Endocrine and electrolyte board review
•Download as PPT, PDF•
3 likes•1,632 views
A 62-year-old man with hypothyroidism symptoms takes amiodarone
Report
Share
Report
Share
![Question: 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Endocrine emergency cases
A 24-year-old female presented with fever, abdominal pain, nausea, vomiting, dysuria, palpitations, anxiety, eye swelling and pain, and atrial fibrillation. She had a history of Graves' disease and was non-compliant with medication for 2 months. Examination found tachycardia, enlarged thyroid with bruit, and exophthalmos. This presentation, along with recent stress and UTI, was consistent with thyroid storm. Treatment for thyroid storm focuses on cooling, hydration, antithyroid drugs to prevent synthesis and release of thyroid hormone, and beta-blockers to treat peripheral effects.
Electrolyte emergencies cases (C. Meyers)
An 18-year-old woman presented to the ED after having seizures at a rave. She had used ecstasy and witnessed three seizures. Her vitals were stable on examination.
The electrolyte abnormality suspected to have caused her seizures is hypomagnesemia, due to ecstasy use. Immediate management would be IV magnesium replacement. The danger of correcting hypomagnesemia too quickly is cardiac arrest. The appropriate rate of correction is slow intravenous replacement over several hours.
Presentation 9
This document presents a case report of organophosphate poisoning in a 2-year-old child who ingested malathion. It outlines the patient's presentation, management, progress, investigations and discharge. It also provides background information on organophosphate poisoning including pathophysiology, effects on different organ systems, grading of severity, management principles and potential complications.
Thyroid crisis
This document summarizes key endocrine emergencies including thyroid storm, adrenal crisis, and hypoglycemia. Thyroid storm is a life-threatening complication of hyperthyroidism caused by Graves' disease or toxic multinodular goiter in 1-2% of cases, with a mortality rate of 20% without treatment. Adrenal crisis can occur due to primary or secondary adrenal insufficiency and presents with low blood pressure. Hypoglycemia is most commonly caused by insulin therapy in diabetic patients but can occur in non-diabetics, defined as a blood glucose below 50-60 mg/dL.
Endocrine Emergencies
This document discusses various endocrine emergencies, including:
- Glucose metabolism disorders like hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic syndrome.
- Adrenal disorders such as Addison's disease, adrenal crisis, and congenital adrenal insufficiency.
- It provides details on the causes, pathophysiology, symptoms, diagnosis, and treatment of these various conditions. The focus is on clinically relevant information to recognize and manage endocrine emergencies.
Hypokalemia paralyzing revealing a rare association of autoimmune diseases: t...
Hypokalemia is a Paralyzing uncommon pathology, primitive often genetic autosomal dominant. Type 1 diabetes is an autoimmune disease of the pancreas responsible for a total deficit of insulinsecretion and hyperglycaemia. Someclinical manifestations extraglandular, canbe a discovery mode of the disease. We report the case of a patient with hypokalemiamoroccan Paralyzingrevealingthis pathology Whose combination with a renaltubulopathy by distal tubular acidosis (DTA) type 1 and autoimmune diseases of specific organ is rare. The DTA type 1 is related to the Inability of the distal tubule to secrete sufficient amount of hydrogen ions, making it possible to acidification of the urine below pH 5.5. This DTA is responsible for a severe rarely hypokalemia, neuromuscular complications, or revealing of a type 1 diabetes as is the case of our patient. A case of hypokalemiaparalyzingpuring a Sjögren syndrome (GSS) is associated with a thyroiditis was reported. Hypokalemia paralyzing revealing combination of autoimmune diseases annually (type 1 diabetes, thyroiditis and tubulopathy) isuncommon and difficulties to diagnose. Thus, faced with an unexplained hypokalemia neuromuscular paralysis in young patients, we must think although rare to a tubulopathy in the context of autoimmune diseases.
Endocrine emergencies
The document discusses various endocrine emergencies including diabetic ketoacidosis (DKA), hypoglycemia, and thyroid storm. It provides details on the causes, symptoms, diagnostic criteria and treatment approaches for each condition. DKA results from lack of insulin and needs urgent treatment including rehydration, insulin administration, and electrolyte correction. Hypoglycemia can be caused by too much insulin or too little food intake and requires glucose administration. Thyroid storm is a life-threatening exacerbation of hyperthyroidism that requires treatments to correct the hyperthyroidism and address any precipitating factors.
ACTEP2014: What's new in endocrine emergency
This document summarizes guidelines for treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) from the American Diabetes Association (ADA) and Joint British Diabetes Societies Inpatient (JBDS IP). Key points include:
1) Bedside beta-hydroxybutyrate testing is now the best way to monitor treatment response in DKA.
2) For DKA, guidelines recommend fixed rate insulin infusion of 0.1 unit/kg/hr without a priming dose and adjustments to meet metabolic targets.
3) For HHS, the goal of initial therapy is to expand intravascular volume and restore perfusion by replacing approximately 50
Recommended
Endocrine emergency cases
A 24-year-old female presented with fever, abdominal pain, nausea, vomiting, dysuria, palpitations, anxiety, eye swelling and pain, and atrial fibrillation. She had a history of Graves' disease and was non-compliant with medication for 2 months. Examination found tachycardia, enlarged thyroid with bruit, and exophthalmos. This presentation, along with recent stress and UTI, was consistent with thyroid storm. Treatment for thyroid storm focuses on cooling, hydration, antithyroid drugs to prevent synthesis and release of thyroid hormone, and beta-blockers to treat peripheral effects.
