|
Download
Clinical Care
Part II
APPENDIX
Appendix 8
Appendix 8a
| Features of hypoglycaemia in children
and the elderly |
| |
Children |
Elderly |
| Autonomic |
HungerTrembling Pallor |
SweatingShakingPounding heartAnxiety |
| Neuroglycopenic |
DizzinessPoor concentration Drowsiness Weakness |
WeaknessDrowsinessPoor concentrationDizzinessConfusion
Lightheadedness |
| Behavioural |
TearfulConfusedTiredIrritableAggressive |
|
| Neurological |
|
UnsteadyPoor coordinationDouble visionBlurred visionSlurred speech |
Appendix 8b
| Using Glucagon in the management
of hypoglycemia. |
General Instructions for Use:
The diluent is provided for use only in the preparation of glucagon for
parenteral injection and for no other use.
Glucagon should not be used at concentrations greater than 1 mg/ mL (1
unit/ mL).
Reconstituted glucagon should be used immediately. Discard any unused
portion.
Reconstituted glucagon solutions should be used only if they are clear
and of a water-like consistency.
Parenteral drug products should be inspected visually for particulate
matter and discoloration prior to administration.
Directions for Treatment of Severe Hypoglycemia:
Severe hypoglycemia should be treated initially with intravenous glucose,
if possible.
If parenteral glucose can not be used, dissolve the lyophilized glucagon
using the accompanying diluting solution and use immediately.
For adults and for pediatric patients weighing more than 44 lb (20 kg),
give 1 mg (1 unit) by subcutaneous, intramuscular, or intravenous injection.
For pediatric patients weighing less than 44 lb (20 kg), give 0.5 mg (0.5
unit) or a dose equivalent to 20- 30 µg/ kg.
Discard any unused portion.
An unconscious patient will usually awaken within 15 minutes following
the glucagon injection. If the response is delayed, there is no contraindication
to the administration of an additional dose of glucagon; however, in view
of the deleterious effects of cerebral hypoglycemia, emergency aid should
be sought so that parenteral glucose can be given.
After the patient responds, supplemental carbohydrate should be given
to restore liver glycogen and to prevent secondary hypoglycemia.
Appendix 9
Appendix 9a
| Sensation threshold screening using
a 10 gram monofilament (also known as Semmes-Weinstein monofilament). |
Consider feet to be "at risk" if patient cannot feel the 10gm
monofilament at any of the sites marked.
Appendix 9b
| Partial list of common conditions
and drugs in the differential diagnosis of diabetic peripheral neuropathy |
| Amyloidosis |
| Arsenic poisoning |
| B12 deficiency |
| Cancer ( paraneoplastic syndromes) |
| Carpal tunnel and other entrapment syndromes |
| Chacot Marie Tooth disease |
| Guillian Barre Syndrome |
| Heavy metal poisoning |
| Herpes Zoster |
| HIV/AIDS-related neuropathies |
| Leprosy |
| Myaesthenia gravis |
| Peripheral vascular disease |
| Sarcoidosis |
| Vasculitic polyneuropathy |
| Drug related: Alcohol, amiadirone, colchicines, dapsone,
hydralazine, isoniazid, metronidalzole, nitrofurantoin, phenytoin,
pyridoxine, statins, sulfasalazine; |
Appendix 11
Appendix 11a
| Stages of Diabetic Nephropathy |
| POINTERS TO A "NON DIABETIC"
CAUSE OF RAISED UAE |
- a more rapid decrease in the GFR than is expected.
- sudden development of nephrotic syndrome.
- absence of retinopathy.
- presence of hematuria ; although red cell casts have been described
in some patients.
- renal bruit.
- absent pedal pulses.
- disproportionately high serum potassium.
- sudden deterioration in renal function after starting Ace inhibitors.
- presence of cardiac failure, and the use of drugs, like diuretics,
in its management.
- testing after heavy exercise.
- testing during acute illness.
- high protein intake.
- decompensation of metabolic control, including recent ketosis.
Appendix 12
Appendix 12 a
| Stages of Diabetic Retinopathy |
| Stage |
Physical Changes |
Functional Changes |
Nonproliferative
Moderately severe to very severe non-proliferative diabetic retinopathy
is also known as pre-proliferative diabetic retinopathy. |
Mild
Stage of microaneurisms (bulging vessels) tiny retinal blood vessels.
These changes are visible only in an eye exam, when the pupils are
dilated.
Moderate
Some blood vessels that nourish the retina are blocked. Small bleeds
may occur on the surface of the retina.
Severe |
Most individuals perceive no vision changes.
Macular edema, if present, should be considered a medical sight threatening
emergency. |
| |
As more vessels are blocked, parts of the retina are
deprived of blood supply and set the stage of new blood vessels to
be formed to supply these parts.
If vessels begin to leak, the leaking fluid and lipid may collect
in the macula, a condition called "macular edema."
Macular edema can occur at any stage of diabetic retinopathy and should
be considered a medical emergency. |
|
| Proliferative |
Areas with blocked vessels show the growth of thin
walled and fragile new vessels which take an abnormal course across
the retina. (neovascularisation)
These vessels can break and bleed into the vitreous, preventing light
from reaching the retina.
Scar tissue may also form near the retina, detaching it from the back
of the eye and resulting in blindness.
Fluid in the vitreous and/or macular edema may also be present. |
Spotty or cloudy vision, double vision, reduced vision, dark or
floating spots.
In late stages, severe vision loss may occur leading to "legal"
blindness in the affected eye(s).
Macular edema, if present, should be considered a medical sight threatening
emergency. |
Appendix 12 b
- Look at the square (grid).
- Wear your reading glasses (if you use one) and cover one eye.
- Focus on the center dot for one full minute.
- While looking directly at the center, be sure that all the lines
are straight and clear, and all the small squares are the same size.
- Repeat the test in the other eye.
- If any lines or squares appear distorted, wavy, blurred, discolored,
or otherwise abnormal, call your eye doctor right away.
- In healthy eyes the lines are straight.
The Amsler's chart is very useful for early detection of macular problems
and thus is very important as this may be an early sign of macular problems
and lead to a loss of central vision! But one must know its limitations.The
Amsler grid will NOT detect proliferative diabetic retinopathy, most preproliferative
changes and other types of damage that may threaten vision, nor is it
useful for detecting any of the early changes. Remember: a normal Amsler
grid test does not rule out the presence of retinopathy that can threaten
your vision. It cannot replace routine eye exams. Only regular eye exams
can do this.
|
