Diabetes Insipidus, Part 1

Diabetes Insipidus, Part 1

What is it?

• The inability to conserve H20 and maintain optimum free H20 levels
• Pts urinate large amounts of diluted fluid, regardless of the body's hydration state
• Sx: extreme thirst (can even wake pts up at night and drink up to 20L per day!), dry skin, constipation

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Upcoming...
Part 2: Diagnosing DI
Part 3: Treatment for Central DI and Nephrogenic DI






Source: 
Makaryus/Mcfarlane. DI: diagnosis and treatement of a complex disease Cleveland Clinic Journal of Medicine Jan 2006 Vol 73:1

Important Differentiation in Small Bowel Obstruction (SBO)

Small Bowel Obstruction

There are 3 main pts of differentiation to consider with SBO...

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Calculating and Interpreting ABI

http://www.strokescaninc.com/abi.htm

First things first...
What does ABI stand for? 

Ankle-Brachial Index

What arteries are you examining?

Brachial and Dorsalis pedis

How do calculate ABI?

R ABI = highest avg ankle pressure (R dorsalis pedis)/ highest avg arm pressure (either arm)
L ABI = highest avg ankle pressure (L dorsalis pedis)/ highest avg arm pressure (either arm)

http://www.mayoclinic.com/health/medical/IM04412

How do you interpret the #s?

ABI                     Interpretation

>0.90                   Normal LE flow

<0.89 - >0.60      Mild PAD

<0.59 - >0.40      Moderate PAD

<0.39                   Severe PAD

See more about the technique of gathering ABI data in an older ABI post of mine...



Source: Bates Pocket Guide of Physical Examination 6th Ed

Differentiating the Shakes

Essential Tremor v. Parkinson's Disease, Simplified

Of course this topic could be covered in much more depth than shall be covered here... but this is designed to cover the big picture and help you study for the PANCE.

ET
Characteristic: postural and/or intention tremor, meaning when the patient attempts to do something with their arms, the tremor appears or gets worse... these patients have difficulty with eating and drinking. 
Treatment: propranolol and primadone
Other notes: ETOH usually makes tremor BETTER, 50% of pts have a + family hx, tremor can affect voice (remember to ask the pt to say "EEEEEEEEEEE" - you often hear shaking)



PD
Characteristic: resting tremor
Treatment: sinamet, levodopa-carbidopa
Other notes: other PD sx = bradykinesia (slow movements), cog wheeling with passive movements




Source: Hardcore Pathology, by Wahl

Perinatal Infections

Perinatal Infections...

TORCH

Toxoplasmosis
Other (syphillis) - I always hate when "other" is one!
Rubella
Cytomegalovirus
Herpes










Source: Hardcore Pathology by Wahl