compartments could result in an increase in tissue pressure
above the venous pressure, resulting in compartment
syndrome
7.
8.
9. Compartment syndrome (6 P'S)
Pain on passive stretching
Pain out of proportion
Pulselessness
Pallor
Parasthesia
Paralysis
6 Ps with significant swelling in the limb with obvious tenseness on
palpation can lead to the conclusion that the intracompartmental pressure
is above 40 mm of mercury and thus requires a fasciotomy.
10. Local and extensive necrosis resulting from venom action may
necessitate debridement of necrotic tissue.
Criteria for fasciotomy in snake-bitten limbs
(WHO)
• Haemostatic abnormalities have been corrected (antivenom with
or without clotting factors)
• Clinical evidence of an intracompartmental syndrome
• Intracompartmental pressure >30mmHg (varies with age and
clinical status of the child)
•Early treatment with antivenom remains the best way of
preventing irreversible muscle damage.
13. There is no conclusive trial evidence to support a preference for
colloids or crystalloid
Treatment is by means of plasma expanders and raising the foot of
the bed.
In addition fresh frozen plasma or factors present a possibility in
order to boost volume and restore factors.
In many areas, particularly in developing countries, the only
available alternative will be fresh blood.
In cases where generalised capillary permeability has been
established a vasoconstrictor such as dopamine can be used.
Dosing is 2.5- 5μg/kg/minute.
14. RENAL FAILURE
A common complication of species such as Russell's Viper.
Patient's presents with loin pain, haematuria, oliguria/anuria, symptoms and signs
of acute kidney injury/ uraemia (acidotic breathing, hiccups, nausea, pleuritic chest pain.
The contributory factors are intravascular haemolysis, DIC, direct nephrotoxicity,
hypotension and rhabdomyolysis
Renal damage can develop very early in cases of Russell’s viper bite and even when
the patient arrives at hospital soon after the bite, the damage may already have
been done.
15. In patients with AKI, serum/plasma urea, creatinine and
electrolytes should be monitored daily until renal failure is
resolving.
If the patient is passing dark brown urine, it is suggestive of
rhabdomyolysis or intravascular haemolysis.
To minimise the risk of renal damage from excreted myoglobin
and/or haemoglobin:
< correct hypovolaemia and maintain urine output of 200-300ml/hr
< correct s evere acidosis with bicarbonate
< Promote alkalinise diuresis (urine pH > 6.5)
o < continue these measures until there is evidence that
rhabdomyolysis is decreasing (CK level <5000 U).
16.
17. INDICATIONS FOR DIALYSIS
a. Absolute value of Blood urea >130 mg/dl (BUN 100 mg/dl), Sr. Creatinine
> 4 mg/dl OR evidence of hypercatabolism in the form of daily rise in blood
urea 30 mg/dL (BUN > 15), Sr. Creatinine > 1 mg/dL, Sr. Potassium > 1
mEq/L and fall in bicarbonate >2 mmol/L
b. Fluid overload leading to pulmonary oedema
c. Hyperkalaemia (>7 mmol/l (or hyperkalaemic ECG changes)
d. unresponsive to conservative management.
e. Uremic complications – encephalopathy, pericarditis. nausea, vomiting,
hiccups, fetor, drowsiness, confusion, coma, flapping tremor, muscle
twitching, convulsions, pericardial friction rub, signs of fluid overload
18. NEUROPARALYSIS
Neuroparalytic snakebite patients presents with progressive weakness
• In chronological order of appearance of symptoms –
Furrowing of forehead, Ptosis (drooping of eyelids) occurs first
Diplopia (double vision),
Dysarthria (speech difficulty),
Dysphonia (pitch of voice becomes less) followed by Dyspnoea
Dysphagia (Inability to swallow) occurs.
All these symptoms are related to 3rd, 4th, 6th and lower cranial nerve paralysis.
Finally, paralysis of intercostal and skeletal muscles occurs in descending manner.
• Other signs of impending respiratory failure are diminished or absent deep tendon
reflexes and head lag; stridor, ataxia may also be seen.
19. Toxin- alpha neurotoxin; Binds
specifically to acetylcholine receptors,
preventing the interaction between
acetylcholine and receptors on
postsynaptic membrane.
It prevents the opening of the sodium
channel associated with the acetylcholine
receptor and results in neuromuscular
blockade
On ASV administration, there is rapid
reversal of paralysis- causing dissociation
of the toxin-receptor complex, which
leads to reversal of paralysis
Anticholinesterases reverse the
COBRA - POSTSYNAPTIC
ACTION
20. Toxin- Beta bungarotoxin- Phospholipases A2
Inhibiting the release of acetylcholine from the
presynaptic membrane
Presynaptic nerve terminals exhibits signs of
irreversible physical damage and are devoid of
synaptic vesicles
Hence antivenoms and anticholinesterases are
of no effect
paralysis lasts for several weeks and frequently
requires prolonged mechanical ventilation
Recovery is dependent upon regeneration of
axon terminals
KRAIT- PRESYNAPTIC
ACTION
21.
22.
23. The muscles flexing the neck may be paralysed, giving the “broken neck
sign”
secretions accumulating in the pharynx, an early sign of bulbar paralysis.
Ask the patient to take deep breaths in and out."Paradoxical respiration”(
abdomen expands rather than the chest on attempted inspiration)
indicates that the diaphragm is still contracting but that the intercostal
muscles and accessory muscles of inspiration are paralysed
Do not assume that snake-bitten patients are unconscious or even irreversibly
“brain dead” just because their eyes are closed, they are unresponsive to painful
stimuli, are areflexic, or have fixed dilated pupils.
They may merely be paralysed! They may be severely paralysed and lack motor
responses or spontaneous eye movements mimicking coma (locked-in syndrome).