Electrolyte emergencies cases (C. Meyers)
An 18-year-old woman presented to the ED after having seizures at a rave. She had used ecstasy and witnessed three seizures. Her vitals were stable on examination.
The electrolyte abnormality suspected to have caused her seizures is hypomagnesemia, due to ecstasy use. Immediate management would be IV magnesium replacement. The danger of correcting hypomagnesemia too quickly is cardiac arrest. The appropriate rate of correction is slow intravenous replacement over several hours.
Presentation 9
This document presents a case report of organophosphate poisoning in a 2-year-old child who ingested malathion. It outlines the patient's presentation, management, progress, investigations and discharge. It also provides background information on organophosphate poisoning including pathophysiology, effects on different organ systems, grading of severity, management principles and potential complications.
Thyroid crisis
This document summarizes key endocrine emergencies including thyroid storm, adrenal crisis, and hypoglycemia. Thyroid storm is a life-threatening complication of hyperthyroidism caused by Graves' disease or toxic multinodular goiter in 1-2% of cases, with a mortality rate of 20% without treatment. Adrenal crisis can occur due to primary or secondary adrenal insufficiency and presents with low blood pressure. Hypoglycemia is most commonly caused by insulin therapy in diabetic patients but can occur in non-diabetics, defined as a blood glucose below 50-60 mg/dL.
Endocrine Emergencies
This document discusses various endocrine emergencies, including:
- Glucose metabolism disorders like hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic syndrome.
- Adrenal disorders such as Addison's disease, adrenal crisis, and congenital adrenal insufficiency.
- It provides details on the causes, pathophysiology, symptoms, diagnosis, and treatment of these various conditions. The focus is on clinically relevant information to recognize and manage endocrine emergencies.
Hypokalemia paralyzing revealing a rare association of autoimmune diseases: t...
Hypokalemia is a Paralyzing uncommon pathology, primitive often genetic autosomal dominant. Type 1 diabetes is an autoimmune disease of the pancreas responsible for a total deficit of insulinsecretion and hyperglycaemia. Someclinical manifestations extraglandular, canbe a discovery mode of the disease. We report the case of a patient with hypokalemiamoroccan Paralyzingrevealingthis pathology Whose combination with a renaltubulopathy by distal tubular acidosis (DTA) type 1 and autoimmune diseases of specific organ is rare. The DTA type 1 is related to the Inability of the distal tubule to secrete sufficient amount of hydrogen ions, making it possible to acidification of the urine below pH 5.5. This DTA is responsible for a severe rarely hypokalemia, neuromuscular complications, or revealing of a type 1 diabetes as is the case of our patient. A case of hypokalemiaparalyzingpuring a Sjögren syndrome (GSS) is associated with a thyroiditis was reported. Hypokalemia paralyzing revealing combination of autoimmune diseases annually (type 1 diabetes, thyroiditis and tubulopathy) isuncommon and difficulties to diagnose. Thus, faced with an unexplained hypokalemia neuromuscular paralysis in young patients, we must think although rare to a tubulopathy in the context of autoimmune diseases.
Endocrine emergencies
The document discusses various endocrine emergencies including diabetic ketoacidosis (DKA), hypoglycemia, and thyroid storm. It provides details on the causes, symptoms, diagnostic criteria and treatment approaches for each condition. DKA results from lack of insulin and needs urgent treatment including rehydration, insulin administration, and electrolyte correction. Hypoglycemia can be caused by too much insulin or too little food intake and requires glucose administration. Thyroid storm is a life-threatening exacerbation of hyperthyroidism that requires treatments to correct the hyperthyroidism and address any precipitating factors.
ACTEP2014: What's new in endocrine emergency
This document summarizes guidelines for treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) from the American Diabetes Association (ADA) and Joint British Diabetes Societies Inpatient (JBDS IP). Key points include:
1) Bedside beta-hydroxybutyrate testing is now the best way to monitor treatment response in DKA.
2) For DKA, guidelines recommend fixed rate insulin infusion of 0.1 unit/kg/hr without a priming dose and adjustments to meet metabolic targets.
3) For HHS, the goal of initial therapy is to expand intravascular volume and restore perfusion by replacing approximately 50
Myxedema coma
This document discusses myxedema coma, a life-threatening complication of severe hypothyroidism. It can be precipitated by a stressful event in someone who is already hypothyroid. Primary symptoms include altered mental status, low body temperature, low blood pressure, slow heart rate, and hypoventilation. Treatment involves supportive care in the intensive care unit, treating hypothermia, hyponatremia, and providing thyroid hormone replacement through intravenous levothyroxine and possibly liothyronine, as well as hydrocortisone therapy.
Hypoadrenalism feb 2015
This document presents a case study of a 40-year-old man diagnosed with hypoadrenalism. He presented with nausea, vomiting, and weakness over several weeks. Initial lab results showed very low sodium and other electrolyte abnormalities. A short Synacthen test confirmed primary hypoadrenalism. He was started on hydrocortisone and fludrocortisone replacement. The document then reviews adrenal physiology, causes of hypoadrenalism including primary and secondary forms, clinical features such as adrenal crisis, and approaches to diagnosis and treatment including glucocorticoid and mineralocorticoid replacement therapy.
