High Blood Sugar Ebook

Blood Sugar Miracle

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Insulin Therapy Of Diabetic Ketoacidosis

In normal persons, where acute hyperglycemia has been induced by inhibiting insulin production by infusion of somatostatine and glucose, blood glucose lowering after reconstitution of insulin secretion may be up to 500 mg dL per hour. In cases of hyperglycemic patients with diabetes a comparable insulin dose can reduce plasma glucose by only 65 to 125mg mL per hour (16-18). In comparison, this lower decrease in comparison to normal individuals reflects the severe insulin resistance in patients with diabetic coma. Furthermore, substitution of volume alone can lower plasma glucose by about 35 to 70 mg dL per hour. The reasons are an improvement of renal perfusion with an increase of renal excretion of glucose as well as a decrease of contraregulatory hormones (10,17). From the above, in cases of combined therapy of re-hydration and low-dose insulin one can calculate a glucose decrease between 100 and 200mg hr (19). This would already be more than wanted. Since fluid substitution reduces...

Examination Of Candidate Genes For Diabetic Nephropathy

Besides linkage studies for chromosomal regions harboring susceptibility genes for DN and subsequent positional cloning of the putative genes in those regions, an alternative strategy currently employed by many investigators is the candidate gene approach (7,37). Unlike genome scans that do not require prior knowledge of the biology of the susceptibility gene, this approach is hypothesis-driven because it focuses on proteins suspected of involvement in the pathogenesis of DN. A gene encoding for one of these proteins is screened for the presence of DNA polymorphisms (single-nucleotide polymorphisms SNPs , insertion deletions, or microsatellite markers). Then the distributions of alleles and genotypes of these polymorphisms are examined in unrelated diabetic patients with nephropathy (cases) and unrelated diabetic patients who have remained free of DN despite a long duration of diabetes (controls) to determine whether there are differences. If the groups of cases and controls are...

TABLE 302 Anaphylaxis and Allergic Reactions Drug Dosing

For patients taking b blockers with hypotension refractory to fluids and epinephrine, glucagon should be used in a dose of 1 mg IV every 5 min until hypotension resolves, followed by an infusion of 5 to 15 pg min.2 The side effects of glucagon include nausea, vomiting, hypokalemia, dizziness, and hyperglycemia.

Betaadrenergic Blocking Agents

Special Concerns Use with caution in diabetes, thyrotoxicosis, ce-rebrovascular insufficiency, and impaired hepatic and renal function. Withdrawing beta blockers before major surgery is controversial. Safe use during pregnancy and lactation and in children has not been established. May be absorbed systemically when used for glaucoma thus, there is the potential for an additive effect with beta blockers used systemically. Certain of the products for use in glaucoma contain sulfites, which may result in an allergic reaction. Also, see individual agents. Side Effects Oral dry mouth. CV bradycardia, CHF, cold extremities, postural hypotension, profound hypotension, 2nd or 3rd degree heart block. CNS catatonia, depression, dizziness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic agranulo-cytosis, thrombocytopenia. Allergic fever, sore throat,...

Intralesional administration

Endocrine Cushing's syndrome (e.g., central obesity, moonface, buffalo hump, enlargement of supraclavicular fat pads), amenorrhea, postmeno-pausal bleeding, menstrual irregularities, decreased glucose tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirement in diabetics, development of diabetes mellitus, negative nitrogen balance due to protein catabolism, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness (especially during periods of stress). CNS Neurologic Headache, vertigo, insomnia, restlessness, increased motor activity, is-chemic neuropathy, EEG abnormalities, seizures, pseudotumor cerebri. Also, euphoria, mood swings, depression, anxiety, personality changes, psychoses. CV Thromboembo-lism, thrombophlebitis, ECG changes (due to potassium deficiency), fat embolism, necrotizing angiitis, cardiac arrhythmias, myocardial rupture following recent MI, syncopal episodes. Dermatologic...

