CH39: Acquired Metabolic Disorders Flashcards
What is the formula for OSM?(p. 1157)
OSM= 2x Na + glucose/18 +bun/3
mOSM/L
In the physiology of hypoxic and ischemic damage, what level of mmHg will additional compensation in the form of increased oxygen extraction allows normal energy metabolism to continue? (p. 1157)
below 60 to 70mmHg
With predominant anoxia, neurons in portions of these areas are particularly vulnerable (p. 1158)
hippocampus
deep folia of the cerebellum
Mild degrees of hypoxia without los of consciousness symptoms (p. 1158)
inattentiveness, poor judgment, inoccordination
Beyond how many minutes, there will be permanent injury in hypoxia? (p. 1158)
5 mins
Hypoperfusion dominantes. There are two syndromes (p. 1160)
- Visual agnosia including Balint and cortical blindness
2. Man in the barrel syndrome
In carbon monixide poisoning, headache, nausea, dyspnea, confusion, dizzines and clumsiness happens when carboxyhemoglobin level reaches (p. 1162)
20-30% of total hemoglobin
Treatment for carbon monoxide poisoning (p. 1162)
Inspired oxygen, hyperbaric at 2-3 atm
For high altitude sickness, at this level, headache, anorexia, nauea and vomiting, weaknes and insomnia appear (p. 1163)
8,000ft
For high altitude sickness, at this level, ataxia, tremor, drowsines, mild confusion and hallucinations appear(p. 1163)
> 8,000ft
At this level, 50% of individuals develop asymptomatic retinal hemorrhages (p. 163)
16,000ft
For hypercapnic pulmonary disease, this is the most effective therapeutic measure (p. 1163)
positive pressure ventilation
When this drug is admnistered for the treatmetn of underlying pulmonary disease, it may produce high levels and a tendency to produce seizures (p. 1163)
aminophylline
In hypoglycemic encephalopathy, with glucose at about this level, this cerebral disorder takes form of a conusional state (p. 1163)
30mg/dL
In hypoglycemic encephalopathy, with glucose at about this level, coma ensues (p. 1163)
10mg/dL
Glucose is metabolized by the bran at arate of (p. 1164)
60-80mg/min and can sustain cerebral activity for 30mins or less once blood sugar is no longer avilable
How many percent of glucose is oxidized? (p. 1164)
85 to 90 percent. The remainder is used in the formation of proteins and other substances
EEG finding in hepatic stupor or coma (p. 1166)
paroxysms of bilaterally synchronous slow or triphasic waves in the delta range which at first predominate frontally and are insprearsed with alpha activity
Acute vs chronic portal-systemic encephalopathy MRI findings (p. 1168)
Chronic: high signal intensity on T1 weighted sequences in the globus pallidus
Acute: abnormal T2 hyperintensity throughout the cerebral hemispheres in insula, thalamus and cingulate
Pathologic findings of hepatic coma (p. 1167)
diffuse increase in the number and size of the protoplasmic astrocytes in the deep layers of the cerebral cortex, lenticular nuclei, thalamus, SN, cerebellar cortex, red, dentate and pontine nucleus; with little or no visible alteration in the nerve or other parenchymal elements.
Treatment of hepatic encephalopathy (p. 1168)
Restriction of dietary protein
neomycin or kanamycin
lactulose
Mechanism of action of lactulose (p. 1168)
produces hydrogen ions and shifts ammonia to ammonium
This syndrome is characterized by acute brain swelling in association with fatty infiltration of the viscera, particularly the liver (p. 1168)
Reye syndrome
EEG finding in uremic encephalopathy (p. 1169)
diffusely and irregularly slow and may remain so for several weeks after the institution of dialysis
70% of patients experience this symptom in dialysis disequilibrium syndrome (p. 1170)
headache
A characteristic of dialysis encephalopathy is the transient improvement in speech with the administration of ___ (p. 1170)
Intravenous diazepam
EEG in dialysis encephalopathy (p. 1170)
invariably abnormal, taking the form of paroxysmal and sometimes periodic sharp-wave or spike and wave activity, intermixed with abundant theta and delta activity
Dialysis is represented a form of this drug intoxication (p. 1171)
Aluminum
Hypotonic isovolemic hypernatremia is most often a result of __ (p. 1171)
SIADH
Restriction of fluids in SIADH (p. 1172)
500ml/24hrs if Na < 120
1,000ml/24hrs if Na < 130
formula for infused Na load (p. 1172)
([target Na- starting Na] x 0.6) x weight kg= infused Na load (meq)
300 to 500ml of 3% saline, infused rapidly IV will increase he serum Na concenration by about ___ (p. 1172)
1meq/L/h for 4 hours
Level of Ca to produce neurologic symptoms (p. 1173)
12mg/dL
Usual manifestations of hypocalcemia (p. 1173)
paresthesias, tetany and seizures
Pathologic attribute of CPM (p. 1173)
remarkable dissolution of the sheaths of myelinated fibers and the sparing of the neurons
First symptom of chronic acquired hepatocerebral degeneration (p. 1175)
tremor of the outstretched arms, fleeing arrhythmic twitches of the face and limbs or a mild unsteadiness of gait with action tremor
Ammonia levels when neurologic correlates in hepatocerebral degeneration (p. 1176)
> = 200mg/dL
Pathologic findings in chronic acquired hepatocerebral degeneration (p. 1176)
more cortical than Wilson disease
resemble hypoxic ones concentrated in the vascular border zones
myelinated and fibers and nerve cells are destroyed with marginal fibrous gliosis
Calcifications in chronic hypocalcemia (p. 1176)
basal ganglia, dentate nuclei, cerebellar cortex
Pathologic finding in this disease is scattered unusual glycogen-containing bodies (p. 1177)
Cerebellar ataxia with myxedema (the bodies are called myxedema bodies)
The changes in hyperthermia is disproportionaely severe in this structure (p. 1177)
cerebellum
Neuro findings associated with gluten- sensitive eneropathy (p. 1177)
progressive cerebellar ataxia of gait and limbs
sometimes with polymyoclonus in association with a gluten - sensitive enteropathy
In association with sprue in more than 90% of patients with the ___ (p. 1177)
HLA DQ2, DQ8 genotypes
not autoantibodies but are directed against gluten, the offending agent (p. 1178)
antigliadin antibodies
Attributes that usually allow an encephalopathic confusional state to be distinguished from dementia (p. 1178)
drowsiness and inattentiveness
EEG findings in Cushing syndrome and corticosteroid psychosis (p. 1178)
less well-modulated and slower frequencies appear
Neurologic findings in hyperthyroidism (p. 1179)
Action tremor; chorea occasionally w combinations of proximal muscular weakness
Treatment for Hashimoto Encephalopathy (p. 1179)
High tighters of antithyroid antibodies respond well to steroid therapy
