The document discusses various endocrine emergencies including hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, syndrome of inappropriate antidiuretic hormone secretion, myxedema, thyroid storm, and adrenocortical insufficiency. It covers the definitions, etiologies, pathophysiology, clinical manifestations, diagnostic evaluations, and management of each condition. Nursing responsibilities in assessment and treatment are also outlined.
1. Myxedema coma is a life-threatening complication of severe untreated hypothyroidism, often precipitated by an acute illness. It involves altered mental status and multiple organ dysfunction.
2. Clinical features include symptoms of hypothyroidism along with hypothermia, hypotension, hypoventilation, coma and signs of precipitating illnesses. Investigations show features of hypothyroidism.
3. Treatment involves intensive care support including ventilatory support, cardiac monitoring and gradual rewarming. Thyroid hormone replacement is given cautiously along with treating any underlying illnesses.
This document provides guidance on the anaesthetic management of patients with diabetes mellitus, pheochromocytoma, or adrenal insufficiency undergoing surgery. For diabetes, it discusses preoperative assessment and glycemic control, including insulin infusion regimens. For pheochromocytoma, it emphasizes the importance of preoperative alpha-blockade to control blood pressure before surgery. For adrenal insufficiency, it notes the need for glucocorticoid and mineralocorticoid replacement in bilateral adrenalectomy. The document provides detailed recommendations for the perioperative care of patients with these endocrine conditions.
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.
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.
The document discusses hyperglycemia in critically ill patients in the ICU. It reviews the causes and effects of hyperglycemia as well as studies showing improved outcomes with intensive insulin therapy to maintain blood glucose between 110-150 mg/dL. Tight glucose control is beneficial but requires continuous monitoring and administration of dextrose to prevent hypoglycemia.
The child ingested 15 iron tablets containing a total of 975 mg of elemental iron, which is a potentially lethal dose. Diagnostic workup included an abdominal x-ray showing tablets in the stomach and intestine, and serum iron level. Whole bowel irrigation with polyethylene glycol was used for decontamination. The chelating agent desferoxamine was administered at 15 mg/kg/hr due to the large iron ingestion and presence of symptoms. Parameters like anion gap metabolic acidosis, leukocytosis, and hyperglycemia indicate severity. The prognosis depends on the ingested dose, time to treatment, and presence of complications.
This document discusses the management of hyperosmolar hyperglycemic state (HHS), a metabolic emergency seen in uncontrolled type 2 diabetes. It defines HHS as severe hyperglycemia with plasma glucose over 33 mmol/L, altered mental status, and serum osmolarity over 320 mosm/L. Precipitating factors include newly diagnosed diabetes, consumption of sugary drinks, discontinuing medications, surgery, steroids or diuretics. Treatment involves rehydration, insulin to lower blood glucose, electrolyte replacement, and treating any underlying causes. Insulin doses are lower than in diabetic ketoacidosis but doubled if glucose does not fall adequately.
1. Myxedema coma is a life-threatening complication of severe untreated hypothyroidism, often precipitated by an acute illness. It involves altered mental status and multiple organ dysfunction.
2. Clinical features include symptoms of hypothyroidism along with hypothermia, hypotension, hypoventilation, coma and signs of precipitating illnesses. Investigations show features of hypothyroidism.
3. Treatment involves intensive care support including ventilatory support, cardiac monitoring and gradual rewarming. Thyroid hormone replacement is given cautiously along with treating any underlying illnesses.
This document provides guidance on the anaesthetic management of patients with diabetes mellitus, pheochromocytoma, or adrenal insufficiency undergoing surgery. For diabetes, it discusses preoperative assessment and glycemic control, including insulin infusion regimens. For pheochromocytoma, it emphasizes the importance of preoperative alpha-blockade to control blood pressure before surgery. For adrenal insufficiency, it notes the need for glucocorticoid and mineralocorticoid replacement in bilateral adrenalectomy. The document provides detailed recommendations for the perioperative care of patients with these endocrine conditions.
