1/5. Rabson-Mendenhall syndrome.Rabson-Mendenhall syndrome is characterized by growth retardation, dysmorphisms, lack of subcutaneous fat, acanthosis nigricans, enlarged genitalia, hirsutism, premature and dysplastic dentition, coarse facial features, paradoxical fasting hypoglycemia and post-prandial hyperglycemia, extreme hyperinsulinemia and pineal hyperplasia. We describe a six-month-old female child with physical features suggestive of the Rabson-Mendenhall syndrome. The child also had medullary nephrocalcinosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Elevated postmortem ethanol concentrations in an insulin-dependent diabetic.A 54-year-old woman (165 cm, 37 kg) was found dead in her home during a welfare check after not having been seen for at least three days. The body showed clear evidence of decomposition. Her head was in what appeared to be a pool of blood. The residence was clean, neat, and showed no evidence of violence. insulin was found in the refrigerator, and syringes were in the kitchen cabinet. In agreement with these physical findings, her clinical history indicated that she suffered insulin-dependent diabetes mellitus. Autolytic changes were noticed at autopsy, and no obvious cause of death was demonstrated. The autopsy heart blood sample screened negative for cocaine and/or metabolite (benzoylecgonine), phenethylamines, opiates, and barbiturates by radioimmunoassay. The alcohol concentration was 0.51 g/dL in the blood, 0.04 g/dL in the brain, 0.08 g/dL in the liver, and 0.05 g/dL in the urine, and acetone levels were 42 mg/dL, 53 mg/dL, 14 mg/dL, and 19 mg/dL, respectively. Isopropanol was also present in all samples analyzed. The cause of death was ruled as metabolic acidosis due to diabetes mellitus. Possible bacterial postmortem production of ethanol is considered as an explanation for the increased concentration of ethanol found in the postmortem heart blood.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Severe rhabdomyolysis induced acute renal failure, caused by diabetic ketoacidosis.A 23 year-old obese Chinese gentleman was admitted to our hospital with the main problem of conscious disturbance for one day. The physical examination and laboratory data confirmed that this is a case of diabetic ketoacidosis complicated with rhabdomyolysis resulting in acute renal failure three days after admission, and regained his renal function after intensive hemodialysis and other conservative treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Unstable diabetes and unstable families: a psychosocial evaluation of diabetic children with recurrent ketoacidosis.To investigate the physical and psychological factors associated with labile diabetic control, 30 children and adolescents with recurrent diabetic ketoacidosis were included in a retrospective longitudinal review covering an 8-year period. The details of the ketoacidosis episodes and the psychosocial characteristics of the patient and his family were summarized from the medical record. Only a minority of the ketoacidosis episodes were overtly and solely related to intercurrent illness or poor compliance. A majority of the subjects studied lived in families with substantial psychosocial dysfunction, including chronic unresolved interpersonal conflict, inadequate parenting, father not in home, financial stress, and lack of family involvement with the diabetes. Many of the children displayed behavioral and personality problems. In most of these 30 cases, there was evidence that these dysfunctions existed prior to the onset of diabetes. These psychosocial problems were not immediately apparent in many instances, thus requiring more comprehensive psychosocial assessment and involvement by a social worker and/or a psychologist. Ongoing emotional support and counseling were instrumental in reversing the pattern of recurrent ketoacidosis, in coordination with care by all members of the diabetes team. The findings from this experience suggest that recurrent ketoacidosis warrants prompt evaluation from a psychosocial as well as a physical perspective.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/5. Diabetes and transport: a potentially bittersweet combination.These cases represent a portion of the spectrum of medical issues that may be seen in patients with a diagnosis of IDDM. As the first case suggests, knowledge of the disease process and an expanded differential diagnosis is imperative when acting as medical command for these patients. Interfacility transport does not only involve rapid and safe transport between institutions, but must also offer the highest level of expertise available for the referring physician and the patient. For this reason, we recommend the immediate availability of a senior level experienced pediatric physician for involvement in all but the most routine pediatric interfacility transports. Rapid recognition at the time of initial presentation or transport of the correct diagnosis in patient one may have altered potential outcome. Case 2 represents a potential untoward outcome which might be potentiated or exacerbated by the care given during transport. Although this patient's transport time was short, a similar patient may present who needs prolonged transport. The patient might also present to the transport service prior to neurologic deterioration. One must be prepared to intervene for all potential complications as they arise. Case 3 represents a patient whose physical examination suggested more intense therapy was needed than is offered by many DKA protocols. It is important to listen to what the patients are trying to tell us, rather than relying strictly on protocols or guidelines. While protocols or guidelines offer a menu of potential therapies, one must be prepared to vary from these guidelines if suggested by the patient's condition. Recognition of delayed capillary refill in patient 3 allowed for an increase in fluid administration and rapid patient improvement. While not evident with the presented short transports, the use of point of care testing in a transport vehicle can be useful for these types of patients. The opportunity to closely monitor blood chemistry evaluations and gasses can give insight about an ongoing process, suggest therapies, and help direct interventions that, in the past, often waited until the patient arrived at the receiving hospital. That additional information can be invaluable for the ill patient whose outcome may hinge on early recognition of subtle changes with subsequent appropriate interventions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |