Addison's Disesase Management (Precise)
•Download as PPTX, PDF•
1 like•296 views
This document discusses investigations and management for chronic and acute adrenal insufficiency. For chronic illness, it recommends completing blood tests like a complete blood count, electrolytes, and thyroid and hormone function tests. It also recommends assessing glucocorticoid, mineralocorticoid and gonadocorticoid levels. For management of chronic illness, it recommends glucocorticoid replacement therapy with hydrocortisone, mineralocorticoid replacement with fludrocortisone, and androgen replacement if needed. For acute illness or adrenal crisis, it recommends immediate treatment, glucocorticoid replacement, correcting other abnormalities, and identifying the underlying cause.
Report
Share
Report
Share
Recommended
A review article on adrenal crisis nejm 2019
This is a review article on adrenal crisis by R. Louise Rushworth, M.B., B.S., Ph.D., David J. Torpy, M.B., B.S., Ph.D., and Henrik Falhammar, M.D., Ph.D. It was published on The New England Journal of Medicine 381;9 AUGUST 29, 2019. I presented the article on one of our morning sessions.
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.
Perioperative management of a patient with diabetes mellitus
This document discusses the perioperative management of patients with diabetes mellitus. It begins by outlining the WHO diagnostic criteria for diabetes. It then discusses the implications of surgery for diabetic patients, including risks of stress-induced hyperglycemia and hypoglycemia. The document provides guidance on preoperative evaluation and investigations for these patients. It covers anesthetic management principles including glucose control and the effects of anesthetic drugs on blood sugar. Finally, it describes diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state.
ABG analysis
Arterial blood gas analysis is used to determine acid-base imbalances and assess respiratory function. It involves puncturing an artery, usually the radial or femoral, to collect a blood sample. The sample is analyzed to determine levels of pH, oxygen, and carbon dioxide, providing information about conditions like respiratory failure or sepsis. Precautions must be taken to prevent complications from the puncture site and ensure proper blood flow to the hand is maintained.
IABP SHOCK II LONG TERM RESULTS
This document summarizes the journal club discussion on the long term results of the IABP-SHOCK II trial. The trial found no mortality benefit of intra-aortic balloon pump (IABP) counterpulsation compared to standard medical care in patients with cardiogenic shock. Mortality remained high at 6 years of follow up in both groups. While IABP appears to improve hemodynamics, it did not translate into improved survival or quality of life outcomes. Guidelines now recommend against routine use of IABP for cardiogenic shock.
Module 8 sepsis v2
This document provides guidance on resuscitation for patients with sepsis and septic shock. It discusses recognizing sepsis and shock, delivering early targeted resuscitation within 1-6 hours through fluid administration and vasopressors/inotropes, and monitoring patients to meet resuscitation targets like blood pressure and urine output. It also covers special considerations for resuscitating pregnant women and pediatric patients with shock. The goal is to treat infection and tissue hypoperfusion through prompt antimicrobial therapy and resuscitation to prevent organ dysfunction.
Myxedma crisis
A 73-year-old male presented with shortness of breath, cough, confusion and swelling throughout his body. His medical history included a pacemaker implantation and swelling below his eyes. Diagnostic tests found elevated cardiac and liver enzymes, low blood sugar and cortisol levels, and imaging showed pneumonia. He developed respiratory failure, heart issues, stroke and constipation over five days in the hospital. The patient was diagnosed with myxedema crisis, a life-threatening condition caused by severe hypothyroidism that affects multiple organ systems, which was likely precipitated by his pneumonia.
Parenteral Nutrition - Monitoring and Guidelines
This document discusses parenteral nutrition, including its indications, types, components, guidelines for administration and monitoring. Parenteral nutrition involves intravenous delivery of nutrients like protein, carbohydrates and fat. It is used when oral or enteral nutrition is not possible. The document outlines the different types of parenteral access, infusion schedules, nutrient components and their daily requirements. It also discusses complications of parenteral nutrition and their management. Studies have found that initiating parenteral nutrition later, around day 8, in critically ill pediatric patients results in fewer infections and shorter hospital stays compared to early initiation within 24 hours.
Recommended
A review article on adrenal crisis nejm 2019
This is a review article on adrenal crisis by R. Louise Rushworth, M.B., B.S., Ph.D., David J. Torpy, M.B., B.S., Ph.D., and Henrik Falhammar, M.D., Ph.D. It was published on The New England Journal of Medicine 381;9 AUGUST 29, 2019. I presented the article on one of our morning sessions.
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.
Perioperative management of a patient with diabetes mellitus
This document discusses the perioperative management of patients with diabetes mellitus. It begins by outlining the WHO diagnostic criteria for diabetes. It then discusses the implications of surgery for diabetic patients, including risks of stress-induced hyperglycemia and hypoglycemia. The document provides guidance on preoperative evaluation and investigations for these patients. It covers anesthetic management principles including glucose control and the effects of anesthetic drugs on blood sugar. Finally, it describes diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state.