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.
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.
The document discusses hyperglycemia in critically ill patients in the ICU. It reviews the causes and effects of hyperglycemia as well as studies showing improved outcomes with intensive insulin therapy to maintain blood glucose between 110-150 mg/dL. Tight glucose control is beneficial but requires continuous monitoring and administration of dextrose to prevent hypoglycemia.
The child ingested 15 iron tablets containing a total of 975 mg of elemental iron, which is a potentially lethal dose. Diagnostic workup included an abdominal x-ray showing tablets in the stomach and intestine, and serum iron level. Whole bowel irrigation with polyethylene glycol was used for decontamination. The chelating agent desferoxamine was administered at 15 mg/kg/hr due to the large iron ingestion and presence of symptoms. Parameters like anion gap metabolic acidosis, leukocytosis, and hyperglycemia indicate severity. The prognosis depends on the ingested dose, time to treatment, and presence of complications.
This document discusses the management of hyperosmolar hyperglycemic state (HHS), a metabolic emergency seen in uncontrolled type 2 diabetes. It defines HHS as severe hyperglycemia with plasma glucose over 33 mmol/L, altered mental status, and serum osmolarity over 320 mosm/L. Precipitating factors include newly diagnosed diabetes, consumption of sugary drinks, discontinuing medications, surgery, steroids or diuretics. Treatment involves rehydration, insulin to lower blood glucose, electrolyte replacement, and treating any underlying causes. Insulin doses are lower than in diabetic ketoacidosis but doubled if glucose does not fall adequately.
This document discusses diabetes mellitus and its effects and management. It begins by describing how the pancreas normally secretes insulin and insulin's effects on the liver, muscle, and fat tissues. It then defines diabetes as a condition of high blood glucose levels and classifies the main types as type 1 (insulin-dependent) and type 2 (insulin-resistant). Complications of diabetes include acute issues like diabetic ketoacidosis and hypoglycemia as well as chronic microvascular and macrovascular damage. Proper management of diabetes and blood glucose levels during surgery is also discussed.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
This document outlines the key points about diabetes mellitus and its acute complications. It begins with definitions of diabetes mellitus and an overview of the different types. The acute complications discussed are diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), and hypoglycemia. For DKA, it covers causes, pathophysiology, signs/symptoms, diagnostic tests, medical management including fluid resuscitation and insulin therapy, and nursing care. HHNS is defined as a hyperglycemic condition without acidosis seen in older patients. Risk factors, signs, and treatment are also summarized.
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) and diabetic ketoacidosis (DKA) are complications of diabetes that can occur when insulin levels are inadequate. HHNS typically occurs in non-insulin dependent diabetics and is characterized by severe hyperglycemia and hyperosmolality without acidosis. DKA usually occurs in insulin-dependent diabetics and results in hyperglycemia, dehydration, and metabolic acidosis. Treatment of DKA involves fluid resuscitation, electrolyte replacement, and administration of insulin to resolve the acidosis.
1) Hypoglycemia and diabetic ketoacidosis (DKA) are complications of diabetes that can occur when blood sugar levels fall too low or become too high, respectively.
2) Hypoglycemia is caused by too much insulin or medication, too little food, and can cause symptoms ranging from sweating to seizures. DKA is caused by a lack of insulin and can cause nausea, vomiting, and altered mental status.
3) Treatment for hypoglycemia involves consuming carbohydrates, while DKA treatment consists of rehydration, insulin administration, electrolyte replacement, and monitoring for complications like cerebral edema.
Complications of Diabetes Mellitus & its Management.pptsaranpratha12
In diabetes mellitus (DM), years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular) or both.
Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity.
A review of the investigation and management of diabetic ketoacidosis in newly diagnosed type I diabetes. Patient details have been changed and anonymised to protect the identity of the individual.
