Obesityconsiderations gestationaldiabetes

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Unformatted text preview: ­coma due to shrinkage of brain cells TREATMENT OF HHNC TREATMENT OF HHNC Regular insulin 10 units IVP then recheck Isotonic salt solution 2­3 liters over the first 1­2 hours Subsequent half­strength saline When plasma glucose level approaches normal start D5W When urine output is resumed supplement potassium Remember: this can be reversed with fluids alone, go slowly ANESTHETIC MANAGEMENT ANESTHETIC MANAGEMENT Same as IDDM except omit oral hypoglycemic the morning of surgery Keep in mind long duration of action of oral hypoglycemic drugs Obesity considerations GESTATIONAL DIABETES GESTATIONAL DIABETES Glucose intolerance first detected during pregnancy 2­3% of all pregnancies Detected in the last trimester Resembles NIDDM (50% develop NIDDM within 10 years) Risk factor for fetal morbidity Neonatal hypoglycemia Increased Respiratory Distress Syndrome, cardiomegaly and congenital abnormalities THYROID GLAND DYSFUNCTION THYROID GLAND DYSFUNCTION Overproduction or underproduction of T3 and/or T4 Negative feedback regulated by the anterior pituitary gland and the hypothalmus T3 and T4 act on cells through the adenylate cyclase system, producing changes in speed of biochemical reactions, total body oxygen consumption, and heat production HYPERTHYROIDISM HYPERTHYROIDISM Prevalence: 2% women, 0.2% men Decreased TSH and increased T4 Causes: Grave’s Disease, iatrogenic, Toxic nodular goiter and Thyroiditis Signs and symptoms: goiter, tachycardia, anxiety, tremor, heat intolerance, fatigue, weight loss, eye signs, skeletal muscle weakness and atrial fibrillation Stimulation of the sympathetic nervous system TREATMENT OF TREATMENT OF HYPERTHYROIDISM Antithyroid drugs: (methimazole, carbimazole, propylthiouracil) inhibit oxidation/formation of iodothyromines before treatment with radioiodine or surgery B­adrenergic antagonists (propranolol, nadolol, atenolol) decrease some of the tachycardia, anxiety and tremor Inorganic iodine inhibits the release of T4 and T3 for a l...
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