ABG analysis
Arterial blood gas analysis is used to determine acid-base imbalances and assess respiratory function. It involves puncturing an artery, usually the radial or femoral, to collect a blood sample. The sample is analyzed to determine levels of pH, oxygen, and carbon dioxide, providing information about conditions like respiratory failure or sepsis. Precautions must be taken to prevent complications from the puncture site and ensure proper blood flow to the hand is maintained.
IABP SHOCK II LONG TERM RESULTS
This document summarizes the journal club discussion on the long term results of the IABP-SHOCK II trial. The trial found no mortality benefit of intra-aortic balloon pump (IABP) counterpulsation compared to standard medical care in patients with cardiogenic shock. Mortality remained high at 6 years of follow up in both groups. While IABP appears to improve hemodynamics, it did not translate into improved survival or quality of life outcomes. Guidelines now recommend against routine use of IABP for cardiogenic shock.
Module 8 sepsis v2
This document provides guidance on resuscitation for patients with sepsis and septic shock. It discusses recognizing sepsis and shock, delivering early targeted resuscitation within 1-6 hours through fluid administration and vasopressors/inotropes, and monitoring patients to meet resuscitation targets like blood pressure and urine output. It also covers special considerations for resuscitating pregnant women and pediatric patients with shock. The goal is to treat infection and tissue hypoperfusion through prompt antimicrobial therapy and resuscitation to prevent organ dysfunction.
Myxedma crisis
A 73-year-old male presented with shortness of breath, cough, confusion and swelling throughout his body. His medical history included a pacemaker implantation and swelling below his eyes. Diagnostic tests found elevated cardiac and liver enzymes, low blood sugar and cortisol levels, and imaging showed pneumonia. He developed respiratory failure, heart issues, stroke and constipation over five days in the hospital. The patient was diagnosed with myxedema crisis, a life-threatening condition caused by severe hypothyroidism that affects multiple organ systems, which was likely precipitated by his pneumonia.
Parenteral Nutrition - Monitoring and Guidelines
This document discusses parenteral nutrition, including its indications, types, components, guidelines for administration and monitoring. Parenteral nutrition involves intravenous delivery of nutrients like protein, carbohydrates and fat. It is used when oral or enteral nutrition is not possible. The document outlines the different types of parenteral access, infusion schedules, nutrient components and their daily requirements. It also discusses complications of parenteral nutrition and their management. Studies have found that initiating parenteral nutrition later, around day 8, in critically ill pediatric patients results in fewer infections and shorter hospital stays compared to early initiation within 24 hours.
Comatose patient case discussion
This document discusses the case of a 34-year-old male found unconscious after ingesting radiator fluid. The patient presents with coma, hypothermia, respiratory distress, renal failure, and a high anion gap metabolic acidosis. Laboratory findings include an elevated osmolal gap and normal arterial blood gases. The registrar analyzes the patient's condition and laboratory results, determining the likely diagnosis is ethylene glycol poisoning presenting late with complications including aspiration pneumonia and renal failure. Immediate management should include interventions for hypothermia, renal replacement therapy, and antidote therapy with fomipizole or ethanol infusion.
Pals 2017 post arrest
This document provides guidelines for post-arrest care in pediatric patients. It outlines recommendations for respiratory care to maintain oxygen saturation between 94-99% and use of inotropic drugs like milrinone and epinephrine for cardiac care. It also discusses guidelines for neurological care, ongoing assessment, and treatment of hypotension. Specific recommendations are provided for ventilation, drug therapies including epinephrine, dopamine, norepinephrine and factors influencing outcomes. Targeted temperature management and control of blood glucose are also addressed.
Anesthetic considerations for endocrine diseases – an overview
This document provides an overview of anesthetic considerations for various endocrine diseases. It discusses the perioperative management of diabetes mellitus, thyroid diseases including hyperthyroidism and hypothyroidism, adrenal cortical diseases such as Cushing's syndrome and Conn's syndrome, adrenal medulla diseases including pheochromocytoma, and pituitary diseases. The goals of anesthesia for patients with endocrine diseases are to maintain appropriate glycemic and electrolyte control, minimize further organ damage, and carefully titrate medications due to altered drug sensitivities.
Future of Hyertension
- Uncontrolled hypertension affects 30-45% of the population and 10-15% have treatment resistant hypertension. Only 6 new drugs have been approved since 2001 to treat hypertension.
- Future management may include telemonitoring blood pressure using mobile apps to engage patients. Interventional therapies like baroreceptor activation therapy, renal denervation, and ROX coupler implantation are being studied for resistant hypertension.
- Chronotherapy using timed drug administration and endothelin receptor antagonists are also potential future strategies. Researchers are working on a vaccine against the renin-angiotensin system to control blood pressure long-term.
Salon b 15 kasim 10.45 12.00 yusuf savran-ing
This document discusses guidelines for admission to the intensive care unit (ICU). It presents four priority levels for ICU admission. Priority 1 patients are critically ill and unstable, requiring intensive treatments like ventilator support that cannot be provided elsewhere. Priority 2 patients need close monitoring and may need urgent intervention for acute illnesses complicating chronic conditions. Priority 3 patients are critically ill but have a low likelihood of recovery due to underlying illness. Priority 4 patients generally should not be admitted to the ICU as they will not benefit from intensive care. The document also outlines diagnosis- and parameter-based models for determining ICU admission.
