Metabolism, abnormal

Insulin resistance occurs when the normal response to a given amount of insulin is reduced. Resistance of liver to the effects of insulin results in inadequate suppression of hepatic glucose production insulin resistance of skeletal muscle reduces the amount of glucose taken out of the circulation into skeletal muscle for storage and insulin resistance of adipose tissue results in impaired suppression of lipolysis and increased levels of free fatty acids. Therefore, insulin resistance is associated with a cluster of metabolic abnormalities including elevated blood glucose levels, abnormal blood lipid profile (dyslipidemia), hypertension, and increased expression of inflammatory markers (inflammation). Insulin resistance and this cluster of metabolic abnormalities is strongly associated with obesity, predominantly abdominal (visceral) obesity, and physical inactivity and increased risk for type 2 diabetes, cardiovascular and renal disease, as well as some forms of cancer. In addition to obesity, other situations in which insulin resistance occurs includes... 

Thiamin deficiency can result in three distinct syndromes a chronic peripheral neuritis, beriberi, which may or may not be associated with heart ilure and edema acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, without peripheral neuritis and Wernicke s encephalopathy with KorsakofPs psychosis, which is associated especially with alcohol and dmg abuse. The central role of thiamin diphosphate in... 

Upid metabolism abnormality in ovariectomized rats by soy isoflavones, daidzin, genistin, and glycitin. Biol Pharm Bull 24, 368-72. 

Diuretics cause numerous adverse effects and metabolic abnormalities, with severity linked to diuretic potency. A particularly worrisome adverse effect in the setting of HF is... 

Describe the major hemodynamic and metabolic abnormalities that occur in patients with hypovolemic shock. 

Profuse or prolonged vomiting can lead to complications of dehydration and metabolic abnormalities. Patients must have adequate hydration and electrolyte replacement orally (if tolerated) or intravenously to prevent and correct these problems. Some pharmacologic treatments work locally in the GI tract (e.g., antacids and prokinetic agents), whereas others work in the central nervous system (e.g., antihistamines and antiemetics).1... 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

Monitor the appropriate laboratory measures to prevent or minimize metabolic abnormalities and other side effects. 

Patients with acromegaly experience a two- to three-fold increase in mortality rate.8 Normalization of GH and IGF-I levels reverses the mortality risk and alleviates significant comorbid complications, especially cardiovascular, pulmonary, and metabolic abnormalities. Reduction of IGF-I levels alone does... 

Evaluate the patient for the presence of metabolic abnormalities and cardiovascular and fracture risks. 

Hypercalcemia is the most common metabolic abnormality experienced by patients with cancer. Once hypercalcemia occurs, it is associated with a very poor prognosis owing to the frequent association with advanced or metastatic disease.26... 

Patients with tumor lysis syndrome experience a wide range of metabolic abnormalities. The massive cell lysis that occurs leads to the release of intracellular electrolytes, resulting in hyperkalemia and hyperphosphatemia. High concentrations of phosphate bind to calcium, leading to hypocalcemia and calcium phosphate precipitation in the renal tubule. Purine nucleic acids are also released that are subsequently metabolized to uric acid... 

Rosen JF. 1989. Metabolic abnormalities in lead toxic children Public health implications. Bull N Y Acad Med 65 1067-1084. 

Kowluru, R. A., B. Menon et al. (2008). Beneficial effect of zeaxanthin on retinal metabolic abnormalities in diabetic rats. Invest. Ophthalmol. Vis. Sci. 49(4) 1645-1651. 

London, E.D., Simon, S.L., Berman, S.M. et al. Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers. Arch. Gen. Psychiatry. 61 73, 2004. 

Hoyer S (2000). Brain glucose and energy metabolism abnormalities in sporadic Alzheimer disease. Causes and consequences An update. Experimental Gerontology, 351, 1363-1372. 

Today, approaches to mechanical cleansing vary considerably. The historically touted 5-day preoperative preparation has been abandoned due to the risk of inducing severe metabolic abnormalities. Modern approaches fall into two general categories (1) whole-gut lavage with... 