Acute complications of Diabetes
This document discusses acute complications of diabetes. It begins with objectives and an introduction on diabetes and its complications. Then it describes several acute complications in detail, including diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), hypoglycemia, lactic acidosis, and diabetic coma. For each complication, it covers definition, causes, pathophysiology, signs and symptoms, diagnosis, treatment, and prognosis. The management of DKA and prevention strategies are also discussed in the Ethiopian healthcare context.
Endocrine
This document summarizes key topics in endocrinology, including the major endocrine glands and some common disorders. It discusses the hypothalamus, pituitary gland, thyroid gland, parathyroid glands, thymus, pancreas, adrenal glands, and gonads. For each gland, it outlines the major hormones produced and how they regulate other glands and body processes. It also summarizes common endocrine disorders like Graves' disease, hypothyroidism, Cushing's syndrome, Addison's disease, diabetes mellitus, and diabetic ketoacidosis.
Endocrine emergencies MCQ's/SBA
This document provides a multiple choice question (MCQ) exam on various endocrine emergencies. It covers topics like the management of diabetic ketoacidosis, hyperglycemic hyperosmolar state, thyrotoxicosis, phaeochromocytomas, adrenal insufficiency, and Sheehan's syndrome. The MCQ questions test examinees on the appropriate initial treatment, diagnostic criteria, and guidelines for managing these various acute endocrine conditions.
Endocrineرائع emergencies
This document provides an overview of endocrine emergencies, including diabetic emergencies like diabetic ketoacidosis and hypoglycemia. It also covers other metabolic disorders such as thyrotoxicosis, Addisonian crisis, and electrolyte abnormalities. For each condition, it describes the symptoms, pathophysiology, diagnosis, and treatment approach. The goal is to help recognize and initiate management of these urgent endocrine conditions.
Hypoglycemia
Final year medical student presenting for seminar presentation under supervision of emergency department specialist.
Hypoadrenalism
This document discusses primary hypoadrenalism (Addison's disease), including its symptoms, causes, diagnosis, and treatment. Regarding diagnosis, it emphasizes that the short-synacthen test is the best way to diagnose Addison's disease. For treatment, it recommends hydrocortisone and fludrocortisone as the standard medications, and notes the importance of monitoring patients to ensure the treatment regimen remains adequate. It also discusses how to manage unwell patients with Addison's disease through increasing their glucocorticoid dose and providing intravenous hydrocortisone if needed.
Clozapine-induced myocarditis and pericarditis [Case Report]
This document summarizes a case study of a 50-year-old man who developed myocarditis and pericarditis after starting treatment with clozapine. 17 days after beginning clozapine, the man experienced tachycardia, low blood pressure, and fever. Tests found elevated cardiac enzymes and ECG changes indicative of myocarditis and pericarditis. His symptoms improved after stopping clozapine treatment. The study concludes that older age and concomitant sodium valproate treatment may increase the risk of clozapine-induced cardiac side effects. Medical professionals should investigate potential cardiac complications in patients who recently started clozapine and experience new symptoms like tachycardia, low blood pressure, and fever.
An Interesting Case of Seizure
A 17-year-old female presented with seizures for the past 6 months. On examination, she was found to have hypocalcemia with a serum calcium level of 5.7 mg/dl. Further workup revealed low levels of parathyroid hormone, indicating hypoparathyroidism as the cause of her hypocalcemia and seizures. Brain CT and EEG were normal. She was started on calcium and vitamin D supplementation, which improved her symptoms and lab abnormalities.
Epilepsy case presentation by mehreen taj IVth parm D
Epilepsy:Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.The main causes of Epilepsy and resultant seizures include Meningitis, head injury or trauma, stroke, brain tumour, high fever (Febrile Seizure), and parasite infection Neuro-cysticercosis. The main triggering factors include light, noise, sleep loss, alcohol intake and cigarette smoking.
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizure.
Hepato encephalopathy
Hepatic encephalopathy is a complex, reversible neuropsychiatric disorder seen in patients with severe liver dysfunction. It ranges from mild cognitive impairment (minimal HE) to coma (overt HE). Precipitating factors like infections, GI bleeding, and high protein intake can trigger episodes. Treatment focuses on removing triggers, lowering ammonia with lactulose/rifaximin, and considering liver transplant for persistent cases. Diet, lactulose, antibiotics, and surgery to reduce portosystemic shunting are used to manage and prevent recurrent episodes of hepatic encephalopathy.
Adrenal crisis
This document discusses adrenal crisis and congenital adrenal hyperplasia. It presents four case studies:
1) A 10-day-old neonate with ambiguous genitalia and symptoms of adrenal insufficiency was diagnosed with congenital adrenal hyperplasia.
2) A 2-year-old boy with a history of URI presented with lethargy and hypotension and was found to have metabolic acidosis, suggesting adrenal crisis.
3) A 1-year-old child brought in with fever, cough and cold for 3 days progressed to septic shock despite treatment, and was given stress doses of hydrocortisone for underlying adrenal insufficiency.