Neonatal emergencies require rapid assessment and treatment to identify and manage potential respiratory, circulatory or neurological failure. The key is early recognition and treatment of reversible life-threatening conditions. This document outlines signs, causes, investigations and management approaches for common neonatal emergencies involving the respiratory (e.g. respiratory distress syndrome), cardiovascular (e.g. congenital heart defects), neurological (e.g. seizures), hematologic (e.g. anemia), gastrointestinal (e.g. necrotizing enterocolitis) and metabolic (e.g. hypoglycemia) systems. Initial stabilization is followed by identification of specific conditions and initiation of targeted therapies.
Nephrotic syndrome is a kidney disorder characterized by proteinuria, low blood protein levels, high cholesterol, and edema. It is caused by damage to the glomerular membrane that allows protein to pass into the urine. Primary nephrotic syndrome has no known cause and affects children most, while secondary is caused by conditions like diabetes or lupus. Symptoms include edema, weight gain, fatigue, and susceptibility to infection. Diagnosis involves urine tests showing protein and serum tests of low protein and high cholesterol. Treatment focuses on reducing protein in urine with diuretics, steroids, or immunosuppressants to prevent complications like infections or kidney failure.
1) The document discusses the role of nurses in managing acute complications of diabetes mellitus, focusing on hyperglycemia, hypoglycemia, and diabetic ketoacidosis.
2) It outlines the signs, symptoms, diagnostic measures, treatment and nursing management of these acute complications.
3) The nursing role includes ongoing assessment, accurate monitoring, treatment, education, and psychological support of patients experiencing acute diabetic complications.
Addison's disease results from destruction of the adrenal glands, leading to a lack of cortisol and aldosterone production. It causes symptoms like fatigue, low blood pressure, and skin discoloration. Treatment involves replacing cortisol and mineralocorticoid hormones through medications like hydrocortisone and fludrocortisone. Acute adrenal insufficiency can occur during periods of stress and requires high doses of intravenous hydrocortisone.
Diabetes mellitus is a chronic condition characterized by high blood glucose levels. There are three main types - type 1 caused by lack of insulin production, type 2 caused by insulin resistance, and gestational diabetes during pregnancy. Acute complications include hypoglycemia from too much insulin and diabetic ketoacidosis from lack of insulin. Long term complications damage the heart, blood vessels, nerves, eyes, and kidneys. Proper management of diabetes includes monitoring blood sugar, administering insulin as needed, and treating acute complications promptly to prevent further health issues.
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
Diabetic ketoacidosis occurs when there is little to no insulin present in Type 1 diabetics or occasionally in Type 2 diabetics during illness. This results in high blood sugar, breakdown of fats, production of ketone bodies, and metabolic acidosis. Signs include dehydration, electrolyte abnormalities, Kussmaul breathing, and varying mental status. Treatment focuses on rehydration, electrolyte replacement, and insulin administration to resolve the acidosis. Patient education on sick day rules can help prevent DKA. Hyperosmolar hyperglycemic nonketotic state is a similar emergency characterized by severe hyperglycemia without acidosis. Hypoglycemia and hyponatremia are also
This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
Uncontrolled blood sugar levels can lead to metabolic emergencies like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and hypoglycemia in diabetics. DKA and HHS are caused by high blood sugar and result from insulin deficiency, while hypoglycemia is caused by low blood sugar levels. Treatment for these conditions aims to restore fluid and electrolyte balance, lower blood sugar levels, and treat any underlying precipitating causes. Insulin therapy and intravenous fluids are used to treat DKA and HHS, while oral carbohydrates or intravenous dextrose are given for hypoglycemia. Close monitoring of blood sugar, electrolytes, and acid-base status is
DIABETIC KETOACIDOSIS PRESENTATION BY ROOMA KHALIDRooma Khalid
This document discusses diabetic ketoacidosis (DKA). It defines DKA and its signs and symptoms. DKA occurs more often in type 1 diabetes and is characterized by blood glucose over 250 mg/dl, blood pH below 7.3, and ketones in serum over 5 mEq/L. Proper treatment of DKA involves fluid replacement, insulin administration, and monitoring of blood glucose, electrolytes, and pH to correct dehydration, hyperglycemia, and acidosis. Failure to treat the patient's DKA led to worsening of her condition.
