Fatima was brought confused

Confusion
1. Differential diagnosis
  1. CNS disorders
    1. Vascular
      1. Hemorrage
      2. Encephalopathy
    2. Infections
      1. Meningitis
      2. Encephalitis
    3. Head trauma
    4. Epilepsy
    5. TIA
  2. Metabolic causes
    1. Hypoglycemia
    2. Electrolyte imbalance
    3. Hyperglycemia
      1. Diabetes
        pancrease
        Anatomy
        Histology
        Millions of islets found in pancreatic tissue
        Beta cells: Insulin
        Centrally located
        Alpha cells: Glucagon
        Delta cells: Somatostatin
        PP cells: pancreatic polypeptide
        Epsilon cells: ghrelin
        Regulation of glucose
        Hormones decrease serum glucose
        Insulin
        Amylin
        GIP
        GLP-1
        Hormones increase serum glucose
        Glucagon
        Cortisol
        Epinephrine
        Growth Hormone
        Bichemistry
        Gluconeogenesis
        glycogenolysis
        Carbohydrate, Protein and Fat Metabolism In The Well Fed State
        Hormonal Regulation of Carbohydrate Metabolism
        Insulin
        Increase glycogen synthesis\ Increase glycolysis\ Stimulate PPP\ Decrease glycogenolysis\ Decrease gluconeogenesis
        Glucagon
        Decrease glycogen synthesis\ Increase glycogenolysis\ Increase gluconeogenesis
        Epinephrine
        Decrease glycogen synthesis\ Increase glycogenolysis\ Increase gluconeogenesis
        Cortisol
        Increase glycogenolysis Increase gluconeogenesis
        Growth hormone
        Increase glycogenolysis Increase gluconeogenesis
        Thyroid hormone
        Increase glycogenolysis Increase gluconeogenesis
      2. Cause Polyuria
        Diabetes
        Epidemiology
        The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
        Rate of diagnosed diabetes is 15.1% of American Indians/Alaskan Natives
        in 2017, 17.3% of the UAE population between the ages of 20 and 79 have type 2 diabetes.
        There are over 1 million people living with diabetes in the UAE
        the country 15th worldwide for age-adjusted comparative prevalence.
        Types
        Type 1
        Immune mediated
        Idiopathic
        LADA (1.5)
        Etiology and pathogensis
        Insulin - dependent diabetes mellitus
        Strong association with HLA
        Autoimmunity “Evidence
        Autoantibodies: GAD65 / Insulin / Tyrosine phosphatases IA-2 /ZnT8
        Lymphocytic infiltration (Insulitis)
        Other autoimmune diseases
        Environmental factors
        Virus infection: Islet cell injury / Molecular mimicry / Precipitating virus
        Chemicals/Drugs: Streptozotocin / Alloxan / Pentamidine
        Type 2
        Insulin resistance
        Secretory defect
        Etiology and pathogensis
        Genetic factors
        Environmental factors
        Obesity
        Physical activity
        Psychosocial stress
        Abnormal insulin secretion
        Insulin resistance
        Reduced number of receptors
        Abnormally functioning receptors
        Post-receptor defects associated with normal insulin binding
        Gestational
        Due to hormones
        Monogenic
        MODY
        Permanent Neonatal diabetes
        Mitochondrial diabetes
        Secondary
        Pancreatic disease / Endocrinopathies / Drug induced / Insulin action / Genetics syndromes / Infection
        Clinical presentation
        investigation
        Fasting plasma glucose test
        after fasting for at least 8 hours
        Random plasma glucose test
        Oral glucose tolerance test
        Oral glucose load administered
        Plasma glucose measured 1-3 hours later
        Often used to screen for gestational diabetes
        Hemoglobin A1C
        Reflects average glucose over past 3 months
        Important for monitoring therapy
        Other special tests
        Other tests
        Management
        Lifestyle modification
        Oral hypoglycemics
        Insulin therapy
        Pancreatic transplant
        Indications
        Type 1 diabetes that can't be controlled with standard treatment
        Frequent insulin reactions
        Consistently poor blood sugar control
        Severe kidney damage
        Type 2 diabetes associated with both low insulin resistance and low insulin production
        Complications
        Blood clots\ Bleeding\ Infection\ hyperglycemia\ Urinary complications, including leaking or urinary tract infections\ Failure of the donated pancreas\ Rejection of the donated pancreas
        Management of HTN in diabetes
        Complications
        Diabetic Ketoacidosis
        Free fatty acids released in the periphery are bound to albumin and transported to the liver, converted to ketone bodies.
        The primary ketone bodies β-hydroxybutyrate (βHB) and acetoacetic acid (AcAc) account for the metabolic acidosis seen in DKA. AcAc is metabolized to acetone, another major ketone body.
        Increased ketogenesis. Low insulin levels decrease the ability of the brain and cardiac and skeletal muscle to use ketones as an energy source, increasing ketonemia.
        Hyperglycemia will cause osmotic diuresis resulting in volume depletion.
        As adipose tissue is broken down, prostaglandins I2 and E2 are produced. Both account for the paradoxical vasodilation that occurs despite profound levels of volume depletion.
        High concentrations of ketones can make the urine acidic and cause fruity-smelling breath
        If not managed, this condition can progress to coma (prolonged unconsciousness) and even death.
        Primary Polydipsia
        Central and Nephrogenic Diabetes Insipidus
        Diuretics / Caffeine / Ethanol
    4. hypoxia
    5. Endocrine disorders
  3. medications
    1. Anticholinergics
  4. Withdrawl
    1. Alcohol
  5. Drug Abuse
    1. opoids
  6. MI

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	Criado por hamda ali mais de 5 anos atrás