Complications of insulin-dependent diabetes mellitus: management of insulin reactions and acute illness

Occasional mild hypoglycemia is an unavoidable and usually acceptable side effect of intensive insulin therapy. Patients with insulin-dependent diabetes mellitus may have impaired glucose counterregulation, which may increase the risk of hypoglycemia and justify less ambitious glycemic goals. A conservative but flexible approach to the treatment of insulin reactions is appropriate in order to avoid hyperglycemia. Insulin requirements are often increased during acute illness, and frequent self-monitoring of blood glucose concentrations is necessary to determine the need for supplementation with regular insulin. Frequent supplementation, together with modification of diet and maintenance of fluid intake, should not only minimize the need for hospitalization but also prevent severe deterioration in glycemic control.     

Complications of acute frontal sinusitis.

The bone separating the frontal sinus from the anterior cranial fossa and the orbit is often quite thin. This, plus the interrelated venous drainage system of these areas, forms the anatomic basis for serious orbital and intracranial complications that must be recognized early. These include orbital cellulitis and abscess, cavernous sinus thrombosis, subdural and brain abscess and meningitis. Early hospitalization for intravenous antibiotic therapy and, occasionally, emergency surgical drainage are required.     

Cirrhosis and chronic liver failure: part II. Complications and treatment

Major complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome. Diagnostic studies on ascitic fluid should include a differential leukocyte count, total protein level, a serum-ascites albumin gradient, and fluid cultures. Therapy consists of sodium restriction, diuretics, and complete abstention from alcohol. Patients with ascitic fluid polymorphonuclear leukocyte counts of 250 cells per mm3 or greater should receive empiric prophylaxis against spontaneous bacterial peritonitis with cefotaxime and albumin. Patients who survive an episode of spontaneous bacterial peritonitis should receive long-term prophylaxis with norfloxacin or trimethoprim/sulfamethoxazole. Patients with gastrointestinal hemorrhage and cirrhosis should receive norfloxacin or trimethoprim/sulfamethoxazole twice daily for seven days. Treatment of hepatic encephalopathy is directed toward improving mental status levels with lactulose; protein restriction is no longer recommended. Patients with cirrhosis and evidence of gastrointestinal bleeding should undergo upper endoscopy to evaluate for varices. Endoscopic banding is the standard treatment, but sclerotherapy with vasoconstrictors (e.g., octreotide) also may be used. Prophylaxis with propranolol is recommended in patients with cirrhosis once varices have been identified. Transjugular intrahepatic portosystemic shunt has been effective in reducing portal hypertension and improving symptoms of hepatorenal syndrome, and can reduce gastrointestinal bleeding in patients with refractory variceal hemorrhage. When medical therapy for treatment of cirrhosis has failed, liver transplantation should be considered. Survival rates in transplant recipients have improved as a result of advances in immunosuppression and proper risk stratification using the Model for End-Stage Liver Disease and Child-Turcotte-Pugh scoring systems.     

Complications of acute pancreatitis

In 1925, Sir Berkeley Moynihan stated that "acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera." The case of M.H. clearly reflects the accuracy of that statement. It should be pointed out that through the exceptional, dedicated care provided by all members of the health care team, a young woman whose predicted mortality approached 100 percent was restored to her previous state of good health, and has since delivered a healthy baby girl by cesarean section. This illustrates that the nurse who possesses a sound understanding of the complications of acute pancreatitis and the pathophysiologic processes responsible, can integrate this knowledge into the management of the patient and improve the quality of care.     

Complications of acute respiratory failure

Many complications can occur during the management of acute respiratory failure and may involve multiple organs. Some of these complications can be avoided by preventive measures. We find evaluation of serial chest roentgenograms extremely useful for the early detection of several complications (figure 4). In addition, prophylactic use of heparin to prevent pulmonary emboli, prophylactic antacid or cimetidine therapy to prevent gastric bleeding, careful monitoring of renal function, appropriate measures to reduce the incidence of colonization and nosocomial infection, and early recognition of nosocomial infections are some of the measures essential to increased survival of patients with acute respiratory failure.     

Schedule-induced oral narcotic self-administration: acute and chronic effects.

A pattern of lever pressing was maintained in rats by presenting a food pellet following the first lever press to occur after at least 90-seconds had elapsed (fixed-interval 90-second schedule of food presentation, FI 90-second). With a drinking solution available, a pattern of excessive postpellet drinking (schedule-induced polydipsia) developed and was used to induce rats to drink solutions containing varying concentrations of narcotics. During acute exposure to morphine HCl, morphine SO4 or methadone HCl in the drinking solution, drinking decreased as a function of increasing drug concentration (from 0.3-1 mg/ml), but the total dose of narcotic ingested increased as a function of increasing drug concentration. The highest average dose of morphine HCl consumed in tap water was 30 mg/kg within an hour session. When morphine HCl was presented in an isotonic saline solution, drinking was increased and the highest average dose of morphine HCl ingested was 60 mg/kg within an hour session. The use of an isotonic saline solution did not appreceiably enhance the ingestion methadone HCl (about 30 mg/kg/hr). After chronic exposure to drug solutions for daily 4-hour sessions, the doses ingested averaged between 150 and 250 mg/kg/4 hr for 1 mg/ml solutions of morphine HCl and morphine SO4. The stable pattern of drinking exhibited by rats on the 0.5 mg/ml morphine HCl solution was characterized by a dissociation of drinking from pellet presentation. Chronic exposure to methadone HCl solutions (1 mg/ml) produced less drinking and lower doses ingested (approximately 100 mg/kg) than was obtained with either morphine HCl or morphine SO4 at an equal concentration.     

急慢性胰腺炎后新发2型糖尿病的危险因素Meta分析

目的 系统评价急慢性胰腺炎患者新发2型糖尿病危险因素的相关研究.方法 计算机检索中英文数据库,筛选符合纳入标准的病例对照研究,病例组为急慢性胰腺炎患者中新发2型糖尿病的患者,对照组为急慢性胰腺炎患者中未并发2型糖尿病的患者,对纳入的研究进行质量评估,提取数据并采用Review Manager5.3进行Meta分析及系统...     

Overview: acute and chronic wounds

Knowledge of normal wound healing and the changes associated with chronic wounds have advanced significantly. Distinct characteristics identified through basic and clinical studies are found in nonhealing wounds, including bacterial and growth factor imbalances, increased inflammatory responses, and proteolytic forces that tip the balance toward tissue degradation rather than repair.This article describes the alterations that reduce healing and that also have important implications for the management of chronic wounds and presents a focus for future developments in wound therapy.     

Complications in the acute stages of stroke. Nursing's pivotal role

The body-system alterations that occur in a patient who has suffered a cerebrovascular insult are multiple and often permanent. Even the "uncomplicated" stroke patient presents a challenge for multifaceted nursing care. The patient who develops complications secondary to the event poses even more complex issues for medical and nursing management. The proclivity for complications to evolve varies with age, brain areas involved, whether the event is hemorrhagic or nonhemorrhagic in nature, and the presence of concomitant systemic disease. Today's professional nurse has access to current technology and possesses the assessment skills and knowledge that enable early recognition of signs and symptoms foreboding potentially disastrous complications.