Clinical Emergencies in Diabetes Hypoglycemia

Insulin regulates glycemia through modulation of hepatic glucose production in the postabsorptive state and glucose utilization in the postprandial state, and it is the only hormone able to physiologically reduce glycemic level. In catabolic states (fasting), insulin concentration falls and the levels of counterregulatory hormones rise in fact, hypoglycemia is capable of inducing the release of counterregulatory hormones, including glucagon, catechola-mines (epinephrine and norepinephrine - released both from adrenal medulla and the sympathetic neurons), cortisol and GH. The glucagon secretory response to hypoglycemia is largely CNS-independent whereas catecholamine, cortisol and GH responses are prevailingly CNS-dependent. Glucagon acts within minutes and is the primary hormone of glucose maintenance (by stimulating hepatic glucose production through increase in glycogenolysis and glu-coneogenesis). Catecholamines also act swiftly, stimulating glucose production and limiting glucose...

Clinical Features

Documentation of the medical history of diabetic patients in the emergency department should be complaint directed but generally should also include questions on access to and frequency of home blood glucose monitoring, frequency and causes, if known, of recent hyperglycemia or hypoglycemia, recent glycosylated hemoglobin (HgbA1c) values, presence of and therapy for microvascular and macrovascular complications of diabetes, recent adjustments by the patient or the patient's physician in their glycemic control regimen, any problems with adherence to therapy, and symptomatology suggestive of complications. Symptoms suggestive of potential complications or poor glucose control include visual changes, neurologic symptoms (especially numbness, dizziness, and weakness), chest pain, gastrointestinal symptoms, and genitourinary symptoms (especially overflow incontinence, changes in amount of urine, and sexual dysfunction). A thorough history of any recent or concurrent chronic medical...

Diabetes Mellitus and Metabolic Syndrome

Significantly, Zierler and Rabinowitz 37 showed, in 1964, that infusion of a very small amount of insulin through the brachial artery in human forearm leads to a significant decrease in plasma NEFA concentrations without any concomitant effect on glucose uptake. Consequently, the restraint of NEFA release from adipose tissue is the most sensitive action of insulin compared with other insulin effects. The lack of restraint of NEFA mobilization in hypoinsulinemic states during pathogenesis of NIDDM leads to a marked plasma NEFA increase, ectopic deposition of TAG and insulin resistance with regard to non-oxidative as well as oxi-dative glucose metabolism. The latter fact stresses the negative effect of excessive availability of NEFA in the short term on insulin-mediated glucose utilization in muscle, as shown by Randle and coworkers 38, 39 . It involves a reduction of muscle glycolysis by inhibiting phosphofructokinase in course of elevated cytosol-ic concentrations of citrate and...

Disorders That Occur When Awake

Paroxysmal Kinesogenic Dyskinesia (PKD). Children with paroxysmal kinesogenic dyskinesia have abrupt attacks of dystonia, chorea, ballismus, and combinations of different hyperkinesias (50, 51). These episodes are triggered by movement, most commonly whole-body activity such as initiation of standing or walking, and less frequently, by focal movement or a startle. Multiple episodes less lasting less than a minute can occur each day. The EEG is normal during the episode or shows movement artifacts. Paroxysmal kinesogenic dyskinesia most commonly presents between ages 6 and 15 years, although it has been reported in the first year of life. The disorder can be familial or sporadic. It is responsive to carbamazepine and phenytoin. Sporadic cases sometimes follow such insults as hypoxia, hypoglycemia or hyper-glycemia, hypocalcemia, cerebral vascular injury, multiple sclerosis, and thyrotoxicosis. Some have postulated it is a form of subcortical epilepsy (52).

General Information

Nicotinic acid is also a potent vasodilator, probably by a direct action on smooth muscle cells. It produces cutaneous vasodilatation, itching of the skin, facial flushing, a sensation of feeling hot, pounding in the head, gastric irritation, diarrhea, raised transaminases, hyperglycemia, and hyperuricemia. These unpleasant adverse effects limit its acceptability for many patients. Nicotinic acid as such is not used in the treatment of vascular disorders, but some of its derivatives are, albeit with poor evidence of clinical efficacy. Modified-release formulations of nicotinic acid do not appear to be better tolerated than regular formulations, flushing and itching being the most common adverse effects (SEDA-19, 206). There have also been several reports of hepatotoxicity with this form of the drug (SEDA-16, 438). Other adverse effects are hepatotoxicity (apparently a dose-related direct toxic effect), hyper-glycemia, and hyperuricemia. It has been questioned whether the...