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.
The document discusses the anaesthetic management of diabetes mellitus, including the types and diagnosis of diabetes, physiology of insulin, perioperative response to surgery and anesthesia, complications, and considerations for management related to cardiovascular disease, renal dysfunction, neuropathies, and different types of surgery. It provides guidance on pre-operative, intra-operative, and post-operative glucose monitoring and management through intravenous fluids, insulin administration, and glycemic control targets. Surgical procedures for both insulin-dependent and non-insulin dependent diabetes are outlined.
Diabetic complications can be classified as either long-term macrovascular and microvascular complications, or acute complications like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA is caused by insulin deficiency leading to increased breakdown of fat and muscle, resulting in a biochemical triad of hyperglycemia, ketoacids, and metabolic acidosis. It is treated with IV fluids, insulin, and monitoring of electrolytes and blood gases. HHS involves marked hyperglycemia, hyperosmolarity without severe ketosis, and altered mental status, usually developing over weeks in older patients with type 2 diabetes.
This document discusses diabetes mellitus and its effects and management. It begins by describing how the pancreas normally secretes insulin and insulin's effects on the liver, muscle, and fat tissues. It then defines diabetes as a condition of high blood glucose levels and classifies the main types as type 1 (insulin-dependent) and type 2 (insulin-resistant). Complications of diabetes include acute issues like diabetic ketoacidosis and hypoglycemia as well as chronic microvascular and macrovascular damage. Proper management of diabetes and blood glucose levels during surgery is also discussed.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
This document outlines the key points about diabetes mellitus and its acute complications. It begins with definitions of diabetes mellitus and an overview of the different types. The acute complications discussed are diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), and hypoglycemia. For DKA, it covers causes, pathophysiology, signs/symptoms, diagnostic tests, medical management including fluid resuscitation and insulin therapy, and nursing care. HHNS is defined as a hyperglycemic condition without acidosis seen in older patients. Risk factors, signs, and treatment are also summarized.
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) and diabetic ketoacidosis (DKA) are complications of diabetes that can occur when insulin levels are inadequate. HHNS typically occurs in non-insulin dependent diabetics and is characterized by severe hyperglycemia and hyperosmolality without acidosis. DKA usually occurs in insulin-dependent diabetics and results in hyperglycemia, dehydration, and metabolic acidosis. Treatment of DKA involves fluid resuscitation, electrolyte replacement, and administration of insulin to resolve the acidosis.
1) Hypoglycemia and diabetic ketoacidosis (DKA) are complications of diabetes that can occur when blood sugar levels fall too low or become too high, respectively.
2) Hypoglycemia is caused by too much insulin or medication, too little food, and can cause symptoms ranging from sweating to seizures. DKA is caused by a lack of insulin and can cause nausea, vomiting, and altered mental status.
3) Treatment for hypoglycemia involves consuming carbohydrates, while DKA treatment consists of rehydration, insulin administration, electrolyte replacement, and monitoring for complications like cerebral edema.
Complications of Diabetes Mellitus & its Management.pptsaranpratha12
In diabetes mellitus (DM), years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular) or both.
Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity.
A review of the investigation and management of diabetic ketoacidosis in newly diagnosed type I diabetes. Patient details have been changed and anonymised to protect the identity of the individual.
Neonatal emergencies require rapid assessment and treatment to identify and manage potential respiratory, circulatory or neurological failure. The key is early recognition and treatment of reversible life-threatening conditions. This document outlines signs, causes, investigations and management approaches for common neonatal emergencies involving the respiratory (e.g. respiratory distress syndrome), cardiovascular (e.g. congenital heart defects), neurological (e.g. seizures), hematologic (e.g. anemia), gastrointestinal (e.g. necrotizing enterocolitis) and metabolic (e.g. hypoglycemia) systems. Initial stabilization is followed by identification of specific conditions and initiation of targeted therapies.
