hypoglycemia sultan alhaj ali (2).pptx
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(1) The document discusses hypoglycemia, including its causes, clinical features, diagnosis, and treatment. (2) Hypoglycemia occurs when blood glucose levels drop below normal, usually below 50 mg/dL, and can be caused by an imbalance of insulin or oral medications in diabetics or other conditions. (3) Symptoms range from neuroglycopenic effects like confusion or seizures to autonomic effects like sweating and palpitations, and diagnosis is confirmed through measuring blood glucose levels. Treatment involves oral carbohydrates, glucagon, or intravenous dextrose depending on the severity of symptoms.
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Hypoglycemia
This document discusses hypoglycemia, including its causes, clinical features, diagnosis, and treatment. Hypoglycemia is defined as a low blood glucose level below 70 mg/dL that causes symptoms resolved by glucose administration. Common causes in diabetics include inadequate food intake, excessive insulin, and increased exertion. Symptoms include neuroglycopenic effects like confusion and autonomic effects like palpitations. Diagnosis is confirmed with bedside glucose testing. Treatment depends on the patient's consciousness and includes oral carbohydrates, glucagon, or IV glucose. Most patients fully recover within 20 minutes with treatment of the underlying cause and glucose administration.
Complications of diabetes melitus
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).
Anesthesia considration for DIABETES MELLITUS
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.
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The document discusses acute complications of diabetes mellitus (DM), including hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS). It defines these conditions, describes their pathophysiology and clinical features, and outlines how to diagnose and manage them. The objective is for learners to understand acute DM complications, how to diagnose them, and how to manage hypoglycemia, DKA, and HHS.
ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
diagnosis & complication of Diabetes mellitus including Diabetic ketoacidosis & HHS
anaesthesia managment for patient with DM posted for surgery both emergency and elective surgery
gestational diabetes mellitus
Diabetes Mellitus..an understanding
1. A 30-year-old male was brought to the emergency room unconscious. He was diagnosed with diabetic ketoacidosis and hyperglycemic hyperosmolar state due to insulin deficiency and resistance.
2. Insulin is synthesized and packaged in the pancreas and regulates glucose metabolism by inhibiting glycogenolysis and gluconeogenesis while stimulating glucose uptake in tissues.
3. Hypoglycemia can occur due to impaired counterregulatory hormone response and behavioral defenses in diabetics compared to non-diabetics.
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This document discusses anesthesia considerations for patients with diabetes. It defines diabetes and classifies it into types 1, 2, gestational, and secondary. It describes end-organ complications like cardiovascular, renal, and neurological issues. It also discusses acute complications like diabetic ketoacidosis and hypoglycemia as well as chronic effects of hyperglycemia. The anesthetic management of patients with diabetes focuses on glycemic control and addressing any organ dysfunction or comorbidities.
Hypoglycemia
This document provides an overview of hypoglycemia, including its definition as low blood glucose below 50 mg/dL, importance due to the brain's reliance on constant glucose supply, and symptoms ranging from adrenergic to neuroglycopenic effects. It describes the body's glucoregulatory systems that work to prevent and correct low blood sugar, including the release of glucagon, epinephrine, cortisol and growth hormone. Various causes of hypoglycemia are outlined, from insulin-induced in diabetes to other drug-related, critical illness, hormonal deficiency, tumor and genetic causes. The diagnosis involves considering history, symptoms and confirming a low blood glucose level, while treatment focuses on oral or IV glucose administration and
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Hypoglycemia
This document discusses hypoglycemia, including its causes, clinical features, diagnosis, and treatment. Hypoglycemia is defined as a low blood glucose level below 70 mg/dL that causes symptoms resolved by glucose administration. Common causes in diabetics include inadequate food intake, excessive insulin, and increased exertion. Symptoms include neuroglycopenic effects like confusion and autonomic effects like palpitations. Diagnosis is confirmed with bedside glucose testing. Treatment depends on the patient's consciousness and includes oral carbohydrates, glucagon, or IV glucose. Most patients fully recover within 20 minutes with treatment of the underlying cause and glucose administration.
Complications of diabetes melitus
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).
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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.
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The document discusses acute complications of diabetes mellitus (DM), including hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS). It defines these conditions, describes their pathophysiology and clinical features, and outlines how to diagnose and manage them. The objective is for learners to understand acute DM complications, how to diagnose them, and how to manage hypoglycemia, DKA, and HHS.
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1. A 30-year-old male was brought to the emergency room unconscious. He was diagnosed with diabetic ketoacidosis and hyperglycemic hyperosmolar state due to insulin deficiency and resistance.
2. Insulin is synthesized and packaged in the pancreas and regulates glucose metabolism by inhibiting glycogenolysis and gluconeogenesis while stimulating glucose uptake in tissues.