Neonatal metabolic encephalopathy
This document discusses neonatal metabolic encephalopathy and its causes. It describes neonatal encephalopathy as a clinically defined syndrome of disturbed neurologic function in the earliest days of life, manifested by subnormal consciousness, seizures, and difficulties with breathing and muscle tone. The main causes are listed as hypoxic-ischemic encephalopathy, perinatal stroke, progressive encephalopathy of metabolic, infectious or toxic origin, brain anomalies, hemorrhage, genetic mutations or maternal toxins. Metabolic disorders presenting with encephalopathy are divided into those with significant biochemical abnormalities like hyperammonemia, metabolic acidosis or hypoglycemia, and those without clear abnormalities. Specific metabolic disorders are discussed in detail, along with their
Diabetes Mellitus
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Reye’s syndrome
Reye syndrome is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure. It primarily affects the brain and liver, and can affect all organs. It has a biphasic course beginning with a viral illness that resolves, followed by abrupt onset of vomiting and neurologic impairment. The cause is unknown but aspirin use during a viral illness increases risk significantly. Diagnosis requires evidence of encephalopathy, hepatopathy, and no other reasonable explanations. Prognosis depends on stage - later stages involve deep coma and have high mortality.
Alcohol Intoxication
Alcohol intoxication can present with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic manifestations. Diagnosis involves taking a history, physical exam looking for signs like capillary prominence and spider naevi, and measuring blood alcohol concentration and serum osmolality. Differential diagnosis includes other causes of altered mental status. Management focuses on stabilizing the patient's condition in the emergency department. It can be important to distinguish acute intoxication from chronic alcohol abuse or dependence, which may require different treatment approaches.
Case on nephrotic syndrome
The document summarizes the case of an 82-year-old male patient diagnosed with nephrotic syndrome. It includes details of the patient's medical history, symptoms, lab investigations, biopsy results, medications, and discharge instructions. The patient was started on diuretics, antibiotics, lipid-lowering drugs, thyroid medication, and corticosteroids to treat the condition. The document also provides suggestions to monitor for potential drug interactions and complications related to the patient's treatment and disease.
Diabetic Ketoacidosis
This document provides an overview of diabetic ketoacidosis (DKA) including its pathophysiology, diagnosis, treatment, and complications. It then presents a case study of an 18-year-old female patient presenting with DKA symptoms including abdominal pain and vomiting. The patient's lab results indicate metabolic acidosis and ketosis. The document outlines her recommended treatment including IV fluids, insulin, antibiotics, and electrolyte replacement. It also discusses monitoring her response to therapy and educating her and her family about diabetes management and prevention of future DKA episodes.
Pneumonia in immnocomprimised host
The document discusses various types of pneumonia seen in different at-risk populations. It covers bacterial, fungal, mycobacterial and viral causes of pneumonia and highlights the microbes most commonly seen in immunocompromised groups like HIV/AIDS patients, transplant recipients, diabetics, alcoholics, elderly in nursing homes, and others. Risk factors specific to each population are outlined.
Airway and ventilatory management in trauma
This document discusses airway and ventilatory management in trauma patients. It emphasizes that the airway is the top priority in trauma resuscitation. Failure to recognize airway compromise or establish a definitive airway can lead to death. Signs of airway or ventilation problems are described. Methods for airway maintenance include positioning, oral/nasal airways, and extraglottic devices if intubation is not possible. Rapid sequence intubation is the preferred method when a definitive airway is needed. Surgical airways like needle cricothyroidotomy or surgical cricothyroidotomy are alternatives if intubation fails. Adequate oxygenation and ventilation are also discussed.
A Case of Myxedema Crisis
This document summarizes the case of a patient presenting with symptoms of myxedema crisis including loss of consciousness for 5 days. On examination, the patient was found to have hypothyroid features including an unrousable mental state, dry skin, bradycardia, and hypothermia. Laboratory tests confirmed very high TSH levels and low FT3 and FT4, consistent with severe untreated hypothyroidism. The patient was treated with intravenous thyroxine, hydrocortisone, saline and antibiotics. Myxedema crisis carries high mortality if not treated but can be managed with thyroid hormone replacement and treating any underlying infections or precipitating causes.
More Related Content
What's hot
Myxedema coma
This document discusses myxedema coma, a life-threatening complication of severe hypothyroidism. It can be precipitated by a stressful event in someone who is already hypothyroid. Primary symptoms include altered mental status, low body temperature, low blood pressure, slow heart rate, and hypoventilation. Treatment involves supportive care in the intensive care unit, treating hypothermia, hyponatremia, and providing thyroid hormone replacement through intravenous levothyroxine and possibly liothyronine, as well as hydrocortisone therapy.
Hypoadrenalism feb 2015
This document presents a case study of a 40-year-old man diagnosed with hypoadrenalism. He presented with nausea, vomiting, and weakness over several weeks. Initial lab results showed very low sodium and other electrolyte abnormalities. A short Synacthen test confirmed primary hypoadrenalism. He was started on hydrocortisone and fludrocortisone replacement. The document then reviews adrenal physiology, causes of hypoadrenalism including primary and secondary forms, clinical features such as adrenal crisis, and approaches to diagnosis and treatment including glucocorticoid and mineralocorticoid replacement therapy.
Acute complications of Diabetes
This document discusses acute complications of diabetes. It begins with objectives and an introduction on diabetes and its complications. Then it describes several acute complications in detail, including diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), hypoglycemia, lactic acidosis, and diabetic coma. For each complication, it covers definition, causes, pathophysiology, signs and symptoms, diagnosis, treatment, and prognosis. The management of DKA and prevention strategies are also discussed in the Ethiopian healthcare context.