Nephrotic syndrome is a kidney disorder characterized by proteinuria, low blood protein levels, high cholesterol, and edema. It is caused by damage to the glomerular membrane that allows protein to pass into the urine. Primary nephrotic syndrome has no known cause and affects children most, while secondary is caused by conditions like diabetes or lupus. Symptoms include edema, weight gain, fatigue, and susceptibility to infection. Diagnosis involves urine tests showing protein and serum tests of low protein and high cholesterol. Treatment focuses on reducing protein in urine with diuretics, steroids, or immunosuppressants to prevent complications like infections or kidney failure.
1) The document discusses the role of nurses in managing acute complications of diabetes mellitus, focusing on hyperglycemia, hypoglycemia, and diabetic ketoacidosis.
2) It outlines the signs, symptoms, diagnostic measures, treatment and nursing management of these acute complications.
3) The nursing role includes ongoing assessment, accurate monitoring, treatment, education, and psychological support of patients experiencing acute diabetic complications.
Addison's disease results from destruction of the adrenal glands, leading to a lack of cortisol and aldosterone production. It causes symptoms like fatigue, low blood pressure, and skin discoloration. Treatment involves replacing cortisol and mineralocorticoid hormones through medications like hydrocortisone and fludrocortisone. Acute adrenal insufficiency can occur during periods of stress and requires high doses of intravenous hydrocortisone.
Diabetes mellitus is a chronic condition characterized by high blood glucose levels. There are three main types - type 1 caused by lack of insulin production, type 2 caused by insulin resistance, and gestational diabetes during pregnancy. Acute complications include hypoglycemia from too much insulin and diabetic ketoacidosis from lack of insulin. Long term complications damage the heart, blood vessels, nerves, eyes, and kidneys. Proper management of diabetes includes monitoring blood sugar, administering insulin as needed, and treating acute complications promptly to prevent further health issues.
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
Diabetic ketoacidosis occurs when there is little to no insulin present in Type 1 diabetics or occasionally in Type 2 diabetics during illness. This results in high blood sugar, breakdown of fats, production of ketone bodies, and metabolic acidosis. Signs include dehydration, electrolyte abnormalities, Kussmaul breathing, and varying mental status. Treatment focuses on rehydration, electrolyte replacement, and insulin administration to resolve the acidosis. Patient education on sick day rules can help prevent DKA. Hyperosmolar hyperglycemic nonketotic state is a similar emergency characterized by severe hyperglycemia without acidosis. Hypoglycemia and hyponatremia are also
This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
Uncontrolled blood sugar levels can lead to metabolic emergencies like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and hypoglycemia in diabetics. DKA and HHS are caused by high blood sugar and result from insulin deficiency, while hypoglycemia is caused by low blood sugar levels. Treatment for these conditions aims to restore fluid and electrolyte balance, lower blood sugar levels, and treat any underlying precipitating causes. Insulin therapy and intravenous fluids are used to treat DKA and HHS, while oral carbohydrates or intravenous dextrose are given for hypoglycemia. Close monitoring of blood sugar, electrolytes, and acid-base status is
DIABETIC KETOACIDOSIS PRESENTATION BY ROOMA KHALIDRooma Khalid
This document discusses diabetic ketoacidosis (DKA). It defines DKA and its signs and symptoms. DKA occurs more often in type 1 diabetes and is characterized by blood glucose over 250 mg/dl, blood pH below 7.3, and ketones in serum over 5 mEq/L. Proper treatment of DKA involves fluid replacement, insulin administration, and monitoring of blood glucose, electrolytes, and pH to correct dehydration, hyperglycemia, and acidosis. Failure to treat the patient's DKA led to worsening of her condition.
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.