Placebocontrolled studies

Two doses of oxcarbazepine have been compared in a double-blind, parallel-group, randomized trial in patients with uncontrolled partial-onset epilepsy who had previously taken carbamazepine monotherapy (10). After two open phases in 143 patients, 96 were randomized to oxcarbazepine 300 or 2400 mg day for 126 days. The time to meet an exit criterion was significantly in favor of oxcar-bazepine 2400 mg day. In all, 24 of the 47 non-randomized patients withdrew because of an adverse event, most commonly dizziness, ataxia, headache, nausea, vomiting, or fatigue. Three withdrew because of laboratory abnormalities, one each with leukopenia, hyponatre-mia, and hyperglycemia. Headache, dizziness, and nausea were the only adverse events that occurred in more than 10 in either group. Similar adverse events were reported in the randomized patients, but none withdrew.

Energy Substrates

Low- or high-molecular-weight dextran administration may result in allergic reactions, which are evidenced by urticaria, hypotension, nausea, vomiting, headache, dyspnea, fever, tightness of the chest, and wheezing. Hyperglycemia and phlebitis may be seen with administration of glucose. The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome. Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma.

Genetic Features of HDL2

The HDL2 locus on 16q24.3 is a CTG repeat that is highly polymorphic in length in the general population, with a range of 6-28 and a modal length of 13. Repeat length associated with HDL2 varies from 40 to 59, with potential incomplete penetrance at the lower end of this range. The potential of repeat lengths between 29 and 39 triplets to contribute to disease is uncertain, though repeat length instability may be present. For instance, a mother with an HDL2 repeat of 33 triplets developed a nonprogressive cerebellar disorder after hospitalization for hyperglycemia. Her son, who inherited a slight expansion of this allele to 35 triplets, developed Cogan's syndrome, an incompletely characterized disorder of uncertain etiology involving interstitial keratitis with prominent optic and audiovestibular findings.

Ethacrynic Acid Edecrin

Clearance hepatic metabolism renal elimination. Adverse effects may cause electrolyte imbalance, dehydration, transient hypotension, deafness, hyperglycemia, or hyperuricemia. Clearance renal and hepatic proteolysis. Adverse effects may cause anaphylaxis, nausea, vomiting, hyperglycemia, positive inotropic and chronotropic effects high doses potentiate oral anticoagulants.

Adverse Effects Contraindications and Drug Interactions

Headache, dizziness, impaired memory and concentration, agitation, insomnia, and anxiety occur with regularity. Depression is a common side effect of interferon-a and interferon-p. Suicidal behavior, although rare, can arise in depressed patients therefore, these individuals should be closely monitored. Myelosuppression occurs frequently and may be dose limiting potentially fatal aplastic anemia is rare. Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and anorexia are common however, ulcerative colitis, pancreatitis, hyper-glycemia, and diabetes mellitus are rare. Elevation of hepatic enzymes can occur but rarely necessitate discontinuation of treatment. Injection site reaction is common, as is alopecia, for certain interferon preparations. Interferons can decrease fertility and may cause miscarriage at high doses.

4131 Alternative remedies and phytotherapeutics

The best known of the herbal galactogogues is fenugreek ('Trigonella foenum-graecum), also known as greek hayseed. It is a member of the Leguminosac family of plants, which includes peanuts, soy, and chickpcas. It has the odor of maple syrup, and is used as artificial maple flavoring. When the mother takes the usual dose 1-4 capsules 580-610mg, three to four times daily), her milk, sweat, tears, and urine, and even her baby, smell of maple syrup. Fenugreek has been known for centuries to help some women but not all. It can cause colic in the infant, which is believed to be an allergic response. It can aggravate asthmatic symptoms. It has also been documented to lower blood sugar, and is used as a natural treatment for diabetics. In pregnancy, it can cause uterine cramps. It is available in capsule form or as seeds for teas and decoctions. It probably appears in the milk, as this usually smells of maple syrup. It is given a rating of C (moderate potential for toxicity), which is...