Endocrine
This document summarizes key topics in endocrinology, including the major endocrine glands and some common disorders. It discusses the hypothalamus, pituitary gland, thyroid gland, parathyroid glands, thymus, pancreas, adrenal glands, and gonads. For each gland, it outlines the major hormones produced and how they regulate other glands and body processes. It also summarizes common endocrine disorders like Graves' disease, hypothyroidism, Cushing's syndrome, Addison's disease, diabetes mellitus, and diabetic ketoacidosis.
Endocrine emergencies MCQ's/SBA
This document provides a multiple choice question (MCQ) exam on various endocrine emergencies. It covers topics like the management of diabetic ketoacidosis, hyperglycemic hyperosmolar state, thyrotoxicosis, phaeochromocytomas, adrenal insufficiency, and Sheehan's syndrome. The MCQ questions test examinees on the appropriate initial treatment, diagnostic criteria, and guidelines for managing these various acute endocrine conditions.
Endocrineرائع emergencies
This document provides an overview of endocrine emergencies, including diabetic emergencies like diabetic ketoacidosis and hypoglycemia. It also covers other metabolic disorders such as thyrotoxicosis, Addisonian crisis, and electrolyte abnormalities. For each condition, it describes the symptoms, pathophysiology, diagnosis, and treatment approach. The goal is to help recognize and initiate management of these urgent endocrine conditions.
Hypoglycemia
Final year medical student presenting for seminar presentation under supervision of emergency department specialist.
Hypoadrenalism
This document discusses primary hypoadrenalism (Addison's disease), including its symptoms, causes, diagnosis, and treatment. Regarding diagnosis, it emphasizes that the short-synacthen test is the best way to diagnose Addison's disease. For treatment, it recommends hydrocortisone and fludrocortisone as the standard medications, and notes the importance of monitoring patients to ensure the treatment regimen remains adequate. It also discusses how to manage unwell patients with Addison's disease through increasing their glucocorticoid dose and providing intravenous hydrocortisone if needed.
Clozapine-induced myocarditis and pericarditis [Case Report]
This document summarizes a case study of a 50-year-old man who developed myocarditis and pericarditis after starting treatment with clozapine. 17 days after beginning clozapine, the man experienced tachycardia, low blood pressure, and fever. Tests found elevated cardiac enzymes and ECG changes indicative of myocarditis and pericarditis. His symptoms improved after stopping clozapine treatment. The study concludes that older age and concomitant sodium valproate treatment may increase the risk of clozapine-induced cardiac side effects. Medical professionals should investigate potential cardiac complications in patients who recently started clozapine and experience new symptoms like tachycardia, low blood pressure, and fever.
An Interesting Case of Seizure
A 17-year-old female presented with seizures for the past 6 months. On examination, she was found to have hypocalcemia with a serum calcium level of 5.7 mg/dl. Further workup revealed low levels of parathyroid hormone, indicating hypoparathyroidism as the cause of her hypocalcemia and seizures. Brain CT and EEG were normal. She was started on calcium and vitamin D supplementation, which improved her symptoms and lab abnormalities.
Epilepsy case presentation by mehreen taj IVth parm D
Epilepsy:Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.The main causes of Epilepsy and resultant seizures include Meningitis, head injury or trauma, stroke, brain tumour, high fever (Febrile Seizure), and parasite infection Neuro-cysticercosis. The main triggering factors include light, noise, sleep loss, alcohol intake and cigarette smoking.
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizure.
Hepato encephalopathy
Hepatic encephalopathy is a complex, reversible neuropsychiatric disorder seen in patients with severe liver dysfunction. It ranges from mild cognitive impairment (minimal HE) to coma (overt HE). Precipitating factors like infections, GI bleeding, and high protein intake can trigger episodes. Treatment focuses on removing triggers, lowering ammonia with lactulose/rifaximin, and considering liver transplant for persistent cases. Diet, lactulose, antibiotics, and surgery to reduce portosystemic shunting are used to manage and prevent recurrent episodes of hepatic encephalopathy.
Adrenal crisis
This document discusses adrenal crisis and congenital adrenal hyperplasia. It presents four case studies:
1) A 10-day-old neonate with ambiguous genitalia and symptoms of adrenal insufficiency was diagnosed with congenital adrenal hyperplasia.
2) A 2-year-old boy with a history of URI presented with lethargy and hypotension and was found to have metabolic acidosis, suggesting adrenal crisis.
3) A 1-year-old child brought in with fever, cough and cold for 3 days progressed to septic shock despite treatment, and was given stress doses of hydrocortisone for underlying adrenal insufficiency.
Neonatal metabolic encephalopathy
This document discusses neonatal metabolic encephalopathy and its causes. It describes neonatal encephalopathy as a clinically defined syndrome of disturbed neurologic function in the earliest days of life, manifested by subnormal consciousness, seizures, and difficulties with breathing and muscle tone. The main causes are listed as hypoxic-ischemic encephalopathy, perinatal stroke, progressive encephalopathy of metabolic, infectious or toxic origin, brain anomalies, hemorrhage, genetic mutations or maternal toxins. Metabolic disorders presenting with encephalopathy are divided into those with significant biochemical abnormalities like hyperammonemia, metabolic acidosis or hypoglycemia, and those without clear abnormalities. Specific metabolic disorders are discussed in detail, along with their
Diabetes Mellitus
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Reye’s syndrome
Reye syndrome is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure. It primarily affects the brain and liver, and can affect all organs. It has a biphasic course beginning with a viral illness that resolves, followed by abrupt onset of vomiting and neurologic impairment. The cause is unknown but aspirin use during a viral illness increases risk significantly. Diagnosis requires evidence of encephalopathy, hepatopathy, and no other reasonable explanations. Prognosis depends on stage - later stages involve deep coma and have high mortality.
Alcohol Intoxication
Alcohol intoxication can present with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic manifestations. Diagnosis involves taking a history, physical exam looking for signs like capillary prominence and spider naevi, and measuring blood alcohol concentration and serum osmolality. Differential diagnosis includes other causes of altered mental status. Management focuses on stabilizing the patient's condition in the emergency department. It can be important to distinguish acute intoxication from chronic alcohol abuse or dependence, which may require different treatment approaches.
Case on nephrotic syndrome
The document summarizes the case of an 82-year-old male patient diagnosed with nephrotic syndrome. It includes details of the patient's medical history, symptoms, lab investigations, biopsy results, medications, and discharge instructions. The patient was started on diuretics, antibiotics, lipid-lowering drugs, thyroid medication, and corticosteroids to treat the condition. The document also provides suggestions to monitor for potential drug interactions and complications related to the patient's treatment and disease.
Diabetic Ketoacidosis
This document provides an overview of diabetic ketoacidosis (DKA) including its pathophysiology, diagnosis, treatment, and complications. It then presents a case study of an 18-year-old female patient presenting with DKA symptoms including abdominal pain and vomiting. The patient's lab results indicate metabolic acidosis and ketosis. The document outlines her recommended treatment including IV fluids, insulin, antibiotics, and electrolyte replacement. It also discusses monitoring her response to therapy and educating her and her family about diabetes management and prevention of future DKA episodes.
What's hot (19)
Clozapine-induced myocarditis and pericarditis [Case Report]
Clozapine-induced myocarditis and pericarditis [Case Report]
Epilepsy case presentation by mehreen taj IVth parm D
Epilepsy case presentation by mehreen taj IVth parm D
Viewers also liked
Pneumonia in immnocomprimised host
The document discusses various types of pneumonia seen in different at-risk populations. It covers bacterial, fungal, mycobacterial and viral causes of pneumonia and highlights the microbes most commonly seen in immunocompromised groups like HIV/AIDS patients, transplant recipients, diabetics, alcoholics, elderly in nursing homes, and others. Risk factors specific to each population are outlined.
Airway and ventilatory management in trauma
This document discusses airway and ventilatory management in trauma patients. It emphasizes that the airway is the top priority in trauma resuscitation. Failure to recognize airway compromise or establish a definitive airway can lead to death. Signs of airway or ventilation problems are described. Methods for airway maintenance include positioning, oral/nasal airways, and extraglottic devices if intubation is not possible. Rapid sequence intubation is the preferred method when a definitive airway is needed. Surgical airways like needle cricothyroidotomy or surgical cricothyroidotomy are alternatives if intubation fails. Adequate oxygenation and ventilation are also discussed.
A Case of Myxedema Crisis
This document summarizes the case of a patient presenting with symptoms of myxedema crisis including loss of consciousness for 5 days. On examination, the patient was found to have hypothyroid features including an unrousable mental state, dry skin, bradycardia, and hypothermia. Laboratory tests confirmed very high TSH levels and low FT3 and FT4, consistent with severe untreated hypothyroidism. The patient was treated with intravenous thyroxine, hydrocortisone, saline and antibiotics. Myxedema crisis carries high mortality if not treated but can be managed with thyroid hormone replacement and treating any underlying infections or precipitating causes.
04 overview of atls
The document provides an overview of the Advanced Trauma Life Support (ATLS) protocol for treating trauma patients. It describes the primary and secondary surveys, which focus on identifying life-threatening injuries and obtaining further medical history/examination. The roles of the trauma team members are also outlined. Special considerations are given for penetrating trauma, with emphasis on rapidly identifying all entry/exit wounds and retained projectiles.
Airway management in trauma patients
airway management in trauma patients can be particularly challenging because of the presence of difficult airway and disrupted anatomy.
Anatomical implications, airway assessment in trauma, airway management, helpful airway devices were all mentioned in this presentation.
ATLS 9E Major Changes
Advanced Trauma Life Support (ATLS®): The ninth edition
Journal of Trauma and Acute Care Surgery
2013; 72(5): 1363–1366
Slideshare ppt
Miss goodheart created a PowerPoint to test out the Slideshare tool, which was introduced to her by Sharon Tonner on January 20th, 2011.
Viewers also liked (7)
Similar to Endocrine and electrolyte board review
Theophylline toxicity
A 24-year-old male with a history of gastric sleeve surgery presented to the emergency department after a suicide attempt by ingesting 20 tablets of Quibron SR 300 mg. He was initially drowsy, tachycardic, and hypotensive. Laboratory findings showed metabolic acidosis. He later developed seizures and was intubated. His theophylline level was elevated at 222 umol/L. He received supportive care including fluids, bicarbonate, sedation, and airway protection. He was discharged after extubation but later developed subglottic stenosis requiring balloon dilation.
electrolyte।।।।।।।।।।।।।।।।।।।।।।।।।।।।।.pptx
Sodium imbalance can cause hyponatremia or hypernatremia. Hyponatremia is defined as a serum sodium level below 135 mmol/L and can be caused by conditions that decrease sodium levels like diuretic use. Hypernatremia is a serum sodium over 145 mmol/L due to inadequate sodium retention. Both conditions require slow correction to avoid complications like osmotic demyelination syndrome from overly rapid changes. Proper treatment depends on the severity and chronicity of the sodium imbalance.
