Postgraduate medicine
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Postgraduate medicine · May 2000
ReviewThe pathophysiologic defects of type 2 diabetes. Abnormal insulin action and impaired insulin secretion.
Normal glucose metabolism is dependent on tight interplay among the pancreas, the liver, muscle, and adipose tissue. If this interplay is disturbed by decreased insulin secretion or decreased insulin effectiveness, glucose intolerance and type 2 diabetes ensue. Therapeutic approaches currently available and those under development target the pathophysiologic defects of type 2 diabetes, and treatment must be selected with this in mind, a major goal being to ensure adequate availability of insulin to the tissues.
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Postgraduate medicine · May 2000
ReviewHyponatremia and hypernatremia. A systematic approach to causes and their correction.
Disorders of sodium and water metabolism can be approached by following a few basic steps: Thorough history taking and physical examination that focuses on volume assessment and laboratory evaluation that includes serum osmolality, urine osmolality, and urine sodium concentration are usually all that are required for diagnosis. Results of these findings are helpful in guiding therapy. Monitoring serum sodium concentration often to ensure adequate treatment and to avoid potential complications is required in management of both hyponatremia and hypernatremia.
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Postgraduate medicine · Mar 2000
Review Case ReportsA stepwise approach to acid-base disorders. Practical patient evaluation for metabolic acidosis and other conditions.
Acid-base disorders can usually be approached by following the steps outlined in the text and doing the calculations shown in the box on page 257. Clues about the underlying disorder can be obtained from history taking and physical examination. ⋯ Calculation of the various gaps can be helpful in differential diagnosis (i.e., anion gap for diagnosis of metabolic acidosis, delta anion gap for diagnosis of high-anion-gap metabolic acidosis, and urine anion gap for diagnosis of a non-anion gap metabolic acidosis). Most acid-base problems can be solved with use of the stepwise approach described.