Ann Acad Med Singap
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Ann Acad Med Singap · Oct 1983
ReviewCurrent concepts of the pathogenesis and management of diabetic ketoacidosis (DKA).
Diabetic ketoacidosis (DKA) is the commonest endocrine emergency encountered in clinical practice. Although in the last 3 decades the average worldwide immediate mortality has decreased from 10% to 5%, survival has not improved strikingly. The pathogenesis of DKA is currently attributed to a combination of two hormonal abnormalities--a relative insulin insufficiency and stress hormone excess (glucagon, catecholamines, cortisol and growth hormone). ⋯ Current acceptable treatment of DKA include the following: adequate fluid replacement: low dose insulin therapy at frequent intervals; adequate potassium replacement from time of first insulin therapy with ECG monitoring; bicarbonate replacement if pH less than 7.1; broad spectrum antibiotics if infections is suspected and other supportive measures. The role of phosphate and magnesium replacement is still controversial. An awareness of the complications during the treatment of DKA including cerebral edema (paradoxical acidosis), altered central nervous system oxygenation, vascular thrombosis, shock, myocardial infarction, pancreatitis, infection, inhalation of vomitus , overhydration, underhydration , hypoglycaemia, hyperkalemia and hypokalemia all certainly help improve the morbidity and mortality of DKA.
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Ann Acad Med Singap · Oct 1983
Review Comparative StudyGastritis and duodenitis--a clinical, endoscopic and histological study and review of the literature.
A clinical, endoscopic and histological study of gastritis and duodenitis was carried out in 50 patients. The endoscopic diagnosis of mucosal inflammation was found to be highly reproducible. However there was poor correlation between endoscopic and histological diagnoses of gastritis or duodenitis. ⋯ Gastritis and duodenitis should not be diagnosed by history alone but only by endoscopy or histology. When gastritis or duodenitis is the only pathology demonstrated only symptomatic therapy should be given. The literature on the diagnosis and aetiology of gastritis as well as that of specific varieties of gastritis is reviewed.