Major case chc
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
Salicylate overdose 2
This document provides an overview of salicylate (aspirin) overdose or toxicity. It discusses the therapeutic uses and inherent toxicity of salicylates. It covers the pathophysiology, diagnosis, clinical presentation, and treatment of both acute and chronic salicylate poisoning. Symptoms can involve multiple organ systems. Treatment focuses on decontamination, fluid resuscitation, urinary alkalinization, and hemodialysis in severe cases. Prognosis is generally good for acute overdoses but worse for chronic poisoning.
Hypertensive disorders in pregnancy
Hypertensive disorders in pregnancy are classified into four main categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to maternal endothelial dysfunction and is a leading cause of maternal and fetal morbidity and mortality. Risk factors include obesity, family history, and chronic hypertension. Treatment involves frequent monitoring, antihypertensive medications like labetalol, methyldopa, and nifedipine, and delivery if condition worsens or reaches term.
Perioperative Management of Diabetes Mellitus
Three key points about managing diabetes in surgical patients:
1. Surgery causes stress responses that can worsen blood sugar control and increase insulin resistance. Tight control is important to reduce complications.
2. The document provides guidelines for managing diabetes in both major and minor surgeries, including adjusting insulin doses pre-operatively and monitoring blood sugar closely during and after surgery.
3. For major surgeries, an insulin-glucose infusion is recommended starting before surgery and continuing for at least 24 hours post-operatively to maintain tight control and prevent hyperglycemia from worsening outcomes.
Perioperative Diabetes Management in Patients on Insulin
In these annotated PowerPoints I discuss the control of diabetes in the perioperative period in patients taking insulin. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
Screening of antihypertensiveagent by raunak
Sirt3 reduces vascular dysfunction and hypertension by regulating mitochondrial function and reducing oxidative stress. Sirt3 depletion is linked to vascular inflammation and oxidative stress in essential hypertension. Preclinical screening of antihypertensive agents involves testing potential drugs in animal models to evaluate safety before human clinical trials. Various in vivo and in vitro animal models are used to predict antihypertensive effects, including genetic, dietary, and surgically-induced models of hypertension in rats, dogs, and other species.
RENAL DENERAVTION IN HTN
This document summarizes the Simplicity HTN-2 and Simplicity HTN-3 clinical trials that evaluated the effectiveness of renal denervation for treating resistant hypertension. The Simplicity HTN-2 trial found that renal denervation significantly reduced blood pressure in patients with resistant hypertension compared to a control group. However, the larger Simplicity HTN-3 trial, which was blinded and sham-controlled, did not find a significant reduction in blood pressure between the renal denervation and sham groups at 6 months.
Disorder of cardiovascular system
This document summarizes several common cardiovascular disorders. It begins by describing congenital heart defects, including atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and aortic stenosis. It then discusses cyanotic heart defects such as tetralogy of Fallot, pulmonary stenosis, and tricuspid atresia. For each condition, it provides details on clinical features, diagnostic evaluation, and medical or surgical management approaches. The goal of treatment is to correct defects and restore proper blood flow and oxygen circulation through the heart and body.
Renal ablation.E. Infante de Oliveira
This document describes renal ablation as a new approach for treating resistant hypertension. It begins by providing epidemiological data on hypertension, noting that only half of treated hypertensive patients achieve blood pressure control. It then discusses the role of the kidneys and renal sympathetic nerves in hypertension, and how ablation of these nerves using a catheter-based radiofrequency approach was found to significantly reduce renal norepinephrine levels in preclinical studies. The document outlines the clinical trial program evaluating renal denervation and presents baseline characteristics of patients in the Symplicity HTN-1 study, the first clinical trial to evaluate this approach.
Endocrine hypertension By Abdul Qahar
Endocrine hypertension By Abdul QaharAbdul Qahar {{Abdul Wali Khan University Mardan}} (Buner Campus)
The document discusses endocrine hypertension and provides an overview of the endocrine system and what high blood pressure and prehypertension are. It defines hypertension and discusses classifications of blood pressure. It notes that hypertension has no cure but can be prevented and managed. It provides prevalence statistics and discusses types of hypertension including primary, secondary, essential, and idiopathic hypertension. It describes some specific causes of secondary hypertension like pheochromocytoma, aldosterone, Cushing's syndrome, and renal issues. It outlines the renin-angiotensin system and discusses management of hypertension through lifestyle changes and drug treatments.Therapeutic hypothermia for postresuscitation syndrome and lactate levels
This document discusses therapeutic hypothermia for postresuscitation syndrome and lactate levels. It describes how therapeutic hypothermia between 32-34°C for 12-24 hours after return of spontaneous circulation can improve outcomes for comatose cardiac arrest patients by reducing metabolic rate, oxygen consumption, free radical production and other injury mechanisms. It also notes that induced hypothermia lowers lactate levels by decreasing the rate of anaerobic glycolysis during ischemia.
