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Hyperglycemia management in the Hospital
Control of hyperglycemia in hospitalized patients is important for optimal clinical outcomes, but can be very challenging. Uncontrolled hyperglycemia in hospitalized patients with or without a previous diagnosis of diabetes is associated with adverse outcomes and longer lengths of stay Insulin is the best way to control hyperglycemia in the inpatient setting especially in the critically ill patient. A variable rate, intravenous insulin infusion is the preferred method to achieve the recommended glycemic target. The short half-life of intravenous insulin makes it ideal in this setting because of flexibility in the event of unpredicted changes in an individual’s health, medications, and nutrition.
About the Speaker
Dr. KVS Hari krishna
Consultant Endocrinologist ,Magna clinics
Upcoming Case Discussions
H. pylori Treatment with PYELRA®: Best Practices
PYLERA® is a medication used for the treatment of Helicobacter pylori (H. pylori) infection, a common cause of stomach ulcers and gastritis. It contains a combination of three active ingredients: bismuth subcitrate potassium, metronidazole, and tetracycline. This combination works synergistically to eradicate H. pylori bacteria and reduce associated symptoms. Treatment with PYLERA® typically involves taking multiple capsules four times a day for a specified duration, as prescribed by a healthcare provider. It is important to follow the treatment regimen as directed and to discuss potential side effects
Case Scenario: Role of Point Care Ultrasound in NICU
Point-of-care ultrasound in the NICU allows for early diagnosis of various conditions such as respiratory distress, intraventricular hemorrhage, and congenital heart defects, aiding in timely interventions. POCUS enables real-time bedside monitoring of neonatal patients, providing immediate feedback on cardiac function, lung status, and fluid balance without the need for transportation to a separate imaging facility. Unlike traditional imaging modalities such as X-rays and CT scans, POCUS uses ultrasound waves that do not involve ionizing radiation, making it safer for frequent use in critically ill neonates. POCUS helps assess hemodynamics, including cardiac output, systemic and pulmonary blood flow, and evaluation of ductus arteriosus patency, guiding treatment decisions in hemodynamically unstable infants. Lung ultrasound provides rapid assessment of lung aeration and helps differentiate between different lung pathologies, aiding in the management of respiratory distress syndrome and other respiratory conditions. POCUS devices are portable and easy to use at the bedside, allowing neonatologists and intensivists to obtain immediate diagnostic information during rounds or emergent situations.
Ulcerative colitis: Diagnosis & Management
Ulcerative colitis is diagnosed through a combination of clinical evaluation, laboratory tests, imaging studies, and endoscopic examination of the colon. Key diagnostic tests include stool studies to rule out infections, blood tests for inflammatory markers like C-reactive protein and fecal calprotectin, and colonoscopy with biopsy to visualize the colon and confirm the diagnosis. Imaging studies like CT scans or MRI may be used to assess disease severity and complications such as toxic megacolon or perforation. Management of ulcerative colitis involves a step-wise approach, starting with anti-inflammatory medications like aminosalicylates for mild to moderate disease.Immunosuppressants such as corticosteroids, thiopurines, or biologics (e.g., anti-TNF agents) are used for moderate to severe disease or if patients do not respond to first-line therapy. Regular monitoring of disease activity through symptom assessment, blood tests, and endoscopic evaluation is crucial for disease management and to prevent complications.
Fluid Management and Hemodynamic Optimization
Fluid management and hemodynamic optimization are crucial components of patient care in various clinical settings, particularly in critical care, perioperative care, and the management of sepsis and shock. The goal of fluid management is to achieve an optimal balance between fluid administration and removal, ensuring adequate tissue perfusion while minimizing complications associated with fluid overload or depletion. This involves assessing the patient's fluid status, monitoring hemodynamic parameters such as blood pressure, heart rate, cardiac output, and oxygen delivery, and tailoring fluid therapy accordingly. Strategies for hemodynamic optimization may include the use of fluid resuscitation, vasopressors, inotropes, and other interventions aimed at maintaining organ perfusion and function. However, it's essential to individualize treatment based on the patient's specific condition, comorbidities, and response to therapy, while also considering potential risks such as pulmonary edema, renal impairment, and tissue ischemia. Effective fluid management and hemodynamic optimization require a multidisciplinary approach, close monitoring, and ongoing reassessment to optimize patient outcomes while minimizing complications.
Management of Pulmonary Fibrosis
Pulmonary fibrosis is diagnosed through a combination of medical history, imaging studies (like high-resolution CT scans), pulmonary function tests, and sometimes lung biopsies. Treatment often involves medications such as corticosteroids, immunosuppressants (like azathioprine or mycophenolate), and antifibrotic drugs (such as pirfenidone or nintedanib) to slow disease progression and manage symptoms.Supplemental oxygen therapy is commonly prescribed to relieve shortness of breath and improve oxygen levels in the blood. This program combines exercise training, education, and breathing techniques to improve overall physical condition and quality of life. Patients with pulmonary fibrosis should receive vaccinations against influenza and pneumococcal pneumonia to reduce the risk of respiratory infections. In severe cases, lung transplantation may be considered for eligible patients to improve survival and quality of life. Treatments like nutritional support, psychological counseling, and palliative care can provide comprehensive support and symptom management.
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Control of hyperglycemia in hospitalized patients is important for optimal clinical outcomes, but can be very challenging. Uncontrolled hyperglycemia in hospitalized patients with or without a previous diagnosis of diabetes is associated with adverse outcomes and longer lengths of stay Insulin is the best way to control hyperglycemia in the inpatient setting especially in the critically ill patient. A variable rate, intravenous insulin infusion is the preferred method to achieve the recommended glycemic target. The short half-life of intravenous insulin makes it ideal in this setting because of flexibility in the event of unpredicted changes in an individual’s health, medications, and nutrition.