The document discusses the anaesthetic management of diabetes mellitus, including the types and diagnosis of diabetes, physiology of insulin, perioperative response to surgery and anesthesia, complications, and considerations for management related to cardiovascular disease, renal dysfunction, neuropathies, and different types of surgery. It provides guidance on pre-operative, intra-operative, and post-operative glucose monitoring and management through intravenous fluids, insulin administration, and glycemic control targets. Surgical procedures for both insulin-dependent and non-insulin dependent diabetes are outlined.
Diabetic complications can be classified as either long-term macrovascular and microvascular complications, or acute complications like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA is caused by insulin deficiency leading to increased breakdown of fat and muscle, resulting in a biochemical triad of hyperglycemia, ketoacids, and metabolic acidosis. It is treated with IV fluids, insulin, and monitoring of electrolytes and blood gases. HHS involves marked hyperglycemia, hyperosmolarity without severe ketosis, and altered mental status, usually developing over weeks in older patients with type 2 diabetes.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
Visit : https://massagespaajman.com/
Call : 052 987 1315
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
2. HYPOGLYCEMI
A
Hypoglycemia relating to an abnormally low level of the
sugar glucose in the blood, usually a complication of diabetes,
in which body does not produce enough insulin to fully
metabolize glucose which known as hypoglycemia.
4. Due to etiological causes
Redundant counter-regulatory mechanisms
As glucose levels decline, major defenses
include
Decrease in insulin secretion
Increase in glucagon secretion
5. Increase in epinephrine secretion.
Increased cortisol and growth hormone secretion also
occur.
If these defenses fail, plasma glucose levels will
continue to fall.
Hypoglycemia
8. Moderate hypoglycemia
▶ CNS may include inability to concentrate
▶ Headache
▶ Lightheadedness
▶ Confusion
▶ Memory lapses
9. Moderate hypoglycemia
▶ Numbness of the lips and tongue
▶ Slurred speech, impaired coordination
▶ Emotional changes
▶ Irrational, double vision, and drowsiness.
10. ▶ CNS function is so impaired that the patient needs the assistance of
another person for treatment of hypoglycemia.
▶ Symptoms may include disoriented behavior, seizures, difficulty arousing
from sleep, or loss of consciousness
13. MANAGEMENT
NON PHARMACOLOGICALMANAGEMENT
Immediate treatment must be given when hypoglycemia occurs. The usual
recommendation is for 15 g of a fast-acting concentrated source of
carbohydrate such as the following, given orally:
Three or four commercially prepared glucose tablets
4 to 6 of fruit juice or regular soda
6 to 10 Life Savers or other hard candies
2 to 3 teaspoons of sugar or honey
14. ▶ It is not necessary to add sugar to juice, even if it is labeled as unsweetened juice: the
fruit sugar in juice contains enough carbohydrate to raise the blood glucose level.
▶ The blood glucose level should be retested in 15 minutes and retreated if it is less than 70
to 75 mg/dL .
15. ▶ If the symptoms persist more than 10 to 15 minutes after initial treatment, the treatment
is repeated even if blood glucose testing is not possible.
▶ Once the symptoms resolve, a snack containing protein and starch (eg, milk or cheese
and crackers) is recommended unless the patient plans to eat a regular meal or snack
within 30 to 60 minutes.
16. ▶ An injection of glucagon 1 mg can be administered either subcutaneously or
intramuscularly.
▶ Injectable glucagon is packaged as a powder in 1-mg vials and must be mixed with a diluent
before being injected.
17. ▶ After injection of glucagon, it may take up to 20 minutes for the patient to regain
consciousness.
▶ Assuring patency of the intravenous (IV) line used for injection of 50% dextrose is
essential because hypertonic solutions such as 50% dextrose are very irritating to the
vein.
19. DEFINITION
▶ DKA is caused by an absence or
markedly inadequate amount of
insulin. This deficit in available
insulin results in disorders in the
metabolism of carbohydrate,
protein, and fat.
25. COLLABORATIVE MANAGEMENT
Ensure patent airway.
