Drug Causing edema 😅

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هذا من دايفدسون

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Corrected QT interval

Especially in case of Tachycardia

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Creatinine clearance formula

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Creatinine clearance with How to Calculate IBW ?? ..

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Read This ..

Side effects of Doxycycline

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Effect of Angiotensin on the efferent Arteriole ,

Therefore, Using ACEI , Or ARB drugs are preferred in CKD patients

بنلاحظ في اول استخدامنا لهذي الأدوية نتيجة ال Vasodilation اللي بيحصل انو ال GRF بيقل و ال Cr levels في أول اسبوع باترتفع ..
لكن بعدها يعتبر مفيد لل Glomeruli لانه بيخفض الضغط فيها..
فيمنع ال Further damage of Glomeruli

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Both drugs are contraindicated in Renal artery stenosis . Or Creatinine level more than 3

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ايش يهمنا نعرف بال Score هذا ؟!

في عندنا قسمين :-
1) Pysical maturity.
2) Nueromuscular maturity.


ال Score من -1 الى 5 او 4.

في ال Pysical معانا ( 5 ) لو نبدء من ال Head وننزل :-
1- Ear lobule / eye
2- Breast
3- lanugo hair
4- Gentalia
5- planter Surface " creases"

في ال Neuromuscular معانا ( 6 ) :-

1- Posture
2- Square window " Wrist "
3- Arm recoil
4- Scarf sign
5- Poplitial angle
6- Heel to ear

نحسب ال كم حاصل جمع ال Score.
و نحطه في الجدول ونعرف ما يقابله في ال Weeks للطفل .

#أطفال

بسم الله الرحمن الرحيم
موضوعونا اليوم عن DKA

اولا التعريف
Metabolic error caused by acute insulin deficiensy

طيب ايش الاسباب اللي عملت هذا الشي اولا في معانا اسباب في الانسولين1/decrease dose of insulin
2/increase demand
3/bad storage of insulin

وفي معانا السبب الثاني وهو اي stress.
ومختصر ب 5I
1/Infection :pneumonia, UTI, celluitis
2/inflammation:pancreatitis, cholycystis
3/increase use:alcohol, cocaine
4/infarction:MI, CVA
5/iatrogenic:Drug like steroid
Surgery


الان معانا pathophysiology
اولا🔴 بالطبيعي انه الجلوكوز يدخل الى داخل الخلايا ويحصل aerobic and anerobic metabolism
وبعدين يخرج ATP
🔴ثانيا
K sensitive channel close which lead to activation of ca voltage channel

This lead to increase of ca in cells which lead to activation of insulin vesicle then release insulin

Another mechanism of activation of insulin vesicle is by

Glutamic acid decarboxylase enzyme
By conersion of gutamic acid to GABA
Which lead to activation of vesicle and release insulin


So in type one DM there are antibodies that affect this normal mechanism

1/anti ilet's cell antibody (in receptor of glucose)

2/anti glutamic acid decarboxylase enzyme antibody

3/anti insulin anti body


In DKA:
occur of any stress which mention above
Lead to activation of sympathetic nervous system
Lead to release of epinephrine and NE
Lead to activation of Glucagon which lead to

☄1/lipolysis >FFA oxidation>acetyl CoA>krebs cycle >ketones bodies>Aceto actate decarboxylation to acetone and then go to lung

, B-hydroxy butrate rlease hydrogen ions And lead to acidosis

☄2/Liver>gluconeogenesis and glycogenolysis >increase glucose

The ketone bodies📍 activation of chemotriggor zone which lead to reflex vomiting

Hydrogen ions lead to
📍 acidosis and abdominal pain
📍hyperkalemia by k out of cells
And Na/k pump fialure
📍activation of peripheral chemoreceptor(aortic and carotid )lead to activation of vagus and glossopharngeal nerves which lead to reflex Increase R.R To out CO2



when the Glucose increase in blood this lead to increase osmolality of blood (hyper osmolar blood )and traction more water >polyuria

The hyper osomolar blood lead to ctivation of osmoreceptor in hypothalamus (thirst center )>drink more water(polydipsia)
when glucose decrease inside cells this lead to decrease ATP and the body need energy >polyphagia


Pathophysioilogy of complication in two types in general( DM1, 2)

When glucose increase in blood and don't enter the cells it conjugate with (lipid and proteins)this named (non enzymatic glycation

This lead to form very potent inflammatory molecules which leads to. Inflammation of BVs with increase of LDL this
1/🔴deposits in basement membrane (hyline artriosclerosis)lead to decrease blood volume
And gas exchange this can cause many disease such as(CAD, PAD, stroke, Retinopathy)

2/🔴damage of glomeruli which lead to increase filtration of protein like albumin (microalbuminurea)>chronic kidney disease

Note⭐️ When insulin rlease also amyline released which functions are(inhibit food intake, delayed gastric empyting, decrease blood glucose, reduction of body weight )

So when there is no insulin production amyline may accumulate and lead to damage of cells

#أطفال

Toxins of E.coli
Causes aggregation of Platelets in small Blood vessels " Glomeruli ... inducing Thrombocytopenia

When the RBCs enters this Glomeri , It is destroyed.
لانها بتدخل في Blood vessel مش طبيعي

Causing " MAHA " ❤️

Micro -Angiopathic Heamolytic anemia

وبسبب ال Platelets Aggregation:-

Decrease the Glomerular Filtration >> AKI

وبهذا :-
1- Heamolytic anemia ( Jaundice , pallor)
2- Thrombocytopenia ( purpuric rash )
3- AKI

With History of Bloody Diarrhea

( Hemolytic Uremic syndrome ) " HUS "

#أطفال

🛑Hyperthyroidism is characterised by increased thyroid hormone synthesis and secretion from the thyroid gland,

whereas

🛑thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source.

🛑Thyroid storm (also known as thyroid or thyrotoxic crisis) represents the severe end of the spectrum of thyrotoxicosis and is characterized by compromised organ function.

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Thyrotoxicosis vs Throid Strom" crisis "

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Corticosteriod Dose Equivalents
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