Endocrine emergencies
The document discusses various endocrine emergencies including diabetic ketoacidosis (DKA), hypoglycemia, and thyroid storm. It provides details on the causes, symptoms, diagnostic criteria and treatment approaches for each condition. DKA results from lack of insulin and needs urgent treatment including rehydration, insulin administration, and electrolyte correction. Hypoglycemia can be caused by too much insulin or too little food intake and requires glucose administration. Thyroid storm is a life-threatening exacerbation of hyperthyroidism that requires treatments to correct the hyperthyroidism and address any precipitating factors.
08. fluid and electrolytes
This document discusses fluid and electrolytes in the human body. It provides information on:
- Water content and distribution in the body
- Distribution of electrolytes like sodium, potassium, calcium, and magnesium between intracellular, interstitial, and intravascular fluid compartments
- Daily water requirements
- Causes, signs, and treatments of electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, and hypercalcemia.
Hypokalemia paralyzing revealing a rare association of autoimmune diseases: t...
Hypokalemia is a Paralyzing uncommon pathology, primitive often genetic autosomal dominant. Type 1 diabetes is an autoimmune disease of the pancreas responsible for a total deficit of insulinsecretion and hyperglycaemia. Someclinical manifestations extraglandular, canbe a discovery mode of the disease. We report the case of a patient with hypokalemiamoroccan Paralyzingrevealingthis pathology Whose combination with a renaltubulopathy by distal tubular acidosis (DTA) type 1 and autoimmune diseases of specific organ is rare. The DTA type 1 is related to the Inability of the distal tubule to secrete sufficient amount of hydrogen ions, making it possible to acidification of the urine below pH 5.5. This DTA is responsible for a severe rarely hypokalemia, neuromuscular complications, or revealing of a type 1 diabetes as is the case of our patient. A case of hypokalemiaparalyzingpuring a Sjögren syndrome (GSS) is associated with a thyroiditis was reported. Hypokalemia paralyzing revealing combination of autoimmune diseases annually (type 1 diabetes, thyroiditis and tubulopathy) isuncommon and difficulties to diagnose. Thus, faced with an unexplained hypokalemia neuromuscular paralysis in young patients, we must think although rare to a tubulopathy in the context of autoimmune diseases.
Diabetes mellitus
A 56-year-old woman presents with increased urinary frequency and thirst. Her blood glucose is elevated at 223 mg/dL and hemoglobin A1c is 9.2, consistent with diabetes. She is obese and eats an unhealthy diet. The document defines diabetes mellitus and the differences between type 1 and type 2 diabetes. It discusses common symptoms, diagnostic tests including blood glucose and hemoglobin A1c levels, and treatment options including lifestyle changes, oral medications, and insulin. Complications like diabetic ketoacidosis are also reviewed.
3. Thyroid disorders in children-1.pptx
1. Goitre is an enlargement of the thyroid gland that can be congenital or acquired. It can cause the thyroid to function normally, be underactive (hypothyroidism), or overactive (hyperthyroidism).
2. The most common causes of congenital goitre are factors transmitted from the mother to the fetus during pregnancy that interfere with fetal thyroid function, such as antithyroid drugs or hyperthyroidism.
3. Hypothyroidism in infants is the most common cause of congenital hypothyroidism and occurs when the fetal thyroid system fails to develop correctly, resulting in mental retardation if not treated.
Diabetic ketoacidosis by dr. noman
Diabetic ketoacidosis is a life-threatening complication of diabetes that occurs when there is not enough insulin in the body. It is characterized by high blood sugars, high ketones, and metabolic acidosis. The main treatment involves fluid replacement, insulin therapy to lower blood sugars and ketones, correcting electrolyte imbalances like potassium, and treating any underlying infections. Complications can include hypokalemia, hypoglycemia, cerebral edema, and pulmonary edema. Patient education focuses on medication adherence, sick-day management, and seeking medical care if symptoms worsen.
PICU OSCE.pdf
1. The child has relapsed acute lymphoblastic leukemia (ALL) and underwent reinduction chemotherapy.
2. Following the first cycle of reinduction therapy, laboratory tests show: a white blood cell count of 21,900, uric acid level of 9, and LDH level elevated.
3. These laboratory abnormalities indicate tumor lysis syndrome, a potential complication of effective chemotherapy in patients with high tumor burden. Urgent intervention is needed to prevent renal failure and other complications.
Disorders Of Sodium And Potassium Metabolism
This document discusses disorders of sodium and potassium metabolism. It outlines the major mediators that regulate sodium and water balance, including the renin-angiotensin-aldosterone axis and antidiuretic hormone. It then reviews the etiologies and pathophysiology of abnormalities in potassium and sodium balance, such as hyperkalemia, hypokalemia, hyponatremia, and hypernatremia. Finally, it presents four case studies to illustrate different disorders of electrolyte and fluid balance.
Disorders Of Sodium And Potassium Metabolism
This document discusses disorders of sodium and potassium metabolism. It outlines the major mediators that regulate sodium and water balance, including the renin-angiotensin-aldosterone axis and antidiuretic hormone. It then reviews the etiologies and pathophysiology of abnormalities in potassium and sodium balance, including hyperkalemia, hypokalemia, hyponatremia, and hypernatremia. Finally, it presents four case studies as examples.