Dehydration With Metabolic Alkalosis

CBC leukocytosis (14,000) (without infection). I.ytes hyponatremia (130 mEq L). ABGs markedly reduced bicarbonate (10 mEq L) acidosis (pH 7.1). Increased ketones in blood increased creatinine hyperglycemia increased anion gap (between 10 and 18) (anion gap is calculated as follows Na + K - Ci + HCO J ) increased amylase (without pancreatitis). UA glycosuria ketonuria. A 58-year-old white female comes to see her internist because of the development of polyuria, polydipsia (due to hyperglycemia), and a skin eruption that comes and goes in different parts of her body ( N EC RO LYTIC MIGRATORY RASH). CBC anemia (Hb 7.4 mg dl.). Markedly increased serum glucagon levels hyperglycemia. A pancreatic islet cell neoplasm (of alpha cells) that secretes abnormally high amounts of glucagon with resulting symptomatic hyperglycemia may also secrete ACTH and serotonin. Glucagonomas arise from alpha-two islet cells in the pancreas, and the majority (> 70 ) are malignant. Glucagonomas may also be...

Diabetic Ketoacidosis

ID CC A 58-year-old white female comes to see her internist because of the development of polyuria, polydipsia (due to hyperglycemia), and a skin eruption that comes and goes in different parts of her body (necrolytic migratory rash). Labs CBC anemia (I lb 7.4 mg clL). Markedly increased serum glucagon levels hyperglycemia. Discussion Glucagonoma is a pancreatic islet cell neoplasm (of a cells) that secretes abnormally high amounts of glucagon with resulting symptomatic hyperglycemia it may also secrete gastrin, ACTH, and serotonin. Glucagonomas arise from ot2 islet cells in the pancreas, and the majority (> 70 ) are malignant. Glucagonomas may also be associated with multiple endocrine neoplasia (MEN) type I.

Looking for Hypoglycemia

How do you know whether you have had a hypoglycemic reaction during the night Certain symptoms may tell you. Do you find your pajamas and sheets damp with sweat in the morning Have you had restless sleep and nightmares When you wake up, do you have a headache or still feel tired Do you have ketones in your urine in the morning without a high blood glucose You may want to test your blood around 2 or 3 a.m. a few times and try to match your results with your food, exercise, and medication doses from the previous day and evening. This will help you pinpoint what is really going on.

Alternative remedies and phytotherapeutics

The best known of the herbal galactogogues is fenugreek ('Trigonella foenum-graecum), also known as greek hayseed. It is a member of the Leguminosac family of plants, which includes peanuts, soy, and chickpeas. It has the odor of maple syrup, and is used as artificial maple flavoring. When the mother takes the usual dose 1-4 capsules 580-610mg, three to four times daily), her milk, sweat, tears, and urine, and even her baby, smell of maple syrup. Fenugreek has been known for centuries to help some women but not all. It can cause colic in the infant, which is believed to be an allergic response. It can aggravate asthmatic symptoms. It has also been documented to lower blood sugar, and is used as a natural treatment for diabetics. In pregnancy, it can cause uterine cramps. It is available in capsule form or as seeds for teas and decoctions. It probably appears in the milk, as this usually smells of maple syrup. It is given a rating of C (moderate potential for toxicity), which is...

Oculovestibular Reflex Cold caloric maneuver

Differential Diagnosis of Delirium Electrolyte imbalance, hyperglycemia, hypoglycemia (insulin overdose), alcohol or drug withdraw or intoxication, hypoxia, meningitis, encephalitis, systemic infection, stroke, intracranial hemorrhage, postictal state, exacerbation of dementia narcotic or anticholinergic overdose steroid withdrawal, hepatic encephalopathy psychotic states, dehydration, hypertensive encephalopathy, head trauma, subdural hematoma, uremia, vitamin B12 or folate deficiency, hypothyroidism, ketoacidosis, factitious coma.

