Fatima was brought confused

Fatima was brought confused

1. Confusion

   • Differential diagnosis
     • CNS disorders
       • Vascular
         • Hemorrage
         • Encephalopathy
       • Infections
         • Meningitis
         • Encephalitis
       • Head trauma
       • Epilepsy
       • TIA
     • Metabolic causes
       • Hypoglycemia
       • Electrolyte imbalance
       • Hyperglycemia
         • 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
         • 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
       • hypoxia
       • Endocrine disorders
     • medications
       • Anticholinergics
     • Withdrawl
       • Alcohol
     • Drug Abuse
       • opoids
     • MI

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