Diabetic Ketoacidosis Overview

Diabetic Ketoacidosis (DKA)

• Insulin deficiency leading to ketone production
• Triggered by illness, non-compliance, or stress (e.g., surgery)
• Symptoms: Polyuria, polydipsia, nausea, vomiting, abdominal pain, Kussmaul respirations (deep, labored breathing), fruity breath odor, altered mental status
• History: Diabetes history, insulin use, recent infections, polyuria/polydipsia, weight loss
• Investigations: Blood glucose (>250 mg/dL), arterial blood gas (metabolic acidosis with anion gap), serum ketones, electrolytes (low bicarbonate, hyperkalemia), urinalysis (ketones, glucose)
• Differential Diagnoses: Hyperosmolar hyperglycemic state (HHS), sepsis, lactic acidosis
• Management: IV normal saline initially (1L in the first hour), insulin infusion, treat underlying cause (e.g., antibiotics for infection), add 5% dextrose to fluids when blood glucose falls to 200–250 mg/dL
• Complications: Hypokalemia, cerebral edema, arrhythmias

Celiac Disease

• Autoimmune response to gluten in genetically susceptible individuals (HLA-DQ2/DQ8)
• Symptoms: Diarrhea, bloating, weight loss, fatigue, dermatitis herpetiformis
• History: Chronic diarrhea, anemia, family history, gluten exposure
• Investigations: Anti-tTG (tissue transglutaminase) antibodies, duodenal biopsy (villous atrophy), IgA deficiency
• Differential Diagnoses: IBS, Crohn's disease, lactose intolerance
• Management: Gluten-free diet, nutritional supplementation (iron, calcium, vitamins)
• Complications: Malabsorption, osteoporosis, enteropathy-associated T-cell lymphoma (EATL)

Parkinson's Disease

• Degeneration of dopaminergic neurons in the substantia nigra
• Symptoms: Bradykinesia, rigidity, resting tremor, postural instability, gradual onset, handwriting changes, tremor, falls, sleep disturbances
• Investigations: Clinical diagnosis, MRI to rule out secondary causes
• Differential Diagnoses: Essential tremor, drug-induced Parkinsonism, Lewy body dementia
• Management: Levodopa-Carbidopa, dopamine agonists (Pramipexole, ropinirole), MAO-B inhibitors (Selegiline)
• Complications: Dyskinesias, falls, cognitive decline

Hyperthyroidism (Graves' Disease/Thyroid Storm)

• Autoimmune activation of TSH receptor
• Symptoms: Heat intolerance, weight loss, palpitations, exophthalmos, tachycardia, pretibial myxedema
• History: Recent stressor, family history, palpitations, anxiety
• Investigations: Low TSH, high T4/T3, thyroid antibodies (TSI, TSH receptor Ab)
• Differential Diagnoses: Toxic multinodular goiter, subacute thyroiditis, hemochromatosis
• Management: Beta-blockers, antithyroid drugs (Carbimazole, Methimazole or PTU), iodine, steroids
• Complications: Atrial fibrillation, thyroid storm

HIV Presenting with PCP

• Pneumocystis jirovecii infection in immunocompromised patients (CD4 <200)
• Symptoms: Progressive dyspnea, non-productive cough, hypoxia, fever, history of HIV
• History: HIV status, antiretroviral therapy adherence, recent opportunistic infections
• Investigations: CXR (bilateral interstitial infiltrates), Chest X-ray, HRCT, Physical examination (decreased breath sounds, crackles)
• Management: TMP-SMX, steroids if hypoxia (PaO2 <70 mmHg), antiretroviral therapy initiation after stabilization, nucleoside reverse transcriptase inhibitors (NRTIs)
• Complications: Respiratory failure

Allergic Bronchopulmonary Aspergillosis (ABPA)

• Hypersensitivity reaction to Aspergillus fumigatus in individuals with asthma or cystic fibrosis
• Risk factors: Asthma, cystic fibrosis, exposure to moldy environments
• Symptoms: Worsening asthma symptoms (wheezing, breathlessness), cough (often productive with brownish sputum plugs), hemoptysis (in advanced cases), fever, malaise, weight loss
• History: Long-standing asthma or cystic fibrosis, recent worsening of asthma control, episodes of hemoptysis or coughing up sputum plugs
• Investigations: Total serum IgE elevated (>1000 IU/mL), Aspergillus-specific IgE and IgG, eosinophil count elevated, Chest X-ray (transient or fixed pulmonary infiltrates, bronchiectasis), HRCT.
• Management: Glucocorticoids, antifungal therapy (itraconazole or voriconazole), minimizing exposure to moldy environments, treating concomitant allergic rhinitis.
• Complications: Chronic bronchiectasis, pulmonary fibrosis, recurrent lung infections.

...(and so on, listing other conditions as needed)

This quiz covers the key aspects of Diabetic Ketoacidosis (DKA), including its causes, symptoms, investigations, differential diagnoses, and management strategies. It aims to enhance understanding of this critical condition in patients with diabetes. Test your knowledge on recognizing and managing DKA effectively.