Rule out organic disorders like Electrolyte disturbances Hypothyroidism Alzheimer's disease Uncontrolled DM and Hypertension. Auto- brewery syndrome If above disorders are ruled out It is a case of NARCOLEPSY without catapexy . Treatment is CNS stimulants like Amphetamine Dextroamphetamine Modafinil A newer drug - Solriamfetol is promising
Diabetic pt c/o sleepiness Hyperkalemia/hyponatremia Electrolyte imbalance need to r/o DKA Secondaly hypothyroidism Yes sleep apnoea also to be r/o just check sp02 pt may be hypoxic
Hypersomnolence/Narcolepsy Dd. Hyponatremia Hypothyroidism Chronic debilitating diseases.. diabetes.. renal impairment... IHD Cortical atrophy. Sug. Serum sodium.. potassium.. bicarb... chloride Tfts Glycemic status Ecg Urine re.. acr.. BUN.. s. Creat. Ct. Brain.
Hypersomnia in this case may be due to chronic hypoglycemia . Need to check BSF and PP and HbA1c. Other general causes are Hypothyroidism OSA Chronic nocturnal insomnia,and hypnotic drug abuse . Narcolepsy 3red ventricle tumour , pituitary tumors Need investigations, including polysomnography.
Must evaluated by neurologist. Detail history regarding sleep onset, latency, maintenance 3xplqin sleep hygiene and healthy sleep practice Evaluation of etiology like any metabolic or structural abnormalities. If required Polysomniography (sleep study) for pathological sleep disorder
? SLEEP APNOEA .. ? DIBETES RELATED INSOMNIA.. NEED'S.. EXPERTS OPINION
Here are differentials DM with DKA Hypothyrodism Hyponatremia Narcolepsy Alzemers diease
Diabetic PT with sleep apnea. At night time, sarpghanda vati,Brahmi vati, tab mentaid, saraswatarisht, helpful. In daytime, medication,yoga, Pranayam helpful.with a control at Diabetes and other ailments..
Sleep Apnea I think shirodhara is best for this condition. And avoiding vatakar ahar vihar. Pranayama and asana like sarvangasan, halasan are good.
Thyroid function hb electrolytes and blood sugar
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A 43yrs old female pt. complaining of fatigue. on examination vitals stable, weight 68kg. routine investigations are normal(hb-11mg/dl) but patient FT4 slightly low with normal TSH(report attached). what is further management of this case please help meDr. Mahaveer Jakhar2 Likes14 Answers
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3 year male child..suffring from constipation.. abdominal tenderness.. abdominal pain irritable crying since 3 day.... plzz.dx and rx i was given proctolysis enema yesterday and today..stool pass but in small quantity..and hard... urine pass..colour dark yellowDr. Nitin Deshmukh2 Likes16 Answers
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Hyperthyroidism Hyperthyroidism (overactive thyroid) is a condition in which the thyroid gland produces the high level of the hormone thyroxine. In other words, it can be called as overreactive thyroid. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. When the thyroid gland is overactive (hyperthyroidism) the body’s processes speed up and you may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, and sleep problems, among other symptoms. Pathophysiology In hyperthyroidism, serum T3 usually increases more than does T4, probably because of increased secretion of T3 as well as the conversion of T4 to T3 in peripheral tissues. In some patients, only T3 is elevated (T3 toxicosis). T3 toxicosis may occur in any of the usual disorders that cause hyperthyroidism, including Graves’ disease, multinodular goitre, and the autonomously functioning solitary thyroid nodule. If T3 toxicosis is untreated, the patient usually also develops laboratory abnormalities typical of hyperthyroidism (ie, elevated T4 and 123I uptake). The various forms of thyroiditis commonly have a hyperthyroid phase followed by a hypothyroid phase. Causes A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Other causes of hyperthyroidism include: Excess iodine, a key ingredient in T4 and T3 Thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland Tumours of the ovaries or testes Benign tumours of the thyroid or pituitary gland Large amounts of tetraiodothyronine taken through dietary supplements or medication Risk factors Have a family history of thyroid disease Have other health problems, including Pernicious anaemia, a condition caused by a vitamin B12 deficiency Type 1 diabetes Primary adrenal insufficiency, a hormonal disorder Eating large