Hyperglycemic emergencies: diabetic ketoacidosis and hyperosmolar hyperglycemia state

Posted by & filed under Endocrinology.

Definition Diabetes Spectrum. January 2002 vol. 15 no. 1 28-36 CMAJ. 2003 Apr 1;168(7):859-66. Diabetic ketoacidosis (DKA), the hallmark of type 1 diabetes mellitus (T1DM), and hyperglycemic hyperosmolar state (HHS), primarily seen in type 2 diabetes (T2DM), are hyperglycemic emergencies that may lead to death if untreated. They are both associated with: Insulin deficiency (absolute… Read more »

Heart failure

Posted by & filed under Cardiology.

Definition N Engl J Med. 2010 Jan 21;362(3):228-38 N Engl J Med. 2003 May 15;348(20):2007-18. It is important to note that heart failure is not a diagnosis. Rather, it represents a constellation of signs and symptoms resulting from the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of… Read more »

Introduction to immunology

Posted by & filed under Infectious diseases, Rheumatology.

Overview N Engl J Med. 2000 Aug 3;343(5):338-44. Trends Immunol. 2001 May;22(5):235-6. Nat Immunol. 2012 Feb 16;13(3):214-22. Medicine. 2009 Oct 37(10): 510-517 Jpn J. Infec Dis. 2004 57: 236-247. Microorganisms that cause disease in humans and animals enter the body at different sites and produce disease symptoms by a variety of mechanisms. Microbial invasion is… Read more »

Diuretics and renal hormones

Posted by & filed under Nephrology.

Physiologic hormones affecting the kidney Hormone Trigger and pathway Site of action in the nephron (see figure) Net effect Angiotensin II (Ang II) Synthesized in response to hypotension. (See AKI and CKD chapters for details of Ang II production pathway) Afferent and efferent arteriole Afferent and efferent (higher degree) arteriolar constriction leading to a rise in… Read more »

Nephrotic syndrome

Posted by & filed under Nephrology.

Definition N Engl J Med. 1998 Apr 23;338(17):1202-11. Kidney disease causing proteinuria (3 or more grams of protein/24 hours), hypoalbuminemia, and edema. Etiology and pathogenesis Semin Nephrol. 2009 Jul;29(4):389-98. Lancet. 2003 Aug 23;362(9384):629-39. Crit Rev Clin Lab Sci. 2008;45(2):139-220. J Am Soc Nephrol. 2012 Mar;23(3):381-99. The glomerular capillary walls are composed of three structures: the endothelial cells, the glomerular basement membrane… Read more »

Oncologic emergencies

Posted by & filed under Oncology.

Definition Complications due to active malignancies or chemotherapy. Metabolic, cardio-respiratory, neurological, structural, or mechanical in nature. Requires active monitoring and immediate management. Metabolic N Engl J Med. 2011 May 12;364(19):1844-54. Endocrinol Nutr. 2010 May;57 Suppl 2:30-40. Cleve Clin J Med. 2004 Aug;71(8):639-50. Humoral hypercalcemia of malignancy (HHM) Etiology and pathophysiology Three major mechanisms lead to elevated serum calcium levels…. Read more »

Calcium homeostasis and osteoporosis

Posted by & filed under Endocrinology.

Calcium homeostasis N Engl J Med. 2007 Jul 19;357(3):266-81. Clin J Am Soc Nephrol. 2010 Jan;5 Suppl 1:S23-30. Clin Chem. 1999 Aug;45(8 Pt 2):1347-52. Calcium is found primarily in bone (99%), blood and ECF. The overall goal of calcium homestasis is to maintain biologically active ionized [Ca] within a narrow acceptable range (1.1-1.4 mmol/L) in order for critical functions… Read more »


Posted by & filed under Gastroenterology.

Definition Annu Rev Pharmacol Toxicol 2005;45:605-28 Lancet 2008;371:838-51 Acute liver injury leads to complex inflammatory reactions and matrix remodeling processes which result in the restoration of normal architecture Chronic liver injury leads to prolonged and dysregulated healing with accumulation of matrix proteins which ultimately progresses to cirrhosis Cirrhosis is an advanced stage of liver fibrosis… Read more »

Breast cancer

Posted by & filed under Oncology.

Overview Definition: breast cancer refers to several types of neoplasm arising from breast tissue, the most common being adenocarcinoma of the cells lining the terminal duct lobular unit. This chapter only discusses this adenocarcinoma type. Breast cancer is the most prevalent cancer in Canadian women, and is the second leading cause of cancer deaths in… Read more »

Lung cancer

Posted by & filed under Oncology, Respirology.

Overview Clin Chest Med. 2011 Dec;32(4):605-44. Canadian Cancer Society: Canadian Cancer Statistics 2012 Lung cancer is the leading cause of cancer-related death in Canada and worldwide (about 27% of cancer deaths in Canada). Overall incidence of lung cancer is: Higher in men than women Declining for men since 1980s Declining for women since mid-2000s (reversal of… Read more »