Special Features Of Hyperosmolar Nonketotic Coma

Many properties elucidated above for diabetic ketoacidosis are also true for hyperosmolar non-ketotic diabetic coma and will not be repeated. The hyperosmolar coma corresponds to extreme hyperglycemia with a high level of dehydration and appears very frequently in elderly patients with type 2 diabetes (Table 8) (11). Mortality is higher than in diabetic ketoacidosis. Since there is only relative insulin deficiency, the liver is still seeing enough insulin to prevent severe ketoacidosis. However, some patients might develop mild acidosis. Extremely high levels of blood glucose concentrations of sometimes more than 1000 mg dL are not a rarity. The latter is the main player of elevated plasma osmolality. The fluid deficit may even be more pronounced than in diabetic ketoacidosis. Severe hyperglycemia Initial administration of insulin can be waived, as long as blood glucose decreases by infusion treatment Reduce blood glucose slowly by approximately 50mg dL hr Decrease plasma osmolality...

Classification Antibacterial fluoroquinolone

Ic Diaphoresis, vasculitis, photosensitivity, rash, pruritus. Hematologic Leukocytosis, lymphocytopenia, eo-sinophilia. Musculoskeletal Asthenia, extremity pain, arthralgia, myalgia, possibility of osteochondrosis. Miscellaneous Chills, malaise, syncope, hyperglycemia or hypoglyce-mia, whole body pain, thirst, weight loss, photophobia, trunk pain, pa-resthesia, visual disturbances, hyper-sensitivity, hearing loss, fever.

Adrenal Insufficiency

Rheumatic disease patients on glucocorticoids are usually instructed to seek medical care urgently if an illness like gastroenteritis prevents taking or absorption of prednisone. In general, the course of a rheumatic disease is not worsened by administration of stress glucocorticoids for a day during an acute illness, even if the dose is much larger than the usual daily dose. A large dose of glucocorticoid may cause labile hyperglycemia in diabetic patients, but no more so than the underlying acute condition. Other medications used to treat rheumatic diseases can be held safely for a brief bout of gastroenteritis. These include NSAIDs, cyclophosphamide or chlorambucil, methotrexate, hydroxychloroquine (Plaquenil), and calcium channel blockers, if they are only used to treat Raynaud phenomenon.

Acetaminophen Tylenol

Contraindications hepatic failure, severe renal failure. Adverse effects may increase insulin requirements in diabetic patients may cause renal calculi in patients with past history of calcium stones may cause hypokalemia, thrombocytopenia, aplastic, anemia, increased urinary excretion of uric acid, and hyperglycemia.

Complications

Clinically, cerebral edema develops in patients, usually with new-onset diabetes, several hours after the institution of therapy when clinical and biochemical indices suggest improvement. Manifestations of cerebral edema include symptoms and signs of raised intracranial pressure such as headache, deterioration in consciousness, bradycardia, papilledema, development of fixed dilated pupils, and, occasionally, polyuria (secondary to diabetes insipidus), which may be misdiagnosed as osmotic diuresis resulting from hyperglycemia. CT scanning has revealed that subclinical cerebral edema is common in children being treated for DKA (18). Magnetic resonance imaging (MRI) and CT scanning have additionally indicated that at least some of these children have cerebral thrombosis and infarction in addition to cerebral edema (26,31). In adults, monitoring by indwelling intrathecal catheters indicates that there is a rise in cerebrospinal fluid pressure in all patients during fluid and insulin...

Previous page 115

Replaced with complex carbohydrates (starch, dietary fiber) (2). Chocolate, of course, was restricted because of its high sucrose content (5055 by weight). The terms simple and complex carbohydrates are, in fact, no longer recommended because this chemical distinction means little in clinical terms (3). The assumption that sugars would be more rapidly digested and absorbed than starches, and therefore aggravate high blood glucose levels to a greater degree, was found to be incorrect. Similarly, the reasoning that the large molecular size of starches would render them more slowly digested and absorbed was also wrong in most cases. There is now abundant scientific proof that modern starchy foods have a greater impact on blood glucose and insulin levels than most foods containing sugar, whether naturally occurring or refined (4, 5).