Metabolic abnormalities / Renal and hepatic function / Concomitant drug therapy... 

Disease state-specific formulations are designed to meet specific nutrient requirements and to manage metabolic abnormalities. Unfortunately, scientific and clinical research supporting their efficacy is minimal, except for low carbohydrate formulations supplemented with specific fatty acids and antioxidants for patients with acute respiratory distress syndrome. Oral supplements are not intended for tube feeding. They are sweetened to improve taste and are therefore hypertonic. 

Metabolic Abnormalities Associated with Parenteral Nutrition Macronutrients... 

Electrolyte or metabolic abnormalities (calcium or sodium fluctuations, hyper- or hypoglycemia)... 

Arterial blood gases are measured to determine oxygenation and acid-base status (Fig. 74-1). Low pH values (less than 7.35) indicate acidemia, whereas high values (greater than 7.45) indicate alkalemia. The PaC02 value helps to determine if there is a primary respiratory abnormality, whereas the I IC( )3 concentration helps to determine if there is a primary metabolic abnormality. Steps in acid-base interpretation are described in Table 74-2. 

B8. Beutler, E., Congenital metabolic abnormalities of the erythrocyte Drug sensitivity and galactosemia. Proc. 4th Intern. Congr. Clin. Chem., Edinburgh, I960, pp. 110-119 (1961). 

Zl. Zinkham, W. H., and Lenhard, R. E., Jr., Metabolic abnormalities of erythrocytes from patients with congenital nonspherocytic hemolytic anemia. ]. Pediat. 55, 319-336 (1959). 

Finally, a laboratory evaluation completes the initial evaluation. This includes a battery of blood tests to rule out infection, metabolic abnormality, or hormonal disturbance. It must also include a drug screen. Unfortunately, most drug screens do not detect the designer drugs like Ecstasy that are an ever-increasing cause of acute psychosis. The initial evaluation should always include a CT or MRI brain scan, preferably the latter. 

The primary developmental mechanism of the atherosclerotic process is not completely understood. It seems likely that the development of atherosclerosis is preceded by metabolic abnormalities of the synthesis, transport, and utilization of lipids. Lipids such as triglycerides and cholesterol esters are circulated in the blood in the form of particles (lipoproteins) wrapped in hydrophilic membranes that are synthesized from phospholipids and free cholesterol. Cholesterol is transported by particles of various sizes synthesized from triglycerides, cholesterol esters, and phospholipids, each of which plays a very specific role. 

A stands for provision of airway B stands for breathing and ventilation C stands for circulation support D stands for drug-induced depression (central nervous and respiratory system) and E for electrolyte and metabolic abnormalities and... 

Considerations in the selection of ARV treatment regimens at both the programme level and at the level of an individual patient should include the potency, side effect profile, the potential for maintenance of future treatment options, the anticipated adherence of the patient population with a regimen, coexistent conditions (e.g., co-infections, metabolic abnormalities), pregnancy or the risk thereof, the use of concomitant medications (i.e. potential drug interactions), the potential for primary acquisition of resistant viral strains, and cost and access (Table 8). 

S. Smesny, T. Rosburg I. Nenadic, et ah. Metabolic mapping using 2D P-MR spectroscopy reveals frontal and thalamic metabolic abnormalities in schizophrenia. Neuroimage, 2007, 35, 729-737. 

Once the essential initial ABCD interventions have been instituted, one can begin a more detailed evaluation to make a specific diagnosis. This includes gathering any available history and performing a toxicologically oriented physical examination. Other causes of coma or seizures such as head trauma, meningitis, or metabolic abnormalities should be looked for and treated. Some common intoxications are described under Common Toxic Syndromes. 

Carson NAJ, Neill DW (1962) Metabolic abnormalities detected in a survey of mentally backward individuals in Northern Ireland. Arch Dis Child 37 505-513... 

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