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CASE

CASE. 45 YEARS OLD Saudi lady. Fatigue Tiredness Increased skin pigmentation. Typical electrolytes. Na 126 K 5.5 Cl 89 Bicarb 20. What about glucose ! ?. Causes of fasting hypoglycemia. EX P L A I N. Fasting Hypoglycemia. Exogenous insulin or OHA PITUITARY DIS LIVER DIS

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CASE

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  1. CASE

  2. 45YEARS OLD Saudi lady Fatigue Tiredness Increased skin pigmentation

  3. Typical electrolytes Na 126 K 5.5 Cl 89 Bicarb 20

  4. What about glucose ! ?

  5. Causes of fasting hypoglycemia EX P L A I N

  6. Fasting Hypoglycemia Exogenous insulin or OHA PITUITARY DIS LIVER DIS Addion’sdis Insulinoma Neoplasm

  7. CBC NEUTROPENIA RELATIVE LYMPHOCYTOSIS

  8. TREATMENT IV SALINE +GLUCOSE IV STEROIDS

  9. PREVENTION Extra steroids at times of stress

  10. CASE

  11. 35 YEARS OLD LADY ( post surgery) Fever : 40c Agitation Tachycardia : 140 /min

  12. MANAGEMENT IODIDE ANTI THYROID DRUGS BETA BLOCKERS STEROIDS ANTI PYRETICS SUPPORTIVE CARE

  13. CASE

  14. 81 YEARS OLD LADY FOUND IN COMA TEMPERATURE : VERY LOW PULSE : 45 /MIN

  15. WHAT OTHER CLINICAL FINDINGS MAY BE FOUND Dry skin Loss of eyebrows Big tongue Look for a thyroidectomy scar

  16. DO NOT FORGET BREATHING HYPOVENTILATION IS A BIG PROBLEM TYPICAL ABG’S : PCO2 : HIGH PO2 : LOW PATIENTS MAY NEED ASSISSTED VENTILATION

  17. sodium Look for hyponatremia High cholesterol High CPK

  18. ECG : LOW VOLTAGE & BRADYCARDIA

  19. TREATMENT OF MYXEDEMA COMA VENTILATION IV THYROXINE IV STEROIDS WARM PATIENT

  20. SEVERE HYPOCALCEMIA TETANY CONVULSIONS ESP. IN THE YOUNG ECG CHANGES ( QT INTERVAL)

  21. PROLONGED QT INTERVAL

  22. TREATMENT OF SEVERE HYPOCALCEMIA IV CALCIUM GLUCONATE SLOWLY AND UNDER ECG MONITORING

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