Graded Therapy

The third stage is stabilization of blood glucose levels around 200 mg dL with a consecutive lowering into the normal range within the next 2 days (9). In cases where blood glucose levels are around 250 mg dL, the insulin dose is greatly reduced and if needed additional infusion of glucose (5 glucose) is used. In cases where the aim of a slow and a gradual decrease of the glucose weight in stage 2 of approximately 50 mg dL per hour has been achieved using a very low dose of insulin therapy and there are no clinical indications for a syndrome of disequilibrium, one can reduce blood glucose levels from 250 mg dL to normoglycemia within a half or whole day. Through close to normal values of blood glucose the course of concomitant diseases or complications like sepsis and infections are decreased (12,13).

Glimepiride

Action Kinetics Lowers blood glucose by stimulating the release of insulin from functioning pancreatic beta cells and by increasing the sensitivity of peripheral tissues to insulin. Completely absorbed from the GI tract within 1 hr. Time to maxi Uses As an adjunct to diet and exercise to lower blood glucose in non-insulin-dependent diabetes mellitus (Type II diabetes mellitus). In combination with insulin to decrease blood glucose in those whose hyperglycemia cannot be controlled by diet and exercise in combination with an oral hypoglycemic drug. Contraindications Diabetic ke-toacidosis with or without coma. Use during lactation. Special Concerns The use of oral hypoglycemic drugs has been associated with increased CV mortality compared with treatment with diet alone or diet plus insulin. Safety and efficacy have not been determined in children.

Nadolol

Special Concerns Diabetes mellitus, hyperthyroidism, lactation, myasthe-nia gravis, peripheral vascular disease, renal disease. Side Effects Oral Dry mouth, taste disturbances. CV AV block, bradycardia, CHF, hypotension, palpitations. CNS Depression, dizziness, drowsiness, fatigue, hallucinations, headache, lethargy, paresthesias. GI Colitis, constipation, cramps, diarrhea, flatulence, hepatomegaly, nausea, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergie fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin pruritus, rash, fever. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, noctu-ria. Other Hypoglycemia or hyper-glycemia. Respiratory Broncho-spasm, cough, dyspnea, laryngos-pasm, nasal stuffiness, pharyngitis, respiratory dysfunction, wheezing. Drug Interactions See also Drug Interaetions for Beta-Adrenergie Blocking Agents and Antihyperten-sive Agents.

Drug overdose

It can cause alkalemia or acidemia, alkaluria or acid-uria, hyperglycemia or hypoglycemia, and water and electrolyte imbalances. However, the usual picture is one of hypokalemia with metabolic acidosis and respiratory alkalosis. Effects on hearing have been referred to in the section on Sensory systems in this monograph. Nausea, vomiting, tinnitus, hyperpnea, hyperpyrexia, confusion, disorientation, dizziness, coma, and or convulsions are common. They are expressions of the nervous system effects of the salicylates. Gastrointestinal hemorrhage is frequent.

Metastasis

Metformin (glucophage) A drug used to treat high blood sugar level. Metformin helps to reduce the amount of glucose produced by the liver, thereby generally leading to reduced amounts of insulin and glucose in the bloodstream. Metformin helps antagonize the insulin resistance characteristic of type 2 diabetes mellitus. It is being tested for treatment of lipodystrophy and high blood sugar level in HIV disease, since protease inhibitors, corticosteroids, and Megace all increase insulin resistance. There is some concern about whether it could

The Sugar Blues

Diabetes is a disease in which an insufficient amount of insulin (a hormone necessary for the metabolism of blood glucose or blood sugar) is produced by the body. This leads to an abnormally high blood glucose level. When the body functions normally, it releases insulin to counteract the increased sugar as blood glucose levels rise after

Pentafuside See T20

It can be administered intravenously or delivered directly into the lungs as an aerosol, using a breathing machine. Common side effects of intravenous pentamidine are low blood pressure, low blood sugar, high blood sugar, kidney failure, liver disease, low blood counts, or inflammation of the pancreas. Because it doesn't go directly into the bloodstream, aerosol, or nebulized, pentamidine rarely causes severe side effects (the most frequent are coughing and tightening of the chest that interferes with breathing). Fatigue, metallic taste in the mouth, decreased appetite, dizziness, rashes, nausea, irritation of mouth or nasal cavities, congestion, night sweats, chills, and vomiting also occur. It does not, however, affect PCP in parts of the body other than the lungs, so intravenous treatment is usually preferred for advanced PCP infections. Generally it is felt that pentamidine should be dispensed with caution if given with other drugs that can damage the kidneys. In addition,...