Disorders Of Sodium And Potassium Metabolism
This document discusses disorders of sodium and potassium metabolism, including abnormalities that can cause hyperkalemia or hypokalemia, as well as hyponatremia or hypernatremia. It outlines the major mediators that regulate sodium and water balance, including the renin-angiotensin-aldosterone axis and antidiuretic hormone. It then presents four case studies and the relevant lab results, which illustrate different disorders of electrolyte and fluid balance.
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...YasserMohammedHassan1
- A 25-year-old female patient presented to the emergency department with irritability, rapid breathing, and dizziness after a suicide attempt using multiple oral drug strips containing propranolol, amitriptyline, paracetamol, pseudoephedrine, caffeine, and chlorpheniramine.
- She was found to have hypocalcemia-induced QT prolongation on electrocardiography. Calcium supplementation reversed her symptoms and ECG abnormalities.
- This case report describes the first reported occurrence of these adverse drug reactions, including hypocalcemia, QT prolongation, and respiratory effects, resulting from an overdose of these multiple drugs. Close monitoring of electrolytes and drug interactions is importantHypokalemia Hypokalemia for icu admitted.pptx
This document discusses hypokalemia, including its pathophysiology, causes, symptoms, diagnosis, and management. Some key points:
- Hypokalemia is defined as a serum potassium level below 3.5 mmol/L. It can be caused by decreased intake, gastrointestinal loss, renal loss, or shifts of potassium into cells.
- Symptoms vary but can include cardiac arrhythmias, muscle weakness, and neurological issues. Diagnosis involves checking electrolytes, ECG, and investigating underlying causes.
- Treatment involves addressing the underlying cause, stopping offending drugs, and oral or IV potassium supplementation. Severe cases require IV potassium. Specific conditions like Gitelman syndrome are managed long
Fluid And Electrolyte Emergencies In Critically Ill Children
This document presents several case studies of pediatric patients with fluid and electrolyte disorders. It discusses the differential diagnoses, diagnostic evaluations and treatment approaches for conditions such as Syndrome of Inappropriate Antidiuretic Hormone (SIADH), diabetes insipidus, adrenal insufficiency, and hypokalemia. Through a series of questions and answers, it aims to teach learners how to recognize, diagnose and manage common fluid and electrolyte emergencies in critically ill children.
Endocrine emergencies
This document discusses endocrine emergencies including disorders of the pancreas, pituitary, adrenal and thyroid glands. It covers the pathophysiology, manifestations, and treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), as well as hypoglycemia, Addison's disease, and adrenal crisis. The key aspects of assessment and management are fluid resuscitation, electrolyte replacement, insulin therapy, and treatment of acidosis for DKA and HHS patients. Nursing diagnoses related to ineffective breathing, gas exchange, fluid deficits, and therapeutic management are also reviewed.
ICU presentation.pptx
Q: A 70 y.o. man is brought to ER by his nephew because he was found poorly responsive at home. The nephew had not checked on the patient for two weeks. The patient lives alone and has been noted by his nephew to be more confused and less active over the past few months.
The nephew was uncertain about the patient's past medical history. He recalls that the patient takes several pills per day for some 'heart issues,' blood pressure, and headaches.
He also recalls that the patient was seen in ER recently for muscle pains and was given opioid analgesics.
Pearls In Endocrine Emergencies.pptx
This document discusses the diagnosis and management of two endocrine emergencies: myxedema coma and thyroid storm. It describes the key features of each condition, including precipitating factors, clinical presentation, diagnostic criteria, and treatment approach. For myxedema coma, treatment involves intravenous thyroid hormone replacement after excluding adrenal insufficiency, glucocorticoid therapy, rewarming, and treating any precipitating infections. For thyroid storm, treatment involves intensive care monitoring, fluid management, beta-blockade, antithyroid medications, iodine, glucocorticoids, and addressing any precipitating factors. Careful monitoring is needed for both conditions given their high mortality risks if not properly treated.
Hypothyoidism
Hypothyroidism..introduction prevalence clinical features instigation treatment and its effect on renal diseases
Clinical approach to patient with Hyperkalemia
Clinical approach to patient with Hyperkalemia
In internal medicine
Causes
Clinical findings
Complications
Treatment
Similar to Endocrine and electrolyte board review (20)
Hypokalemia paralyzing revealing a rare association of autoimmune diseases: t...
Hypokalemia paralyzing revealing a rare association of autoimmune diseases: t...
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...
Fluid And Electrolyte Emergencies In Critically Ill Children
Fluid And Electrolyte Emergencies In Critically Ill Children
Recently uploaded
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
The Best Ayurvedic Antacid Tablets in India
Treat the symptoms of indigestion, heartburn and stomach reflux with the 10 Best Ayurvedic Antacid Tablets in India.
A Classical Text Review on Basavarajeeyam
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
STIs may cause PID. For the both disease, herbal medicine Fuyan Pill can be a solution.
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
Efficacy of Avartana Sneha in Ayurveda
Avartana Sneha is a unique method of Preparation of Sneha Kalpana in Ayurveda, mainly it is indicated for the Vataja rogas.
Top-Vitamin-Supplement-Brands-in-India List
Swisschem Dermacare provides the Top 10 Vitamin Supplement Brands in India. To know more about us give us call at our official number
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
ABDOMINAL TRAUMA in pediatrics part one.
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recently uploaded (20)
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Endocrine and electrolyte board review
- 1. Endocrine Emergencies and Electrolytes Board Review Dr. John Mathew