morning report n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Morning Report PowerPoint Presentation
Download Presentation
Morning Report

Loading in 2 Seconds...

play fullscreen
1 / 17

Morning Report - PowerPoint PPT Presentation


  • 240 Views
  • Uploaded on

Morning Report. November 2, 2010. Glycemic Control. Normal Endocrine system Responds and regulates Functional enzymes Produce glucose Adequate supply of substrate. Sources of Glucose. Meals Muscle or Hepatic Glycogen Gluconeogenesis. Hypoglycemia. <40 or 50 mg/ dL

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Morning Report' - maille


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
morning report

Morning Report

November 2, 2010

glycemic control
Glycemic Control
  • Normal Endocrine system
    • Responds and regulates
  • Functional enzymes
    • Produce glucose
  • Adequate supply of substrate
sources of glucose
Sources of Glucose
  • Meals
  • Muscle or Hepatic Glycogen
  • Gluconeogenesis
hypoglycemia
Hypoglycemia
  • <40 or 50 mg/dL
  • Symptoms in Infancy
    • Irritable
    • Jittery
    • Feeding problems
    • Lethargy
    • Cyanosis
    • Tachypnea
    • Hypothermia
hypoglycemia1
Hypoglycemia

Autonomic

neuro

  • Sweaty
  • Weakness
  • Tachycardia
  • Tremor
  • Nervous
  • Hunger
  • “warning signs”
  • BG 40-70
  • Lethargy
  • Irritable
  • Confusion
  • Strange behavior
  • Hypothermia
  • Seizure
  • Coma
  • BG – 10-50
critical sample
Critical Sample
  • 5-10mL of blood
  • Substrates
    • Glucose, FFAs, β-hydroxybutyrate, lactate, total and free carnitine and acylcarnitine
  • Hormones
    • Insulin, C-peptide, cortisol, and growth hormone
  • Other
    • Lytes, LFTs, ammonia, tox, metabolic
  • Urine
    • Ketones, reducing substances
treatment
Treatment
  • PO glucose
  • IM
    • Glucagon 0.3mg/kg (max 1mg)
  • IV
    • D10 - 2cc/kg
    • GIR 6-9
  • Frequent Accu checks
    • 70-120
  • Avoid fasting
diagnosis
Diagnosis
  • Depends on history and symptoms
  • Glucagon challenge
    • Hyperinsulinemia
  • Elective fast
    • Measure critical sample
impaired carb metabolism
Impaired Carb Metabolism
  • Disorders of glycogenolysis
    • Glycogen storage diseases
  • Disorder of gluconeogenesis
    • Glucose-6-phosphatase def, fructose 1,6 diphosphatase def, pyruvatecarboxylase def, PEPCK def
  • Galactosemia
  • Hereditary Fructose Intolerance
disorders of aa metabolism
Disorders of AA Metabolism
  • Organic Acidemias
    • Maple syrup urine disease, propionicacidemia, methylmalonicacidemia, glutaricaciduria, and tyrosinemia
  • Fatty Acid Oxidation
    • Carnitine deficiency, fatty acid transportation defects, and defects of beta-oxidation enzymes

Disorders of FA Metabolism

increased utilization of glucose
Increased Utilization of Glucose
  • Hyperinsulinism
    • Insulinoma, exogenous
  • Oral hypoglycemics
  • Diabetes mellitus
    • Treatment
miscellaneous
Miscellaneous
  • Ketotic hypoglycemia
    • 18m-5y
      • Resolves by 8-9y
    • Unknown cause
    • Diagnosis of exclusion
    • Treatment
      • Increased carbs
      • Increased protein
      • Frequent meals
miscellaneous1
Miscellaneous
  • Ketotic hypoglycemia
    • Diagnosis
      • Decreased insulin
      • Increased
        • GH, cortisol, FFA and ketones
      • Decreased alanine
      • Normal thyroxine
      • Normal carnitine
      • No reducing substances in urine
miscellaneous2
Miscellaneous
  • Hormone deficiencies
    • GH
    • Cortisol
  • Ingestions
    • Ethanol
    • Salicylates
    • Oral hypoglycemics
    • β-blockers