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
pulmonary embolism emergency protocol
This document provides guidance on managing acute pulmonary embolism. It outlines that pulmonary embolism should be considered for any patient presenting with acute shortness of breath. It recommends assessing a patient's risk factors and vital signs, and using diagnostic tests like CT angiography and duplex ultrasonography according to the clinical probability of pulmonary embolism. It also provides treatment guidelines, noting that intravenous unfractionated heparin or subcutaneous low molecular weight heparin are effective initial treatments, while warfarin is recommended for long-term anticoagulation. Thrombolytic therapy may be considered for haemodynamically unstable patients.
Endocrine causes of hypertension
1. The document discusses hypertension in young patients from an endocrinologist's perspective and presents 5 case studies.
2. Case 1 involves a 25-year-old male with high blood pressure found on a pre-employment checkup, prompting evaluation for secondary causes of hypertension.
3. Case 2 is a 35-year-old male with signs and symptoms of Cushing's syndrome, which can cause high blood pressure.
Management of pulmonary artery hypertension
This document discusses the management of pulmonary artery hypertension. The goals of therapy are to prevent disease progression in stable patients through lifestyle changes and education, and to stabilize right-sided heart function, provide symptomatic relief, and improve hemodynamics in unstable patients. Treatment includes pharmacological therapies like prostanoids, endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, and soluble guanylate cyclase stimulators. Non-pharmacological options include oxygen supplementation and surgical interventions like balloon atrial septostomy and lung transplantation. Combination therapy with multiple drug classes may provide added benefits over monotherapy.
Endocrine disorders-Nursing Maseno.ppt11
This document provides an overview of endocrine disorders and endocrine system dysfunction. It discusses the roles of various hormones and endocrine glands like the hypothalamus, pituitary gland, thyroid gland, parathyroid glands, adrenal glands, and pancreas. It also summarizes different endocrine diseases, their signs and symptoms, diagnostic tests, and treatment and management approaches.
Adrenal insufficiency.pptx
This document discusses hypoadrenalism, including primary and secondary adrenal insufficiency. It notes that the adrenal cortex produces glucocorticoids, mineralocorticoids, and androgen precursors. Primary adrenal insufficiency can be caused by autoimmune adrenalitis, congenital adrenal hyperplasia, infections, tumors, or drugs. Secondary adrenal insufficiency results from hypothalamic-pituitary dysfunction. Symptoms include fatigue, low blood pressure, and electrolyte abnormalities. Treatment involves glucocorticoid and mineralocorticoid replacement therapy.
More Related Content
What's hot
Comatose patient case discussion
This document discusses the case of a 34-year-old male found unconscious after ingesting radiator fluid. The patient presents with coma, hypothermia, respiratory distress, renal failure, and a high anion gap metabolic acidosis. Laboratory findings include an elevated osmolal gap and normal arterial blood gases. The registrar analyzes the patient's condition and laboratory results, determining the likely diagnosis is ethylene glycol poisoning presenting late with complications including aspiration pneumonia and renal failure. Immediate management should include interventions for hypothermia, renal replacement therapy, and antidote therapy with fomipizole or ethanol infusion.
Pals 2017 post arrest
This document provides guidelines for post-arrest care in pediatric patients. It outlines recommendations for respiratory care to maintain oxygen saturation between 94-99% and use of inotropic drugs like milrinone and epinephrine for cardiac care. It also discusses guidelines for neurological care, ongoing assessment, and treatment of hypotension. Specific recommendations are provided for ventilation, drug therapies including epinephrine, dopamine, norepinephrine and factors influencing outcomes. Targeted temperature management and control of blood glucose are also addressed.
Anesthetic considerations for endocrine diseases – an overview
This document provides an overview of anesthetic considerations for various endocrine diseases. It discusses the perioperative management of diabetes mellitus, thyroid diseases including hyperthyroidism and hypothyroidism, adrenal cortical diseases such as Cushing's syndrome and Conn's syndrome, adrenal medulla diseases including pheochromocytoma, and pituitary diseases. The goals of anesthesia for patients with endocrine diseases are to maintain appropriate glycemic and electrolyte control, minimize further organ damage, and carefully titrate medications due to altered drug sensitivities.
Future of Hyertension
- Uncontrolled hypertension affects 30-45% of the population and 10-15% have treatment resistant hypertension. Only 6 new drugs have been approved since 2001 to treat hypertension.
- Future management may include telemonitoring blood pressure using mobile apps to engage patients. Interventional therapies like baroreceptor activation therapy, renal denervation, and ROX coupler implantation are being studied for resistant hypertension.
- Chronotherapy using timed drug administration and endothelin receptor antagonists are also potential future strategies. Researchers are working on a vaccine against the renin-angiotensin system to control blood pressure long-term.