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This document provides an overview of hypoglycemia, including its definition as low blood glucose below 50 mg/dL, importance due to the brain's reliance on constant glucose supply, and symptoms ranging from adrenergic to neuroglycopenic effects. It describes the body's glucoregulatory systems that work to prevent and correct low blood sugar, including the release of glucagon, epinephrine, cortisol and growth hormone. Various causes of hypoglycemia are outlined, from insulin-induced in diabetes to other drug-related, critical illness, hormonal deficiency, tumor and genetic causes. The diagnosis involves considering history, symptoms and confirming a low blood glucose level, while treatment focuses on oral or IV glucose administration and
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This document provides information about hypoglycemia for diabetes educators. It defines hypoglycemia as a blood glucose level below 70 mg/dL and describes the physiological response and counter-regulatory hormones involved. Symptoms of hypoglycemia are outlined as either hyperadrenergic or neuroglycopenic depending on blood glucose level. Causes of hypoglycemia include insulin excess, reduced food intake, exercise, and organ dysfunction. Management involves prevention through education, recognition and treatment of low blood sugar with fast-acting carbohydrates, and addressing the underlying cause to prevent future episodes.
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This document discusses hypoglycemia, defining it as low plasma glucose levels leading to symptoms that are resolved by raising glucose levels. It notes hypoglycemia is common in type 1 diabetes and less frequent in type 2 diabetes. The defenses against hypoglycemia are impaired in diabetes due to defective insulin, glucagon, and epinephrine responses. Recent low blood sugar can cause hypoglycemia-associated autonomic failure, increasing risk of future episodes. Causes of hypoglycemia include medications, medical conditions, and nonislet cell tumors.
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Hypoglycemia
Hypoglycemia occurs when blood glucose levels fall below normal levels. When this happens, the body activates mechanisms to raise blood glucose like increasing glucagon release and reducing glucose uptake. Prolonged insulin therapy can impair these mechanisms. Symptoms of hypoglycemia range from sweating to confusion. Treatment involves consuming carbohydrates to raise glucose levels. Patients at risk require education to prevent hypoglycemia and its complications like hypoglycemia unawareness.
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2. Symptoms of diabetes include fatigue, weight loss, polyuria, polydipsia, and blurry vision. Diagnosis involves blood glucose criteria and HbA1c levels. Treatment involves lifestyle changes, oral medications like metformin and sulfonylureas, and insulin for more severe cases.
3. Complications include diabetic ketoacidosis, characterized by
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This document discusses hypoglycemia, defining it as low plasma glucose levels leading to symptoms that are resolved by raising glucose levels. It notes hypoglycemia is common in type 1 diabetes and less frequent in type 2 diabetes. The defenses against hypoglycemia are impaired in diabetes due to defective insulin, glucagon, and epinephrine responses. Recent low blood sugar can cause hypoglycemia-associated autonomic failure, increasing risk of future episodes. Causes of hypoglycemia include medications, medical conditions, and nonislet cell tumors.
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Tuberculosis is a chronic, communicable disease caused by the Mycobacterium tuberculosis bacterium, which is commonly spread through inhalation or ingestion. It primarily affects the lungs but can spread to other organs like the kidneys, bones, and lymph nodes. Symptoms include fatigue, weight loss, cough, and night sweats. Diagnosis involves physical exams, chest X-rays, sputum cultures, and tuberculin skin tests. Treatment requires taking a combination of antibiotics daily for 6-12 months.
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pneomonia.pptx
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bronchitis.pptx
Bronchitis is an infection and inflammation of the bronchial tubes that connect the nose to the lungs. It can be acute, lasting a few weeks, or chronic, lasting for months. Symptoms include cough, mucus production, wheezing, and shortness of breath. Treatment involves antibiotics, cough medicine, bronchodilators, and avoiding irritants like tobacco smoke. Nursing care focuses on breathing exercises, suctioning mucus, providing oxygen, and health education about the condition.
asthma.pptx
Asthma is a chronic lung disease characterized by episodic airway obstruction due to bronchospasms, increased mucus secretion, and mucosal edema. It is triggered by both extrinsic allergens like pollen, animal dander, and foods as well as intrinsic factors like respiratory infections, stress, and pollution. Symptoms range from mild wheezing to difficulty breathing and low oxygen levels. Diagnosis involves pulmonary function tests, allergy testing, and monitoring lung function and oxygen levels. Treatment focuses on avoiding triggers, using bronchodilators and corticosteroids to reduce inflammation and open airways, and humidified oxygen for severe attacks to prevent complications like respiratory failure.
chemistry and immunology tests.pptx
This document provides an overview of various medical tests categorized by body system or condition. It describes tests for clinical chemistry, renal function, liver function, cardiac markers, minerals, blood disorders, diabetes, inflammation (CRP), lipids, immunology, tumor markers, fertility hormones, maternal care, infectious diseases, and thyroid function. For each category, it lists specific tests and biomarkers and what they indicate about health and disease states.
