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Pathophysiology of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Hyperglycemia is the primary manifestation of diabetes mellitus. It develops from impaired insulin secretion plus varied amounts of peripheral insulin resistance. Hyperglycemia may also occur in newborns after glucocorticoid hormones are administered, or because of excessive infusion of IV solutions containing glucose. This is common in poorly monitored hyperalimentation over a long period of time. Hyperglycemia causes osmotic diuresis. This is due to glycosuria, which leads to urinary frequency, plus polyuria and polydipsia. Orthostatic hypotension and dehydration can result. Hyperglycemia also causes weight loss, nausea, vomiting, blurred vision, and a predisposition to bacterial or fungal infections. Poorly controlled hyperglycemia that continues for years leads to vascular complications that affect the microvascular or macrovascular vessels, or both. There is glycosylation of the glomerular proteins in the kidneys. This may result in mesangial cell proliferation, expansion of the matrix, and vascular endothelial damage. There is usually a thickening of the glomerular basement membrane.
Safe Patient Handling and Mobility
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Christopher M. Wilson, Amy J. Litterini
A relatively common event when working with individuals who are medically unstable is orthostatic hypotension. This condition is characterized by an acute drop in blood pressure when changing position, most commonly from lying down to sitting to standing in a rapid manner. There are a number of potential causes of orthostatic hypotension including neurologic disorders (Parkinson’s disease, multiple sclerosis), oncologic conditions (spinal cord tumors), autonomic neuropathies, as well as sustained bed rest (from delayed or failed baroreceptor reflexes).11 In addition, anemia and dehydration can cause orthostatic hypotension.10 Prevention and early identification of these hypotensive episodes is an important step in preventing a fall or emergency intervention (e.g. lowering a patient to a floor or needing to emergently call out for assistance to get a chair). In some cases, despite the vigilant screening and efforts by a therapist, a patient may experience progressive hypotension without any precursor symptoms. In these situations, interventions such as physical counterpressure maneuvers (PCMs) can be the difference between needing to lower a patient to the ground or coaching the patient through these emergency procedures until a safe, secure place to sit or lie is encountered.
Prescribing for a first episode of schizophrenia-like psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Adrenoreceptor blockade can lead to miosis, nasal stuffiness, orthostatic hypotension and priapism or inhibition of ejaculation. Orthostatic hypotension should be managed by rising slowly from a seated or lying position and possibly increasing dietary salt intake. Tachycardia may be an anticholinergic effect, or may occur secondary to orthostatic hypotension; if severe, a low-dose peripherally acting β-blocker may be used (eg atenolol). Thioridazine and clozapine have the greatest adrenoreceptor antagonist activity.
When Blood Pressure Increases with Standing: Consensus Definition for Diagnosing Orthostatic Hypertension
Published in Blood Pressure, 2023
Jens Jordan, Italo Biaggioni, Guido Grassi, Artur Fedorowski, Kazuomi Kario
When changing from the supine to the standing position approximately 500–1000 ml blood is pooled below the diaphragm and hydrostatic pressure forces fluids from the intravascular to the interstitial compartment. These changes impose a major hemodynamic burden on the cardiovascular system. Baroreflex-mediated withdrawal of cardiac parasympathetic activity and sympathetic activation maintain standing blood pressure in healthy persons. Orthostatic hypotension occurs when these counterregulatory mechanisms fail. Conversely, some patients have a paradoxical increase in upright blood pressure to hypertensive levels, presumably due to sympathetic activation overshoot. This orthostatic hypertension is not a benign condition because it is associated with increased cardiovascular morbidity and mortality independently of traditional risk factors.1,2 Yet, there has not been a uniform definition of orthostatic hypertension and the entity is not covered in current hypertension guidelines. Because diagnostic criteria vary profoundly between studies, data on epidemiology, associated health risks, and management of orthostatic hypertension in the existing literature is difficult to interpret.
Characteristics of patients with autonomic dysfunction in the Transthyretin Amyloidosis Outcomes Survey (THAOS)
Published in Amyloid, 2022
Fabio A. Barroso, Teresa Coelho, Angela Dispenzieri, Isabel Conceição, Marcia Waddington-Cruz, Jonas Wixner, Mathew S. Maurer, Claudio Rapezzi, Violaine Planté-Bordeneuve, Arnt V. Kristen, Alejandra González-Duarte, Doug Chapman, Michelle Stewart, Leslie Amass
Demographic and clinical characteristics and QoL at enrolment were compared in patients with and without autonomic dysfunction. Patients with autonomic dysfunction were identified as those having orthostatic hypotension or at least one of the following symptoms recorded as definitely related to ATTR amyloidosis: early satiety, nausea, vomiting, constipation, alternating diarrhoea/constipation, diarrhoea, urinary retention, fecal/urinary incontinence, erectile dysfunction, dry eye, dyshidrosis, or dizziness. Orthostatic hypotension was defined as a decrease in systolic blood pressure of at least 20 mm Hg or a decrease in diastolic blood pressure of at least 10 mm Hg within 3 min of standing. Patients who did not satisfy these autonomic symptom criteria but had missing information for at least one symptom were classified as having ‘unknown’ status.
How can we better manage hypotensive syndromes in older adults?
Published in Expert Review of Cardiovascular Therapy, 2022
Treatment of orthostatic hypotension should be geared to the patient’s symptoms and their impact on daily function rather than a target blood pressure. The main goal is symptom relief in treating OH, not bringing it to a target BP value, such as the drop of systolic blood pressure (SBP) <20 or diastolic blood pressure (DBP) <10 mm of Hg. Discontinuation of medications by changing, stopping, or decreasing the dose of the offending medications that cause hypotensive syndromes is the first step in medical management. Adequate control of hypertension is also important in reducing the OH episodes. The Epicardian study pointed out that among older adults with adequate control of hypertension, the prevalence of OH is low [5]. At the same time, overtreatment of hypertension, especially in the frail elderly, can also result in hypotensive syndromes.