Salon b 15 kasim 10.45 12.00 yusuf savran-ing
This document discusses guidelines for admission to the intensive care unit (ICU). It presents four priority levels for ICU admission. Priority 1 patients are critically ill and unstable, requiring intensive treatments like ventilator support that cannot be provided elsewhere. Priority 2 patients need close monitoring and may need urgent intervention for acute illnesses complicating chronic conditions. Priority 3 patients are critically ill but have a low likelihood of recovery due to underlying illness. Priority 4 patients generally should not be admitted to the ICU as they will not benefit from intensive care. The document also outlines diagnosis- and parameter-based models for determining ICU admission.
Major case chc
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
Salicylate overdose 2
This document provides an overview of salicylate (aspirin) overdose or toxicity. It discusses the therapeutic uses and inherent toxicity of salicylates. It covers the pathophysiology, diagnosis, clinical presentation, and treatment of both acute and chronic salicylate poisoning. Symptoms can involve multiple organ systems. Treatment focuses on decontamination, fluid resuscitation, urinary alkalinization, and hemodialysis in severe cases. Prognosis is generally good for acute overdoses but worse for chronic poisoning.
Hypertensive disorders in pregnancy
Hypertensive disorders in pregnancy are classified into four main categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to maternal endothelial dysfunction and is a leading cause of maternal and fetal morbidity and mortality. Risk factors include obesity, family history, and chronic hypertension. Treatment involves frequent monitoring, antihypertensive medications like labetalol, methyldopa, and nifedipine, and delivery if condition worsens or reaches term.
Perioperative Management of Diabetes Mellitus
Three key points about managing diabetes in surgical patients:
1. Surgery causes stress responses that can worsen blood sugar control and increase insulin resistance. Tight control is important to reduce complications.
2. The document provides guidelines for managing diabetes in both major and minor surgeries, including adjusting insulin doses pre-operatively and monitoring blood sugar closely during and after surgery.
3. For major surgeries, an insulin-glucose infusion is recommended starting before surgery and continuing for at least 24 hours post-operatively to maintain tight control and prevent hyperglycemia from worsening outcomes.
Perioperative Diabetes Management in Patients on Insulin
In these annotated PowerPoints I discuss the control of diabetes in the perioperative period in patients taking insulin. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
Screening of antihypertensiveagent by raunak
Sirt3 reduces vascular dysfunction and hypertension by regulating mitochondrial function and reducing oxidative stress. Sirt3 depletion is linked to vascular inflammation and oxidative stress in essential hypertension. Preclinical screening of antihypertensive agents involves testing potential drugs in animal models to evaluate safety before human clinical trials. Various in vivo and in vitro animal models are used to predict antihypertensive effects, including genetic, dietary, and surgically-induced models of hypertension in rats, dogs, and other species.
RENAL DENERAVTION IN HTN
This document summarizes the Simplicity HTN-2 and Simplicity HTN-3 clinical trials that evaluated the effectiveness of renal denervation for treating resistant hypertension. The Simplicity HTN-2 trial found that renal denervation significantly reduced blood pressure in patients with resistant hypertension compared to a control group. However, the larger Simplicity HTN-3 trial, which was blinded and sham-controlled, did not find a significant reduction in blood pressure between the renal denervation and sham groups at 6 months.
Disorder of cardiovascular system
This document summarizes several common cardiovascular disorders. It begins by describing congenital heart defects, including atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and aortic stenosis. It then discusses cyanotic heart defects such as tetralogy of Fallot, pulmonary stenosis, and tricuspid atresia. For each condition, it provides details on clinical features, diagnostic evaluation, and medical or surgical management approaches. The goal of treatment is to correct defects and restore proper blood flow and oxygen circulation through the heart and body.
Renal ablation.E. Infante de Oliveira
This document describes renal ablation as a new approach for treating resistant hypertension. It begins by providing epidemiological data on hypertension, noting that only half of treated hypertensive patients achieve blood pressure control. It then discusses the role of the kidneys and renal sympathetic nerves in hypertension, and how ablation of these nerves using a catheter-based radiofrequency approach was found to significantly reduce renal norepinephrine levels in preclinical studies. The document outlines the clinical trial program evaluating renal denervation and presents baseline characteristics of patients in the Symplicity HTN-1 study, the first clinical trial to evaluate this approach.
Endocrine hypertension By Abdul Qahar
Endocrine hypertension By Abdul QaharAbdul Qahar {{Abdul Wali Khan University Mardan}} (Buner Campus)
The document discusses endocrine hypertension and provides an overview of the endocrine system and what high blood pressure and prehypertension are. It defines hypertension and discusses classifications of blood pressure. It notes that hypertension has no cure but can be prevented and managed. It provides prevalence statistics and discusses types of hypertension including primary, secondary, essential, and idiopathic hypertension. It describes some specific causes of secondary hypertension like pheochromocytoma, aldosterone, Cushing's syndrome, and renal issues. It outlines the renin-angiotensin system and discusses management of hypertension through lifestyle changes and drug treatments.Therapeutic hypothermia for postresuscitation syndrome and lactate levels
This document discusses therapeutic hypothermia for postresuscitation syndrome and lactate levels. It describes how therapeutic hypothermia between 32-34°C for 12-24 hours after return of spontaneous circulation can improve outcomes for comatose cardiac arrest patients by reducing metabolic rate, oxygen consumption, free radical production and other injury mechanisms. It also notes that induced hypothermia lowers lactate levels by decreasing the rate of anaerobic glycolysis during ischemia.
