Diabetic Ketoacidosis (DKA)

Diabetic Ketoacidosis (DKA) Physiology: Hyperglycemia: ➧ Increased hepatic production of glucose. ➧ Diminished glucose uptake by peripheral tissues. ➧ Insulinopenia / Hyperglucagonemia. Ketoacidemia: ➧ The ketoacid is acetoacetic acid. The byproduct is acetone. The non-keto-acid is beta-hydroxybutyric acid. ➧ Increased lipolysis and hepatic ketogenesis ➧...

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Hypoglycemic Coma

Hypoglycemic ComaHypoglycemia in Type I DM: ➧ Common in patients intensively controlled with insulin. ➧ Asymptomatic blood glucose levels of < 50 mg/dL occur daily in up to 56% of patients. ➧ Symptomatic hypoglycemia occurs 2X/week on average. Severe Hypoglycemia: ➧ An episode requires intervention by another person for the patient to recover function. Causes of...

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Acute Hypocalcemia

Acute Hypocalcemia Causes: 1-Hypoparathyroidism ➧ Destruction of parathyroids (most commonly surgical – parathyroid resection or accidental). ➧ Acute hypomagnesemia 2-Reduced 1,25 (OH) vit D 3-Chronic renal insufficiency ➧ Acute systemic illness ➧ Drugs: ketoconazole, doxorubicin, cytarabine ➧ Increased uptake of Ca in bone ➧ Osteoblastic metastases ➧ Hungry...

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Acute Hypercalcemia

Acute Hypercalcemia Most Common Causes: 1-Endocrine: ➧ Hyperparathyroidism ➧ MEN ➧ PTH-related peptide (PTHrP) by solid tumors 2-Neoplastic: ➧ Ca with bone metastases ➧ Myeloma 3-Granulomatous: ➧ Sarcoidosis  ➧ Tuberculosis Clinical picture: ➧ History of polyuria and polydipsia  ➧ Dehydration ➧ Bone pain ➧ Confusion ➧ Anorexia  ➧...

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Thyroid Storm

Thyroid Storm Definition: ➧ Acute life-threatening exacerbation of thyrotoxicosis Precipitating factors: ➧ Withdrawal of antithyroid drugs ➧ Severe infection ➧ Diabetic ketoacidosis (DKA) ➧ Cerebro-vascular accident (CVA) ➧ Cardiac failure ➧ Surgery ➧ Trauma  ➧ Radioiodine ➧ Drug reaction ➧ Iodinated contrast medium Clinical picture: ➧ Patient with Graves disease who has discontinued antithyroid medication OR is previously...

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Myxedema Coma

Myxedema Coma Definition: ➧ The end-stage of untreated or insufficiently treated hypothyroidism. Pathogenesis of Myxedema: (Figure 1) Figure 1: Pathogenesis of Myxedema Coma Precipitating factors: ➧ CVA ➧ Myocardial infarction ➧ Infection (UTI, Pneumonia) ➧ Gastrointestinal hemorrhage ➧ Acute trauma ➧ Administration of sedative, narcotic, or potent diuretics Typical...

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Acute Adrenal Insufficiency

Acute Adrenal Insufficiency Causes: ➧ Usually presents as an acute process in a patient with underlying chronic adrenal insufficiency ➧ Causes of Primary adrenal insufficiency:    - Auto-immune    - TB of adrenals    - Metastatic malignancy to adrenals ➧ Causes of Secondary or Tertiary adrenal insufficiency    - Pituitary or hypothalamic disease ➧ Acute destruction of the adrenals...

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