Administer O2 via nasal cannula or non-rebreather mask.
Establish IV access with large-bore catheter.
Begin fluid resuscitation with 0.9% NaCl solution 1 L/hr
until BP stabilized and urine output 30-60 mL/hr.
Begin continuous regular insulin drip 0.1 U/kg/hr.
Administration of IV fluids
IV administration of short-acting insulin
26. ▶ Assessment of mental status
▶ Recording of intake and output
▶ Central venous pressure monitoring (if indicated)
▶ Assessment of blood glucose levels
▶ Assessment of blood and urine for ketones
▶ ECG monitoring
▶ Assessment of cardiovascular and respiratory status
▶ Correction of fluid loss with intravenous fluids.
27. MEDICAL MANAGEMENT
▶ Correction of hyperglycemia with insulin.
▶ Correction of electrolyte disturbances, particularly
potassium loss.
▶ Correction of acid-base balance.
▶ Treatment of concurrent infection, if present.
29. HYPEROSMOLARHYPERGLYCAEMI
C STATE
▶ Hyperosmolar hyperglycemic state (HHS), also known as non-ketotic
hyperglycemic hyperosmolar syndrome (NKHS), is characterized by
profound hyperglycemia (glucose >600 mg/dL), hyperosmolality and volume
depletion in the absence of significant ketoacidosis (pH >7.3 and HCO3 >15
mEq/L), and is a serious complication of diabetes.
31. CLI
NI
CALMANI
FESTATI
ON
▶ The clinical picture of HHNS is one of hypotension
▶ Visual deficits
▶ profound dehydration
▶ Tachycardia
▶ Variable neurologic signs
34. SIADH (syndrome of inappropriate secretion of antidiuretic
hormone)
Syndrome of inappropriate secretion of antidiuretic hormone
(develops when too much antidiuretic hormone (vasopressin) is
released by the pituitary gland under certain inappropriate conditions,
causing the body to retain fluid and lower the blood sodium level by
dilution.
35. ETI
OLOGY
▶ Medicines, such as certain type 2 diabetes drugs, seizure drugs,
antidepressants, heart and blood pressure drugs, cancer drugs,
anesthesia
▶ Surgery under general anesthesia
▶ Disorders of the brain, such as injury, infections, stroke
▶ Brain surgery in the region of the hypothalamus
▶ Lung disease, such as pneumonia, tuberculosis, cancer, chronic
infection.
36. ▶ OHP PATHO
Due to etiological causes
Increased antidiuretic hormone
Increased water reabsorption in renal
tubules
42. Management objectives in SIADH are:
▶ Looking for the cause if possible
▶ Measure the liquid electrolyte is not balanced
▶ Prevent complications
43. Medical management
▶ Hypertonic IV fluids to correct hyponatremia
▶ Sodium restriction
▶ Diuretics to correct low plasma osmolality
▶ Monitor urine electrolyte loss
▶ Replace electrolyte loss
44. ▶ Demeclocycline to facilitate free water clearance
▶ Conivaptan
▶ Tolvaptan
46. COMPLICATIONS
• Seizures
• Coma
• Permanent brain damage
• Hyperuricemia
• Fluid overload
• Decrease in chloride levels (plasma or serum)
47. • Decrease in osmolarity (plasma)
• Hypokalaemia
• Hypomagnesemia
• Increased levels of sodium (urine)
48. MYXEDEMA
▶ Hypothyroidism results from suboptimal levels of thyroid hormone. Thyroid
deficiency can affect all body functions and can range from mild, subclinical forms
to myxedema.Symptoms of hypethyroidism may later be followed by those of
hypothyroidism and myxedema.
49. ETIOLOGY
▶ Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis)
▶ Atrophy of thyroid gland with aging
▶ Therapy for hyperthyroidism
▶ Radioactive iodine (131I)
▶ Thyroidectomy
▶ Medications
50. ▶ Lithium
▶ Antithyroid medications
▶ Radiation to head and neck for treatment of head and neck cancers, lymphoma
▶ Infiltrative diseases of the thyroid (amyloidosis, scleroderma)
53. Since T3 is available for parenteral use, hence T3 (tri-idothyronine) 20µg IV as a
bolus is given.