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
pulmonary embolism emergency protocol
This document provides guidance on managing acute pulmonary embolism. It outlines that pulmonary embolism should be considered for any patient presenting with acute shortness of breath. It recommends assessing a patient's risk factors and vital signs, and using diagnostic tests like CT angiography and duplex ultrasonography according to the clinical probability of pulmonary embolism. It also provides treatment guidelines, noting that intravenous unfractionated heparin or subcutaneous low molecular weight heparin are effective initial treatments, while warfarin is recommended for long-term anticoagulation. Thrombolytic therapy may be considered for haemodynamically unstable patients.
Endocrine causes of hypertension
1. The document discusses hypertension in young patients from an endocrinologist's perspective and presents 5 case studies.
2. Case 1 involves a 25-year-old male with high blood pressure found on a pre-employment checkup, prompting evaluation for secondary causes of hypertension.
3. Case 2 is a 35-year-old male with signs and symptoms of Cushing's syndrome, which can cause high blood pressure.
Management of pulmonary artery hypertension
This document discusses the management of pulmonary artery hypertension. The goals of therapy are to prevent disease progression in stable patients through lifestyle changes and education, and to stabilize right-sided heart function, provide symptomatic relief, and improve hemodynamics in unstable patients. Treatment includes pharmacological therapies like prostanoids, endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, and soluble guanylate cyclase stimulators. Non-pharmacological options include oxygen supplementation and surgical interventions like balloon atrial septostomy and lung transplantation. Combination therapy with multiple drug classes may provide added benefits over monotherapy.
What's hot (20)
Anesthetic considerations for endocrine diseases – an overview
Anesthetic considerations for endocrine diseases – an overview
Perioperative Diabetes Management in Patients on Insulin
Perioperative Diabetes Management in Patients on Insulin
Therapeutic hypothermia for postresuscitation syndrome and lactate levels
Therapeutic hypothermia for postresuscitation syndrome and lactate levels
Similar to Addison's Disesase Management (Precise)
Endocrine disorders-Nursing Maseno.ppt11
This document provides an overview of endocrine disorders and endocrine system dysfunction. It discusses the roles of various hormones and endocrine glands like the hypothalamus, pituitary gland, thyroid gland, parathyroid glands, adrenal glands, and pancreas. It also summarizes different endocrine diseases, their signs and symptoms, diagnostic tests, and treatment and management approaches.
Adrenal insufficiency.pptx
This document discusses hypoadrenalism, including primary and secondary adrenal insufficiency. It notes that the adrenal cortex produces glucocorticoids, mineralocorticoids, and androgen precursors. Primary adrenal insufficiency can be caused by autoimmune adrenalitis, congenital adrenal hyperplasia, infections, tumors, or drugs. Secondary adrenal insufficiency results from hypothalamic-pituitary dysfunction. Symptoms include fatigue, low blood pressure, and electrolyte abnormalities. Treatment involves glucocorticoid and mineralocorticoid replacement therapy.
ADRENAL-1.pptx
This document discusses Cushing syndrome, which is caused by excessive cortisol production. It can be ACTH-dependent, caused by a pituitary adenoma or ectopic ACTH secretion, or ACTH-independent, caused by an adrenal adenoma or carcinoma. Workup involves tests like the dexamethasone suppression test. Treatment depends on the cause and may include surgery, chemotherapy, or medications. Side effects of excess cortisol include weight gain, high blood pressure, and mood changes. The document also discusses therapeutic uses of glucocorticoids and their potential adverse effects.
Addison disease by dr shahjada selim
- A 40-year-old patient presented with low-grade fever, coughing up blood, and weight loss. Tests showed signs of tuberculosis (TB) and the patient was started on anti-TB drugs. However, the patient died suddenly after 3 days of treatment.
- Addison's disease is a condition caused by insufficient production of hormones by the adrenal glands. It was first described by Dr. Thomas Addison in the 19th century. Common causes include autoimmune disease and TB infection of the adrenal glands.
- Without treatment, Addison's disease can cause low blood pressure, low blood sugar, high potassium levels, and even death. Treatment involves replacing glucocorticoid and
Endocrine Emergencies.pptx
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.
Malaria PRESENTATION.pptx
This document provides information on the clinical presentation, investigation, and treatment of malaria. It discusses how malaria commonly presents with symptoms like fever, chills, sweats, and headaches. It also covers severe complicated malaria and its symptoms. For investigation, it recommends examining blood films under microscopy, using rapid diagnostic tests, and PCR. It provides treatment guidelines for uncomplicated and severe falciparum malaria, including recommended drugs and dosages. It also discusses specific treatment considerations for populations like pregnant women, those with hepatic or renal impairment, children, and prevention through chemoprophylaxis.
