A 35-year-old male presented with skin lesions on his elbows and knees. Laboratory tests showed high total cholesterol, triglycerides, and blood sugar levels. An ECG also showed T-wave changes. Given the patient's family history of diabetes and early heart disease, further investigations of liver, kidney, thyroid, and cardiac function were recommended. The patient is at risk of complications like heart disease and pancreatitis due to secondary hyperlipidemia, which is most likely caused by an underlying condition like hypothyroidism, obesity, or medication use. Treatment would involve lifestyle changes, diabetes control, lipid-lowering medications, and consultation with cardiology.

1. Male patient aged 35 ys
C/o of skin lesions over the
extensor surface of both elbows
and knees

2. Bp 130/80, pulse 80 regular
 Neck
 Chest
 Heart
 Abd
NS

3. Lab Values
 Total cholesterol
508 mg%
 Trigliceride 2894
 Random Sugar 338
 ECG T wave changes in LIII, aVF,V3-V6

4. Ask patient 3 questions
 Family history DM,
 Dyslipedimia
 Early IHD in family
 Thyroid disease
 Drug intake
 Liver,kidney diseases

5. Inferiolateral ischemia

6. Investigations recomended
 Lipid profile
 Liver function
 Renal function
 Thyroid function
 Cardiology consultation Why?

7. Causes of secondary
hyperlipidemia
 Cholestatic liver diseases
 Nephrotic syndrome
 Chronic renal failure
 Hypothyroidism
 Cigarette smoking
 Obesity
 Drugs

8. Expected complications
 IHD, accelerated atherosclerosis
 Pancreatitis
 Gall bladder disease
 Related to medications
 Complications of Diabetes

9. Lipoprotein

10. Type of lipoproteins

11. Lipoproteins suclasses

12. Dyslipedimia

13. Lipid Fredrekhsen classification

14. Plan of your treatment
 Diet
 Diabetes control
 IHD, accelerated atherosclerosis
 Hypolipemic
medications,Statin,Fibrate,Resin
uptake,ezetimibe, nicotinic acid,lipid
apheresis
 others

15. Mechanism of action Statins
 Are specific competitive inhibitors of
microsomal enzyme HMG-CoA reductase,
which catalyses the conversion HMG-Co
A
To mevalonate, a rate- determining step in
cholesterol synthesis

16. Mechanism of action of Fibrates

17. ADR of Statins
 Statins , Rhabdomyalgia ,
Rhabdomyolysis
 Renal impairement
 Raise transaminases
 GIT

18. APHERESIS