Steroid Management

Steroids can cause glucose intolerance in some patients with new onset hyperglycemia and can increase blood glucose levels in patients with existing diabetes. Symptoms would include increased thirst and frequent urination. Diabetic patients will require close monitoring of blood glucose levels and increased doses of insulin are best managed with a sliding scale dosing. Patients with new steroid induced glucose intolerance will also require close monitoring and sliding scale insulin.

Diuretics Thiazides

Electrolyte imbalance Hypokalemia (most frequent) characterized by cardiac arrhythmias. Hyponatremia characterized by weakness, lethargy, epigastric distress, N& V. Hypoka-lemic alkalosis. GI Anorexia, epigastric distress or irritation, N& V, cramping, bloating, abdominal pain, diarrhea, constipation, jaundice, pancreatitis. CNS Dizziness, light-headedness, headache, vertigo, xan-thopsia, paresthesias, weakness, insomnia, restlessness. CV Orthostatic hypotension, MIs in elderly clients with advanced arteriosclerosis, especially if the client is also receiving therapy with other antihypertensive agents. Hematologic Agranulocytosis, aplastic or hypoplastic anemia, hemolyt-ic anemia, leukopenia, thrombocyto-penia. Dermatologie Purpura, photo-sensitivity, photosensitivity dermatitis, rash, urticaria, necrotizing angiitis, vasculitis, cutaneous vasculitis. Metabolic neutropenia, hemolytic anemia. Endocrine Hyperglycemia, glycosuria, hyperuricemia. Miscellaneous Blurred vision,...

Furosemide

Side Effects Electrolyte and fluid effects Fluid and electrolyte depletion leading to dehydration, hypo-volemia, thromboembolism. Hypo-kalemia and hypochloremia may cause metabolic alkalosis. Hyperuricemia, azotemia, hyponatremia. Oral Dry mouth, increased thirst, lichenoid drug reaction. GI Nausea, oral and gastric irritation, vomiting, anorexia, diarrhea (especially in children) or constipation, cramps, pancreatitis, jaundice, ischemic hepatitis. Otic Tinnitus, hearing impairment (may be reversible or permanent), reversible deafness. Usually following rapid IV or IM administration of high doses. CNS Vertigo, headache, dizziness, blurred vision, restlessness, pa-resthesias, xanthopsia. CV Orthos-tatic hypotension, thrombophlebitis, chronic aortitis. Hematologic Anemia, thrombocytopenia, neutrope-nia, leukopenia, agranulocytosis, purpura. Rarely, aplastic anemia. Allergic Rashes, pruritus, urticaria, photosensitivity, exfoliative dermatitis, vasculitis, erythema multiforme....

Pancreas

Insulin deficiency causes diabetes mellitus (die-uh-BEET-eez muh-LIET-uhs), a condition in which cells are unable to obtain glucose, resulting in abnormally high blood glucose concentrations. In type I diabetes the immune system attacks the insulin-producing islet cells. The cells die. Type I generally is treated with daily injections of insulin into the blood and sometimes with islet cell transplant. Type II diabetes usually occurs after age 40, and it is more common than type I. Type II is caused by insufficient insulin or less responsive target cell receptors. Although type II is hereditary, its onset correlates with obesity and an inactive lifestyle. Type II diabetes can often be controlled through exercise and diet. In diabetes, excess glucose inhibits water reabsorption by the kidneys, producing large amounts of urine. Dehydration and kidney damage can result. Lack of insulin can lead to acid-base and electrolyte imbalances. These changes may result in nausea, rapid breathing,...