ADRENAL INSUFFICIENCY - Clinical features , Evaluation & Management
A presentation about adrenal insufficiency , an endocrine disorder , based on Harrison's principles of internal medicine 21st edition.
Syndrome of inappropriate anti diuretic hormone secretion (siadh)
Syndrome of inappropriate anti diuretic hormone secretion (siadh)
Diagnosis
SIgns and Symptoms
Treatment
Hyperthyroidism- Grave's disease.pdf
The patient, a 52-year-old female with known renal failure and anemia, presented with symptoms of hyperthyroidism including palpitations, protruding eyes, and weight loss. Examination found an enlarged thyroid gland with scarring. Blood tests confirmed hyperthyroidism and prior history indicated Graves' disease treated with radioactive iodine. She was diagnosed with Graves' disease and hyperthyroidism, and started on carbimazole and propranolol. Her symptoms improved with antithyroid medication and supportive care.
adrenalcrisis-220627010816-f7d5cddb.pdf
This document summarizes adrenal gland function and adrenal insufficiency. It describes:
1) The adrenal glands produce cortisol, aldosterone, and androgens which regulate stress response, electrolyte balance, and sex characteristics.
2) Primary adrenal insufficiency results from adrenal gland dysfunction and causes deficiencies in cortisol, aldosterone, and sex hormones. Secondary adrenal insufficiency is caused by pituitary or hypothalamic disease and causes cortisol deficiency alone.
3) Adrenal crisis is a life-threatening emergency characterized by refractory hypotension that requires aggressive treatment with glucocorticoid replacement such as hydrocortisone.
Adrenal Crisis.pptx
This document summarizes adrenal gland function and adrenal insufficiency. It describes:
1) The adrenal glands produce cortisol, aldosterone, and androgens which regulate stress response, electrolyte balance, and sex characteristics.
2) Primary adrenal insufficiency results from adrenal gland dysfunction and causes decreased hormone production. Secondary insufficiency is caused by pituitary or hypothalamic disease and causes cortisol deficiency.
3) Adrenal crisis is a life-threatening emergency characterized by refractory hypotension that requires aggressive treatment with glucocorticoid replacement such as hydrocortisone.
Adrenal gland disorders
The document discusses several adrenal gland disorders including:
1. Addison's disease, which is caused by inadequate production of hormones by the adrenal glands due to problems with the pituitary gland or autoimmune destruction of the adrenal glands.
2. Cushing's syndrome, which is caused by excessive cortisol production from either benign or cancerous tumors of the adrenal glands or pituitary gland.
3. Pheochromocytoma, a rare tumor of the adrenal medulla that secretes excess catecholamines and causes symptoms like headaches and sweating.
4. Testing of the corticotropin-releasing factor is discussed as a way to diagnose hypothal
Toxicology Case by David Collins
This case discusses a 79-year-old man who presented with respiratory distress and declining kidney function. He had recently been treated for H. pylori infection with a "triple therapy" of antibiotics that included clarithromycin. His calcium channel blocker medication levels were likely elevated due to a drug interaction with clarithromycin. He developed hypotension, lactic acidosis, and kidney injury consistent with calcium channel blocker toxicity. Management involved fluids, vasopressors, glucagon, and eventually renal replacement therapy. The "triple therapy" he received for H. pylori likely caused an interaction that led to calcium channel blocker overdose and subsequent multi-organ dysfunction.
adrenal glands disorder
The adrenal glands are located above the kidneys and are divided into an outer cortex and inner medulla. The cortex secretes steroid hormones like cortisol and aldosterone which are regulated by the hypothalamus-pituitary-adrenal axis. The medulla secretes catecholamines which are regulated by the sympathetic nervous system. Diseases can result from hypofunction or hyperfunction of the adrenal cortex and include Addison's disease, Cushing's syndrome, Conn's syndrome and pheochromocytoma. Laboratory tests are used to diagnose the underlying cause and guide treatment options such as hormone replacement or surgery.
Oncological Emergencies
1. Oncological emergencies include life-threatening events in cancer patients caused by the malignancy or its treatment.
2. Common oncological emergencies include tumor lysis syndrome, hypercalcemia of malignancy, febrile neutropenia, and superior vena cava syndrome.
3. Tumor lysis syndrome occurs due to the rapid release of intracellular contents from dying tumor cells, causing electrolyte abnormalities. Hypercalcemia of malignancy is most commonly caused by parathyroid hormone-related protein overproduction. Febrile neutropenia is a common complication of chemotherapy. Superior vena cava syndrome involves extrinsic compression of the superior vena cava.
Malignant hyperthermia and dantrolene sodium
Malignant hyperthermia (MH) is a rare but serious genetic disorder triggered by certain anesthetic gases and succinylcholine. It results in excessive calcium accumulation in skeletal muscle and causes a hypermetabolic state. Signs include tachycardia, muscle rigidity, hyperthermia, and metabolic acidosis. Diagnosis is clinical based on signs during or after exposure to triggering agents in susceptible individuals. Treatment involves discontinuing triggers, aggressive cooling, hyperventilation to reduce CO2, and administration of dantrolene sodium which acts directly on skeletal muscle to reduce calcium accumulation and muscle contraction. Ongoing supportive care and monitoring is required to prevent complications like rhabdomyolysis and renal failure.
