Postgraduate medicine
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Atherosclerosis is the leading cause of death in the United States, and its prevention is now a primary goal of health care personnel. Knowledge of the early history of the disease, which would be particularly helpful in determing its pathogenesis, is still lacking. Studies are only now beginning to be directed at younger individuals without clinical evidence of disease. ⋯ Serum lipid and lipoprotein levels used to define hyperlipoproteinemia in the United States are derived from a system in which 95% of the population are regarded as having normal levels. The cut points are set far too high. Mild hyperlipoproteinemia is rampant in this country, as is coronary artery disease, and from the evidence now available, it seems reasonable to try to lower the incidence of the latter by reducing blood lipid levels of the entire population through dietary modification.
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Postgraduate medicine · Jan 1976
Combating diabetic ketoacidosis and other hyperglycemic-ketoacidotic syndromes.
Diabetic ketoacidosis is an acute medical emergency that requires immediate diagnosis and treatment. Diagnosis may be established rapidly by measurement of urinary glucose and ketones, arterial blood pH and blood gases, and serum ketones. Rapid infusion of large volumes of fluids and electrolytes, together with continuous infusion of low doses of insulin, provides effective restoration of fluid and electrolyte balance and correction of metabolic derangements. ⋯ The syndrome differs from diabetic ketoacidosis in that blood glucose levels are lower and glycosuria is absent. Treatment consists of intravenous administration of dextrose in water and, if necessary, of sodium bicarbonate. Insulin administration usually is not necessary.
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The prognosis in cardiogenic shock remains poor despite improvements in treating other complications of acute myocardial infarction. In some situations, left ventricular function can be improved by increasing the vascular volume, but the benefits of increasing the cardiac uutput must be balanced agains the risk of pulmonary edema. ⋯ An aggressive approach will not cure great numbers of extensive myocardial damage remains, but it will identify those who are hypovolemic or who have other correctable contributory factors. Most important, this approach may help to identify therapies currently in use that may actually increase rather than lessen myocardial damage.