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This document provides an overview of the departments and processes within a medical laboratory. It describes the main departments as medical microbiology, clinical chemistry, hematology, immunohematology, coagulation, immunology, and urinalysis. For each department, it outlines the types of tests performed. It also explains the three phases of testing as pre-analytical, analytical, and post-analytical.
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The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Physiology of Chemical Sensation of smell.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Light House Retreats: Plant Medicine Retreat Europe
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Non-respiratory Functions of the Lungs.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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hypoglycemia sultan alhaj ali (2).pptx
- 4. (1) symptoms consistent with the diagnosis (2)symptoms associated with a low glucose level, usually <50 mg/dL (<2.7 mmol/L) (3)symptoms resolve with glucose administration It is clinically defined as follows: WHIPPL E
- 5. • Normal :70-99mg/dL , PP: 140mg/dL • Plasma glucose is normally maintained at 3.6-5.8mmol/L • Cognitive deteriorates at levels <3.0mmol/L • Symptoms are uncommon >2.5mmol/L
- 6. FAC TS
- 7. Human brain depends on glucose as its primary source of energy It is unable to synthesize or store glucose (accounting for the common manifestation of hypoglycemia as altered mental status)
- 8. Physiologic response to low blood glucose suppression of insulin secretion release of the counter- regulatory hormones
- 9. Renal clearance of insulin decreases with age, and this may enhance the risk of hypoglycemia in the elderly.
- 10. CAUS ES
- 11. In diabetics, the commonest cause is a relative imbalance of administered versus required insulin/OHA
- 12. Common scenarios in diabetics: - inadequate/delayed food intake - excessive insulin administration - increased physical exertion - change in drug therapy - drug interactions - sudden reduction in diet
- 13. Other causes are: • Alcohol • Addison’s disease • Pituitary insufficiency • Post gastric surgery • Liver failure • Malaria • Insulinomas • Extra-pancreatic tumors • Attempted suicide/homicide (with large doses of insulin/OHAs)
- 15. Neuroglycope nic Autonom ic Lethargy Confusion Agitation Seizures Combativene ss Unresponsiveness Focal neurologic deficits Alterations in Anxiety Nervousne ss Irritability Nausea Vomiting Palpitations Tremor
- 17. Medical conditions that can be mistaken for hypoglycemia • Stroke • Transient ischemic attack • Seizure disorder • Traumatic head injury • Brain tumor • Narcolepsy • Multiple sclerosis • Psychosis • Sympathomimetic drug ingestion • Hysteria • Altered sleep patterns and nightmares • Depressio n
- 18. DIAGNOSIS
- 19. The diagnosis can easily be confirmed using bedside glucose
- 20. Hypoglycemia should always be considered early as there is a potential cause of altered mental status
- 21. Can mimic any neurological presentations: com a seizur es acute confusion isolated
- 22. Failure to determine the blood glucose level early in the evaluation can result in a delayed or missed diagnosis with associated morbidity because of CNS injury or unnecessary invasive procedures
- 23. TREATMENT
- 24. Depends on conscious state and degree of cooperation of patient
- 25. 1) 5-15g fast acting oral carbohydrate (eg: Lucozade, sugar lumps, Dextrosol, followed by biscuits & milk)
- 26. 2) Glucagon 1mg: SC, IM or IV – Can be administered by relatives or ambulance crew if difficult venous access. – Response to this is slower than IV dextrose, need 7- 10min until normal mental status – Will not work with alcoholics, elderly & depleted glycogen store
- 27. 3) Glucose 10% solution 50ml IV repeated at 1-2min interval until patient fully conscious 4) Glucose 50% solution hypertonic & no more effective than glucose 10% (if used, give into large vein & follow with saline flush) 5) Octreotide (synthetic analog of somatostatin) – Inhibit release of insulin – Used in treatment of sulfonylurea-induced hypoglycaemia – Only consider if doesn’t respond to dextrose
- 28. WARNING! Persistence of an altered conscious level • Suggest underlying pathology (stroke), development of cerebral edema due to hypoglycaemia (high mortality) • Maintain plasma glucose at 7- 11mmol/L • Contact ICU & consider mannitol or dexamethasone • CT scan
- 29. DISCHARGE
- 30. 90% patient fully recover in 20 minutes
- 31. When hypoglycemic cause is identified & fully corrected, patient can be discharged after observation at ED & appropriate follow up.
- 32. Arrange follow up having considered the following: Why did this episode occur? Has there been any recent change of regimen, other drugs, alcohol, etc? Is the patient developing hypoglycemic unawareness or autonomic dysfunction?
- 33. Referenc es • Tintinalli’s Emergency Medicine, A Comprehensive Study Guide, 6th edition, McGraw Hill publication. • Oxford Handbook of Emergency Medicine, 4th edition, Oxford university press publisher.