A bolus dose of oral thyroxine (500µg) followed by 100µg twice or thrice is
administered, if parenteral preparation is not available.
Body temperature rises and patient regains consciousness within 48-72 hours at
which maintenance oral thyroxine may be started.
54.
55. THYROID STORM
▶ Thyroid storm is a form of severe
hyperthyroidism, usually of abrupt onset.
Untreated it is almost always fatal, but
with proper treatment the mortality rate
is reduced substantially. The patient with
thyroid storm or crisis is critically ill and
requires observation and aggressive and
supportive nursing care during and after
the acute stage of illness.
56. ETIOLOGY
▶ Graves’disease, an autoimmune disease that attacks the thyroid gland
▶ viral infections, other autoimmune conditions,
▶ overactive thyroid nodules
▶ tests that use iodine
▶ eating too many foods that contain iodine
▶ consuming large amounts of thyroid hormone
▶ certain tumors of the ovaries or testes
57. PATHOPHYSIOLOGY
▶ Due to etiological causes like Graves’ disease, consuming large amounts of thyroid
hormone
▶ Production of T4 binding inhibitors resulting in decreased binding affinity of T4 and
increase free T4 levels
▶ Rapid release of T4 into the circulation could binding capacity
▶ Development of tissue intolerance
▶ Homeostatic decompensation despite similar hormone levels.
▶ Role of adrenergic activation normal plasma levels of adrenaline noted.
▶ But T4 causes increased receptors in some tissues.
▶ Post receptor action to alter responsiveness to catecholamine
▶ Clinical features
58. CLINICAL MANIFESTATION
▶ High fever (hyperpyrexia) above 38.5°C (101.3°F)
▶ Extreme tachycardia
▶ Exaggerated symptoms of hyperthyroidism with disturbances of a major
system
▶ GI (weight loss, diarrhea,nausea and vomiting,abdominal pain)
▶ Cardiovascular (edema, chest pain, dyspnea, palpitations)
▶ Irregular heart rhythm,
▶ Heart failure
63. ADRENOCORTICAL INSUFFICIENCY
▶ DEFINITION
▶ Addison’s disease: chronic
adrenocortical insufficiency
secondary to destruction of
the adrenal glands adrenal
cortex function is inadequate
to meet the patient’s need for
cortical hormones.
64. ETIOLOGY
▶ Adrenocortical insufficiency (hypofunction of the adrenal cortex) may
be from a primary cause (Addison’s disease) secondary cause (lack of
pituitaryACTH secretion).
▶ All three classes of adrenal corticosteroids are reduced.
▶ ACTH deficiency may be caused by pituitary disease or suppression of
the hypothalamic-pituitary axis because of the administration of
exogenous corticosteroids.
▶ Autoimmune response.
65. CLINICAL MANIFESTATIONS
▶ progressive weakness, fatigue, weight loss, and anorexia as
primary features.
▶ bronze-colored skin hyperpigmentation.
▶ sun-exposed areas of the body; at pressure points; over joints;
and in the creases, especially palmar creases
▶ Other manifestations of adrenal insufficiency are orthostatic
hypotension, hyponatremia, salt craving, hyperkalemia, nausea
and vomiting, and diarrhea.
▶ Irritability and depression
66. History and physical examination
ACTH stimulation test.
Urine levels
ECG
CT scans and MRI
67. COLLABORATIVE MANAGEMENT
•Daily glucocorticoid (e.g., hydrocortisone) replacement (two thirds on awakening
in morning, one third in late afternoon)*
• Daily mineralocorticoid (fludrocortisone [Florinef]) in morning*
• Salt additives for excess heat or humidity
• Increased doses of cortisol for stress situations (e.g., surgery, hospitalization)