Category: Fundamentals
Patients with very high levels of serum triglycerides (greater than 1000 mg/dL) are at risk for pancreatitis. The pathophysiology is not certain, since pancreatitis never develops in some patients with very high triglyceride levels.
Category: Fundamentals
Ezetimibe is a lipid-lowering drug that inhibits the intestinal absorption of dietary and biliary cholesterol by blocking passage across the intestinal wall by inhibiting a cholesterol transporter.
Category: Fundamentals
Niacin causes a prostaglandin-mediated flushing that patients may describe as “hot flashes” or pruritus and that can be decreased with aspirin (81-325 mg/ day) or other nonsteroidal anti-inflammatory agents taken during the same day.
Category: Fundamentals
Niacin reduces the production of VLDL particles, with secondary reduction in LDL and increases in HDL cholesterol levels. The average effect is a 15-25% reduction in LDL cholesterol and a 25-35% increase in HDL cholesterol.
Category: Fundamentals
Fasting patients taking noncardioselective beta-blockers can have an exaggerated hypoglycemic response to starvation. The beta-blockade inhibits fatty acids and gluconeogenesis substrate release and reduces plasma glucagon response.
Category: Fundamentals
The fluoroquinolones, particularly gatifloxacin, have been associated with both hypoglycemia and hyperglycemia. It is thought that the drug acts on the ATP sensitive potassium channels in the beta cell.
Category: Fundamentals
A number of medications apart from the sulfonylureas can occasionally cause hypoglycemia. Common offenders include the fluoroquinolones such as gatifloxacin and levofloxacin, ACE inhibitors and beta-adrenergic blocking agents.
Category: Fundamentals
Patients with autoimmune hypoglycemia have early postprandial hyperglycemia followed by hypoglycemia 3-4 hours later. The hypoglycemia is attributed to a dissociation of insulin-antibody immune complexes, releasing free insulin.
Category: Fundamentals
Hypoglycemia sometimes develops in patients who have undergone gastric surgery (gastrectomy, pyloroplasty, gastrojejunostomy, Bilroth II procedure and Roux-en-Y), especially when they consume high levels of carbohydrates.
Category: Fundamentals
The treatment of choice for insulin-secreting tumors is surgical resection. While waiting for surgery, patients should be given oral diazoxide. Side effects include edema due to sodium retention, gastric irritation and mild hirsutism.
Category: Fundamentals
The so-called Whipple triad is characteristic of hypoglycemia. It consists of (1) a history of hypoglycemic symptoms, (2) an associated fasting blood glucose of 45 mg/ dL or less and (3) immediate recovery upon administration of glucose.
Category: Fundamentals
Alcohol-related hypoglycemia is due to hepatic glycogen depletion combined with inhibition of gluconeogenesis. It is common in malnourished alcohol abusers but can occur in anyone who is unable to ingest food after an acute alcoholic episode.
Category: Fundamentals
Postprandial (reactive) hypoglycemia may be seen after gastrointestinal surgery and is particularly associated with the dumping syndrome after gastrectomy and Roux-en-Y gastric bypass surgery.
Category: Fundamentals
Fasting hypoglycemia may occur in certain endocrine disorders, such as hypopituitarism, Addison disease, or myxedema, and in disorders related to liver malfunction, such as acute alcoholism or liver failure.
Category: Fundamentals
Lactic acidosis is not uncommon in any severely ill patient suffering from cardiac decompensation, respiratory or hepatic failure, septicemia, or infarction of bowel or extremities. The main clinical feature of lactic acidosis is marked hyperventilation.
Category: Fundamentals
Lactic acidosis is characterized by the accumulation of excess lactic acid in the blood. Normally, the principal sources of this acid are the erythrocytes (which lack enzymes for aerobic oxidation), skeletal muscle, skin and brain.
Category: Fundamentals
In diabetic ketoacidosis, when blood glucose falls to 250 mg/dL, the fluids should be changed to a 5% glucose-containing solution. This will prevent the development of hypoglycemia and will also reduce the likelihood of cerebral edema.
Category: Fundamentals
In most patients with diabetic ketoacidosis, the fluid deficit is 4-5 liters. Initially, 0.9% saline solution is the solution of choice to help reexpand the contracted vascular volume and should be started in the emergency department.
Category: Fundamentals
Therapeutic goals for diabetic ketoacidosis are to restore plasma volume and tissue perfusion, reduce blood glucose and osmolality toward normal, correct acidosis, replenish electrolyte losses and identify and treat precipitating factors.