Acute mi
This document discusses acute myocardial infarction (AMI), also known as a heart attack. It defines AMI as necrosis of cardiac muscle due to acute blockage of a coronary artery, usually from a ruptured atherosclerotic plaque forming a thrombus. It lists major risk factors and describes the pathophysiological changes that occur during AMI. It outlines diagnostic tests, treatment including thrombolysis or percutaneous coronary intervention, nursing management, and cardiac rehabilitation post-AMI.
Cushingssyndrome 160827080057
Cushing's syndrome is caused by chronic overexposure to cortisol and can be difficult to diagnose. It may be due to an ACTH-secreting pituitary adenoma (Cushing's disease), an ectopic ACTH-secreting tumor, or an adrenal tumor. Diagnostic tests include midnight salivary cortisol levels, dexamethasone suppression tests, and imaging of the pituitary and adrenal glands. Treatment depends on the cause but may involve surgery to remove tumors, radiation therapy, or medication to suppress cortisol levels. Even after successful treatment, patients remain at higher risk for cardiovascular disease.
Cushing's syndrome
Cushing's syndrome is caused by chronic overexposure to cortisol and can be difficult to diagnose. It may be pituitary-dependent (Cushing's disease), adrenal-dependent (adenoma or carcinoma), or caused by an ectopic ACTH-secreting tumor. Diagnostic tests include urine and salivary cortisol levels, low and high dose dexamethasone suppression tests, and imaging of the pituitary and adrenal glands. Treatment depends on the cause but may involve surgery to remove tumors, adrenalectomy, or medication to suppress cortisol production while managing comorbidities. The prognosis has improved with effective treatments but risks remain high without treatment.
Management of diabetes emergencies''
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.
Similar to Addison's Disesase Management (Precise) (20)
ADRENAL INSUFFICIENCY - Clinical features , Evaluation & Management
ADRENAL INSUFFICIENCY - Clinical features , Evaluation & Management
Syndrome of inappropriate anti diuretic hormone secretion (siadh)
Syndrome of inappropriate anti diuretic hormone secretion (siadh)
Recently uploaded
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Dr. ZANAB FARHEEN FAYAZ ,MDS(ORTHODONTICS & DENTOFACIAL ORTHOPEDICS ).
share - Lions, tigers, AI and health misinformation, oh my!.pptx
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
vonoprazan A novel drug for GERD presentation
Vonoprazan, a new potassium acid channel blocker used in the conditions of GERD and gastric ulcer, duodenal ulcer ....
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Adhd Medication Shortage Uk - trinexpharmacy.com
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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
10 Benefits an EPCR Software should Bring to EMS Organizations
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
une 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Recently uploaded (20)
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Addison's Disesase Management (Precise)
- 2. Investigations – Chronic illness • Complete Blood Count – RBC, TLC, DLC, peripheral smear, MCV, MCHC • Serum electrolyte • Blood glucose level • Thyroid Function test • Serology to detect auto antibodies • Tests for gonadal function • Insulin induced hypoglycemia test
- 3. • Assessment of glucocorticoids: – Short ACTH stmulation test – Long ACTH stimulation test • Assessment of mineralocorticoids: – Plasma renin activity – Aldosterone • Assessment of gonadocorticoids: – In females: DHEA and androstenedione – In males, not necessary
- 4. Investigations – Acute illness • Immediate treatment to be administered and a random blood sample to be taken for measurement of cortisol • It may be appropriate to perform short ACTH stimulation test before administering Hydrocortisone • Other investigations same as Chronic illness but results not awaited for treatment
- 5. Management – Adrenal Crisis • Correction of volume depletion – IV saline to normalise pulse and BP • Correction of glucocorticoids – 100mg IV stat after that 100-200mg IV divided 6th hrly or continuous infusion • Correction of other metabolic abnormalities – Hypoglycaemia and hyperkalaemia if persists • Identification of underlying cause and treatment – Acute precipitating cause eg infection, disease or surgery
- 6. Chronic Illness 1. Glucocorticoid replacement: – Daily oral administration of 15-25 mg hydrocortisone – Doubling of dose in intercurrent illnesses – IV 100 mg daily hydrocortisone given in cases of surgery, trauma etc – Patient to be made aware of the condition and carrying of steroid emergency card to be encouraged
- 7. • Mineralocorticoid replacement: – Initiated at a dose of 100-150μg of fluodrocortisone – Look for postural hypertension – Dosage increased in hot weather – Dosage also titered with dosage of glucocorticoids – May require adjusting during pregnancy – Electrolytes to be measured regularly – Renin levels to be kept in upper normal reference range
- 8. • Adrenal androgen replacement: – Rarely required – Mostly in women, 25-50mg OD DHEA – Monitored by measuring DHEA and androstenedione