amounts of food containing iodine, such as kelp, or use medicines that contain iodine, such as amiodarone, a heart medicine Older than age 60, especially if you are a woman Pregnant within the past 6 months Clinical manifestations The symptoms of hyperthyroidism include the following: An enlarged thyroid gland (goitre), which may appear as a swelling at the base of your neck Fatigue or muscle weakness Light periods or skipping periods. Weight loss Hand tremors Mood swings Rapid heartbeat Nervousness or anxiety Trouble sleeping Protruded eyeballs Skin dryness fine, brittle hair Heart palpitations or irregular heartbeat Increased frequency of bowel movements Breast development in men Complications Heart problems include atrial fibrillation and congestive heart failure An irregular heartbeat that can lead to blood clots, stroke, Brittle bones like osteoporosis Graves’s ophthalmology may exhibit eye problems including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Red, swollen skin. Thyrotoxic crisis. Diagnosis and Test Thyroid function blood test Thyroid function test is performed using a sample of blood obtained from the patient with hyperthyroidism. It is used to check the levels of: Thyroid-stimulating hormone (TSH) – a hormone produced by the pituitary gland (a gland at the base of the brain) that controls the production of thyroid hormones Triiodothyronine (T3) – one of the main thyroid hormones Thyroxine (T4) – another of the main thyroid hormones Your levels will be compared to what’s normal for a healthy person. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid. Radioactive Iodine Uptake Test To detect the way thyroid gland takes in and absorbs the orally given iodine dose and uses it to produce thyroid hormones. Conclusions are drawn based on the results obtained in this test. Thyroid scan A dye-injection or oral iodine dose test that enables visualization of the thyroid gland, which is seen on a computer. It helps to detect whether a region of the thyroid gland or the entire gland is affected. Ultrasound Scan – To detect the enlargement of the thyroid gland and surrounding structures. CT or MRI Scan – Scanning specified region if a tumour is suspected. Treatment and Medications No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health, and your own preference. Antithyroid Drugs: Drugs known as antithyroid agents-methimazole (Tapazole®) or in rare instances propylthiouracil (PTU)-may be prescribed to treat the hyperthyroidism by blocking the thyroid glands to secrete thyroid hormones. Methimazole is preferred due to less severe side-effects. These drugs work well to control the overactive thyroid, and do not cause permanent damage to the thyroid gland. Radioactive Iodine: Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone. Because these cells need iodine to make thyroid hormone, they will take up any form of iodine in your bloodstream, whether it is radioactive or not. The radioactive iodine used in this treatment is administered by mouth, usually in a small capsule that is taken just once. Once swallowed, the radioactive iodine gets into the bloodstream and rapidly it is taken up by the overactive thyroid cells. The radioactive iodine that is not taken up by the thyroid cells disappears from the body within days over a period of several weeks to several months (during which time drug treatment may be used to control hyperthyroid symptoms), radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Thyroid surgery: Hyperthyroidism can be permanently cured by surgical removal of all or most of the thyroid gland. This procedure is best performed by a surgeon who has experience in thyroid surgery. An operation could be risky unless the hyperthyroidism is first controlled by an anti-thyroid drug or a beta-blocking drug, usually for few days before surgery, a surgeon may prescribe to take drops of nonradioactive iodine-either Lugol’s iodine or supersaturated potassium iodide (SSKI). This extra iodine reduces the blood supply to the thyroid gland and thus makes the surgery easier and safer. Beta-Blockers: Beta blockers do not stop thyroid hormone production but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers. Propranolol (Inderal®) was the first of these drugs to be developed. Some physicians now prefer related, but longer-acting beta-blocking drugs such as atenolol (Tenormin®), metoprolol (Lopressor®), nadolol (Corgard®), and Inderal-LA® because of their more convenient once- or twice-a-day dosage. Prevention and Cure Patients being treated for hyperthyroidism need to follow-up with the physician for regular monitoring. For weight loss, fatigue and other complaints a proper nutritional plan is essential. To prevent further weakness, bone thinning and to maintain good health, it is necessary to follow a proper diet plan and healthy routine as advised by the physician. Taking calcium and vitamin D supplements may be considered with medical advice. Regular exercise can help to improve bone and heart health. For those suffering from eye disturbances or Grave’s ophthalmology, special care of the eyes can help. Some measures include wearing sunglasses, applying cool eye compresses, using lubricating eye drops and raising the head while sleeping to relieve pressure on the eyes.Dr. Shailendra Kawtikwar11 Likes21 Answers
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30yrs male swelling of both legs R>L. Since 4days no other complete no pallor no sob / urine problem /no htn dm .. now bp 160/110. PR 75 bmn. Tempr normal..Dr. Vijaykumar Bagale5 Likes23 Answers
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Amazing Benefits Of Shallots (Chota Pyaz) For Skin, Hair And Health stylecraze.com Oct 9, 2017 12:00 PM ￼ Shallots are long, thin bulbs like vegetable. They are smaller in size and grow in clusters of bulbs in the root system. The bulbs have a mild pungent taste and a distinct smell as compared to onions and garlic. This is a popular ingredient used by the chefs around the world. Besides adding flavour to your dishes, shallots have various health benefits and a high nutrient content. They’re also great for your hair and are widely used as an ingredient in hair treatment products. Shallots belong to the onion and allium family. They contain vital nutrients like vitamins B & C, calcium, iron and potassium. There are many varieties of shallots such as French Grey Shallot or Griselle Genus Allium Oschaninii, Pink Shallot or Jersey Shallot, Banana Shallot, Green shallot. Shallots are also known as ‘Chota Pyaz’ in Hindi, ‘Sambar Ullipayalu’ in Telugu, ‘Chinna Vengayam’ in Tamil, ‘Cheriya Ulli’ in Malayalam, ‘Sambar Eerulli’ in Kannada, ‘Sambara Cha Kanda’ in Marathi, ‘Gundhun’ in Bengali. Benefits of Shallots: 1. Iron: Shallots contain iron which is required for proper functioning of your red blood cells. Healthy red blood cells contain a good amount of hemoglobin that helps them transfer oxygen from the lungs to the other tissues of your body. It is also essential for your proper metabolism, brain function and to make your tissues strong. 1 cup of shallots can provide 1.9 milligrams of iron that gives 24 percent of the daily required iron intake for men and 11% for women. 2. Fiber: Shallots help in a healthy digestion. Due to its dietary fiber content, it absorbs water and fills your stomach after a meal. It slowly releases sugar in your bloodstream and helps soften the stool, thus preventing constipation. It is also useful in reducing the blood cholesterol levels, preventing many heart diseases. One cup of shallots can provide 5.1 grams of dietary fiber that is 20 percent of the daily required fiber for women and 13% for men. 3. Potassium: Shallots are a rich source of potassium. One cup of shallots can provide 534 milligrams of potassium that is 11% of your daily required intake. Potassium is useful to regulate the body’s fluid levels. It also aids in the proper functioning of nerve and muscle cells. This helps the metabolism by breaking down carbohydrates into required body fuel. Potassium helps in maintaining a healthy heart by lowering blood pressure. Deficiency of potassium can lead to cramps and weakness in the muscle. 4. Cooking with Shallots: Shallots are commonly used in cooking, hence they are cultivated extensively. They are used as a condiment in various Asian cuisines in a finely sliced or deep-fried form. Shallots are costlier than onions and are popularly used in cuisines like Malaysian and Thai. Benefits of shallots’ nutrients can be gained by adding them directly to your dish, sautéing, adding to pastas. Fresh shallots can be combined with fruits and vegetables for salsas. Add them to your salads, pizzas, sandwiches and wraps as caramelized shallots. You can also grill, roast, bake, fry, blanch, pickle or boil them. Shallots can also be substituted with onions. 