Fatima was brought confused

Fatima was brought confused

1. Causes of confusion

   • Critical
     • Shock and hypoxia
       • Hypoglycemia
         • Head infections
           • Hypertensive encephalopathy
   • Emergent
     • Metabolic diseases
       • Hepatic encephalopathy/failure
         • Sepsis
           • Drugs and poisons

2. Insulin

   • Insulin activation
   • Insulin secretion mechanism

3. Diabetes

   • Types
   • Physical examination
     • Skin
       • Eyes
         • Feet assessment
         • Weight
       • Blood pressure
   • Investigations
     • Blood glucose : fasting glucose >126, Postprandial >200
       • HbA1C (glaciated hemoglobin)
         • Ketone testing
           • Urine for glucosurea and ketonurea
     • Complications
       • Small blood vessels
         • Hyaline arteriosclerosis
         • Efferent blood vessels
           • Nephrotic syndrome
         • Afferent blood vessels
           • glomerulosclerosis
             • Chronic renal failure
       • Osmotic damage PK-C pathway
         • Schwann cells
           • Loss of myelin in PNS
             • Neuropathies
         • lens
           • Cataract
         • Pericytes
           • aneurysms
             • Hemorrhage
               • Blindness
       • Management
         • Biguanides
           • GLP-1 receptor agonists
             • DPP-4 inhibitors
               • SGLT-2 inhibitors
             • Sulfonylureas
           • Insulin
             • Alpha glucosidase inhibitors

4. Hyperosmolar hyperglycemic state

   • A serious condition caused by extremely high blood sugar levels.
   • Causes
     • Illness or infection.
       • Not following a diabetes treatment plan
         • Certain medications
     • Labs
       • Hyperglycemia.
         • Increase serum osmolality
           • No acidosis

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