Check pulse, heart sounds and, if possible, ECG.
24.
25. Death may result from aspiration, airway obstruction or respiratory failure.
A clear airway must be maintained.
INDICATIONS FOR INTUBATION [INSERTION OF
ENDOTRACHEAL TUBE (ETT) OR OTHER AIRWAY]:
a. Imminent respiratory arrest (breathing is absent or inadequate)
b. Neck muscle weakness with shallow respiration or paradoxical
breathing
c. Upper airway obstruction with stridor (secondary to anaphylaxis)
d. Oxygen saturation <90% (equivalent to Pa02 <60 mmHg) despite high
flow oxygen
e. Blood gas measurement showing respiratory acidosis (hypoxia PaO2 <
60 mm Hg with PaCO2 > 45 mm Hg)
26. HAEMOSTATIC ABNORMALITIES
coagulopathy is one of the most common complications of snakebites
Haemorrhage caused by snake venom is often complicated and exacerbated by
patients presenting with blood clotting disturbances as the result of
venom‐induced consumption coagulopathy (VICC).
VICC, a disseminated intravascular coagulation (DIC)‐like syndrome, is characterised
by low or undetectable levels of fibrinogen, resulting in incoagulable blood
It manifested as prolonged INR, hypofibrinogenemia, thrombocytopenia, and
increased fibrin degradation products in laboratory studies
In majority of cases timely use of anti venom will stop bleeding.
27. DIC results from activation of clotting pathway and has a very high mortality.
By contrast, VICC involves a different pathogenic process (specific enzyme
activation) and has a benign course than DIC.
Procoagulant toxins cause rapid clot formation in vitro, but, in vivo, they cause
consumption of severe clotting factors therefore increase the risk of bleeding.
The toxins in venom that cause VICC are classified by where they effect in the
clotting pathway, with the important ones being thrombin-like enzymes (also known
as fibrinogenase), prothrombin activators, factor V and X activators.
28.
29. strict bed rest to avoid even minor trauma including intramuscular
injections;
transfusion of clotting factors and platelets; ideally, fresh frozen plasma
(FFP) or cryoprecipitate with platelet concentrates or, if these are not
available, fresh whole blood.
The indications for these blood components are the same as those for
antivenom administration for bleeding tendency, but it is important to
recognize that, in the presence of un-neutralized circulating venom
procoagulant toxins, administered clotting factors will be rapidly
consumed, with the potential danger of formation of microthrombi.
30. Heparin is ineffective against venom-induced thrombin and may cause
bleeding on its own account. It should never be used in cases of
snake-bite.
Antifibrinolytic agents are not effective and should not be used in
victims of snakebite
In patients with incoagulable blood, any injection (subcutaneous,
intramuscular) and, particularly venepuncture, carries a risk of persistent
bleeding and haematoma formation.
Arterial puncture is contraindicated in such patients.
31. ACUTE PITUITARY FAILURE (SHEEHAN SYNDROME) A Rare case;
A Previously healthy 21-year-old man was envenomed by a Russell's viper and treated
with antivenom.
Ten hours after the bite, he developed persistent hypotension, which responded promptly
to intravenous dexamethasone.
His hormone profiles were consistent with hypocortisolism secondary to acute pituitary
insufficiency. He also developed hypokalaemia.
Analysis of urine and serum electrolytes suggested redistribution of potassium in to the
cells rather than renal loss.
Hypotension and hypoglycaemic coma are life-threatening manifestations of acute
pituitary insufficiency.
34. ACUTE DEMYELINATING ENCEPHALOMYELITIS
ADEM (rare complication) followed by Anti-venom therapy in Russel viper
bite, complicated by the development of immune complex mediated
demyelination.
Presents as acute onset poly symptomatic neurological dysfunction
following triggering events such as infection or vaccination.
Presents with
Encephalopathy( malaise, Irritability, coma)
Fever, nausea, vomiting
Meningeal signs
Weakness ( diffuse or focal), Cranial nerve palsy
Ataxia, Seizures
35. Imaging shows multifocal white and grey matter lesions in brain and spinal
cord.
Clinical examination, MRI and CSF Analysis are most useful in establishing
diagnosis.
Corticosteroids are the mainstay of treatment.
36.
37. GUILLAIN-BARRE SYNDROME FOLLOWING SNAKEBITE
Guillain-Barre syndrome is an acute autoimmune-mediated polyneuropathy that
commonly presents with bilateral symmetrical ascending flaccid paralysis.
Patient presents with Pain, progressive quadriparesis(LMN type), Parasthesia, areflexia,
autonomic dysfunction, hypotension, sphincter disturbance etc.
EMG/NCS shows motor and sensory neuropathy-primarily suggestive of demyelination
with secondary axonal degeneration.
cerebrospinal fluid (CSF) analysis shows cytoalbuminologic dissociation.
cross-reactivity between venom proteins and neuronal GM2 gangliosides (molecular
mimicry), postulating a potential immunological basis for this association rather than
direct venom toxicity.
42. Patients with persistent tubular degenerative changes can shows
continuing albuminuria, hypertension and nocturia for many
months after the bite, despite apparent recovery in renal function.
Patients referred to renal units with acute kidney injury following
Russell’s viper bite suffered oliguria for more than 4 weeks
suggesting the possibility of bilateral renal cortical necrosis and
the need for referral to a nephrologist.
Patients with patchy cortical necrosis show delayed and partial
recovery of renal function but those with diffuse cortical necrosis
require regular maintenance dialysis and eventual renal
transplantation.
43. CHRONIC PANHYPOPITUITARISM
Chronic phase (months to years after the bite):
weakness, loss of secondary sexual hair, loss
of libido, amenorrhoea, testicular atrophy,
hypothyroidism etc