❕Serum osmolality measurement is the first step in the evaluation of verified hyponatremia.

48-year-old man is brought to the emergency department by his wife 20 minutes after she witnessed him vigorously shaking for about 1 minute. During this episode, he urinated on himself. He feels drowsy and has nausea. He has a history of chronic alcohol use disorder; he has been drinking 15 beers daily for the past 3 days. Before this time, he drank 8 beers daily. His last drink was 2 hours ago. He appears lethargic. His vital signs are within normal limits. Physical and neurologic examinations show no other abnormalities. On mental status examination, he is confused and not oriented to time. Laboratory studies show:
Hematocrit 44%
Leukocyte count12,000/mm3
Platelet count320,000/mm3
SerumNa+112 mEq/L
Cl-75 mEq/L
K+3.8 mEq/L
HCO3-13 mEq/L
Urea nitrogen6 mEq/L
Creatinine0.6 mg/dL
Albumin2.1 g/dL
Glucose80 mg/dL
Urgent treatment for this patient's current condition puts him at increased risk for which of the following adverse events?

A 77-year-old woman is brought to the emergency room by her son for confusion for the last 7 days. The patient says she has had nausea and fatigue for the last week but is unable to provide a detailed history. She has Alzheimer disease and type 2 diabetes mellitus, for which she takes metformin and sitagliptin. She lives alone and cares for herself, but her son says she frequently forgets to take her medications. She is lethargic but oriented to place. Her pulse is 85/min, respirations are 16/min, and blood pressure is 115/70 mm Hg. Examination shows dry mucous membranes. Urinalysis shows 2+ glucose and no ketones. Serum beta-hydroxybutyrate is negative. Results of laboratory studies are most likely to show which of the following?

Consider allergic bronchopulmonary aspergillosis if respiratory symptoms worsen and/or features of bronchiectasis develop despite asthma treatment.

It is important to identify CD20-positive lymphomas, as patients may benefit from targeted therapy with CD20 antibodies (e.g., rituximab).

Loperamide should be avoided in patients with suspected invasive diarrhea with inflammatory features, as it reduces intestinal motility, which consequently increases the risk of bacterial colonization and invasion

Q. What are the antibodies found in SLE?
A. As follows:
✓ ANA
✓ Anti-double-standard DNA
✓ Anti-Smith (more specific in SLE)
✓ Anti-Ro/La (responsible for congenital heart block in neonate)
Antiphospholipid antibody/lupus anticoagulant (may cause repeated abortion, thrombocytopenia)
✓Anti-histone (found in drug induced SLE)
✓ Anti-C1q (it has prognostic significance in lupus nephritis)

What are the causes of positive ANA?
A. As follows:
✓ SLE
✓ Sjogren syndrome
✓ Systemic sclerosis
✓ Dermatomyositis
✓ Polymyositis
✓ MCTD
✓Autoimmune hepatitis
✓ Others—rheumatoid arthritis, autoimmune thyroid disease, vasculitis.

Causes of spleen atrophy ?

Causes of huge spleenomegaly ?

Emergency management of anaphylaxis

Causes of mononeuritis multiplex ?

Question
Causes of hypoglycemia ?
Answer :
نقسمهم لقسمين كبيرين إما
Diabetic patients
او
Non Diabetic patients


نبدأ ب
Diabetic patients
ونقسمهم أيضاً الى
✓Insulin-related
✓Glucose-related
✓Acute illness

Insulin related. :
اما. Insulin exces
او Increase insulin sensitivity
او Decreased insulin clearance
طيب أسباب زيادة الأنسولين
Causes of insulin excess:
زادة الجرعه الأنسولين او الأدوية اللي يعتبروا insuline secretagogue
👉Accidental overdose of insulin or noninsulin drugs (e.g., sulfonylureas, meglitinides)
وقت الجرعه خاطئ
👉Wrongly timed medication
او تداخل مع علاجات اخرى جعل تاثيره اكبر ولمده اطول
👉Drug interactions
يعني factitious يعني متصنع ، شخص عمل انسولين من تلقاء نفسه حتى يحصل له hypoglycemia
👉Factitious disorder
Reactive
هذا نوع من أنواع post prandial hypoglycemia بعدما ياكل المريض بساعتين او اربع ساعات وهذا يحصل بسبب excessive execration of insulin after heavy carbohydrate
"" What is the causes of postprandial hypoglycemia ?"
See later
👉Reactive hypoglycemia
✓✓ Increased sensitivity to insulin
👉Weight loss
👉 Increase in activity/exercise

✓ Decreased insulin clearance
👉Renal failure
يعني شخص DM ويستخدم جرعة انسولين محدده وبدأ مع الوقت يحصل له hypoglycemia افحص الكلى لانه في حالة فشل الكلى الأنسولين يبطل يخرج او يتكسر مفعوله يضل اكثر

Glucose-related :
✓Fasting/missed meals
✓Chronic alcohol use
✓ Exercise
في حالة التمارين العضلات تأخذ الجلكوز دون الحاجه الى انسولين
✓✓Acute illness
👉Sepsis
👉Trauma
👉Burns
👉Organ failure
ولهذا
In patients with diabetes who present with hypoglycemia in the absence of medication changes, consider another underlying condition, e.g., acute infection or decreased drug metabolism or drug excretion secondary to new-onset organ impairment

👉(Relative) overdose of insulin or a noninsulin drug is by far the most common cause of hypoglycemia
يتبع ..... بقية الشرح طبعاً اذا في تفاعل😅