5. Heart Health: One of the most spoken of health benefits of shallots is that they are excellent for the blood and help prevent heart disease. Cycloallin, an anticoagulant, is found in shallots that are useful to protect your body against heart disease. It contains allicicn that can block platelet clot formation in your blood vessels to decrease peripheral vascular diseases (PVD), coronary artery disease (CAD), and stroke. They are helpful in producing an anti-coagulant, which thins the blood to cure symptoms of cardiovascular disease, heart attack, atherosclerotic disease, and stroke. 6. Strong Immune System: Shallots can strengthen your immune system efficiently. Consume them daily to prevent and cure cold, flu and other illnesses. 7. Low in Calories: Shallots contain very less amount of calories and loads of nutrients. Calories in a shallot depend on its cooking procedure. If you’re on a diet, you can add shallots to bland foods and enjoy the delicious flavor without piling on calories. 2 tbsp shallots provide just 14 calories. There are 19 calories present in 100 grams of boiled shallots. 8. Anti-oxidants: Shallots contain more nutrition than onions. They have more anti-oxidants, minerals, vitamins and flavonoid anti-oxidants like quercetin and kemferfol. 9. Healing Power: Along with various antioxidants, shallots contain sulphur anti-oxidant compounds like diallyl trisulfide, diallyl disulfide, and allyl propyl disulfide. Shallots also have anti-viral, anti-bacterial, and anti-fungal properties. 10. Reduces Cholesterol: Allicin present in shallots can be useful to reduce cholesterol production. They inhibit HMG-coa reductase enzyme into your liver cells. 11. Lowers High Blood Pressure: Allicin in shallots is helpful in decreasing blood vessel stiffness, as they release vasodialator chemical nitric oxide (NO) that lowers the high blood pressure. 12. Anti-diabetic: Shallots contain phyto-chemical such as allium and Allyl disulphide that have anti-diabetic properties. Shallot is a useful remedy to lower blood sugar levels in diabetics. It prevents the degradation of insulin and increases the metabolism of glucose. 13. Treats Intestinal Worm: Shallots are found effective in curing and treating intestinal worms in the stomach. Shallot juice helps clear thread worms that occur in children. Grind some shallots to make a juice and drink every morning on an empty stomach. 14. Cold or Fever: Shallots are smeared on a baby’s body during cold or fever since it is a medicinal plant that can effectively cure regular cold or fever. ￼ Image: Shutterstock 15. Reduce Phlegm: Shallots are an effective remedy to dilute the phlegm that causes coughing. 16. Reduces Nervous Irritability: Shallots contain many vitamins and minerals like vitamin A, thiamin, vitamin C pyridoxine, folates, etc. Pyridoxine (B-6) present in shallots is useful to raise the GABA chemical levels in your brain to soothe nervous irritability. 17. Prevents Cancer: 100 g of fresh shallots contain 1190 IU that is 35% RDA of vitamin A. Vitamin A is an effective antioxidant that is useful in preventing lung and oral cavity cancers. Shallots are also helpful in preventing liver cancer and destroy their cells. They help the liver in eliminating toxins from your body and contain saponins that kill the cancer cells. Shallots also help reduce the chances of stomach cancer. 18. Rich in Vitamin A: Shallots are the richest source of vitamin A that is required for your good health. Vitamin A (an antioxidant) helps protect you from the harmful free radical damage. They can also be useful in maintaining membranes, prevent infections, lead to good eye health, promote healthy immune system, and for proper growth and development. 19. Low in Fat: Shallots contain very low amount of fat. Hence, they can be effectively used for low-fat diets. 20. Low in Sodium: Shallots are very low in sodium. Our body requires some amount of sodium for survival, but too much can cause high blood pressure. Many flavoring ingredients are high in sodium content, but shallots can be consumed by high blood pressure or kidney patients as a suitable alternative. 21. Flavonoids: Shallots have two sets of compounds including sulphur compounds like allyl propyl disulphide (APDS) and flavonoids like quercetin. Consume flavonoid in your daily diet to reduce the risk of cancer, heart related diseases and diabetes. They are antiviral, anti-allergenic, anti-cancer, antibacterial, and anti-inflammatory. 22. Osteoporosis: Consume shallots in your daily diet for the proper growth of the bone tissue and reduce the risk of osteoporosis by 20 %. 23. Younger Looking Skin: Shallots contain sulphur that helps in giving you younger looking skin. 24. Stomach Infection: Shallots are also advantageous in inhibiting stomach problems. Consume shallots in your regular diet to prevent your stomach from various infections. 25. Alzheimer’s Disease: Shallots help in promoting beneficial brain functions. This is proven to be effective for Alzheimer’s disease. 26. Hair Growth: Shallots are the oldest and most efficient home remedy for hair growth. They are rich in sulphur that helps in the production of collagen tissues. This is useful for the re-growth of hair. Chop shallots into small pieces and squeeze out its juice. Apply it evenly on the scalp and keep for 15 minutes. Rinse off with a mild shampoo that helps in hair growth. 27. Baldness and Hair Loss: If you suffer from bald patches you can use the following remedy: Grind pepper powder, shallot and salt into a fine pasteApply on affected areasThis is an effective way to treat bald patches. 28. Cures Scalp Infection: You can utilize shallot juice to treat scalp infections. Fungal infections damage the hair and also lead to severe hair loss. Shallots can also be useful in opening the clogged pores of your hair follicles. 29. Overcoming Dandruff: You can easily use shallot juice to cure dandruff problems. Mix shallot with lemon juice, buttermilk, and honey. Apply this mixture on your hair and leave on for 30 minutes. Rinse well with a mild anti-dandruff shampoo to cure dandruff naturally. And that is how you can use shallot for hair. 30. Insect Stings: To treat insect sting, rub the affected area with shallot juice. This will help soothe the pain. Shallots can be applied by crushing or cutting and applied on mosquitoes, bee or wasp stings. 31. Warts: Shallots can be used as a poultice. This will drop off the warts on its own. 32. Bronchitis: Mix shallot juice with honey and consume a teaspoon of this mixture thrice daily. This is an effective expectorant that can give you relief from bronchitis, influenza, cold, cough and sore throat. It is also helps liquefy the phlegm and helps in clearing them. 33. Strengthen Capillaries: Consume 5 shallots every day on an empty stomach for 14 days. This is an effective remedy to strengthen capillaries. 34. Eliminate Toxins: Fry four pieces of sliced shallots in ghee. Eat this frequently for 14 days to help your liver in eliminating toxins from the body. 35. Tooth Health: Chew shallots for 3 minutes every day in the morning. This will destroy the bacteria in your teeth. 36. Good Eyesight: The juice of shallots with its flowers promotes good eyesight. This can be used as eye drops. Shallots are rich in sulfur, cysteine, and lecithin that protect the lens of your eyes from cataract formation. Include shallots in your diet to promote good eye health. 37. Get Rid of Headache: Applying shallots on the head can give you relief from headaches. For this, you can make a poultice of shallots and apply on your head for instant relief. 38. Stimulates Hair Growth: Rub shallot juice everyday on your scalp to get rid of dandruff and promote hair growth. 39. Bruise Dressing: You can also use shallots for dressing your bruises. Burns are often dressed with shallots and salt. 40. Treat Boils: Drink shallot juice mixed in water or carrot juice. This can also be applied to the boils. Nutrition Chart of Shallots: Shallots(Allium cepa var. aggregatum), raw, Nutrition value per 100 g.(Source: USDA National Nutrient data base)PrincipleNutrient ValuePercentage of RDAEnergy72 Kcal3.6%Carbohydrates16.80 g13%Protein2.50 g5%Total Fat0.10 g0.5%Cholesterol0 mg0%VitaminsFolates34 µg9%Niacin0.200 mg1.5%Pantothenic acid0.290 mg6%Pyridoxine0.345 mg26.5%Riboflavin0.020 mg2%Thiamin0.060 mg5%Vitamin A1190 IU35%Vitamin C8 mg13%ElectrolytesSodium12 mg1%Potassium334 mg7%MineralsCalcium37 mg4%Copper0.088 mg10%Iron1.20 mg15%Magnesium21 mg5%Manganese0.292 mg13%Phosphorus60 mg8.5%Selenium1.2 µg2%Zinc0.40 mg4% Now you know that shallots are a healthy option for your overall health. So avail its numerous benefits and nutritional properties and tell us how you benefited from them!Dr. Tapan Kumar Sau6 Likes16 Answers