diabetes, kidney and electrolytes
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Diabetes, kidney and electrolytes
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Causes of hyponatremiarenal failure leads to hypervolemiaheart failure leads to hypervolemiaheart failure leads to hypervolemiawater intakeloss of sodium and body fluidhypothyroidism
both thyroid hormone and cortisol are required Addison's disease
to excrete free water
diuretic use factitious hyponatremia or Isotonic hyponatremia, more commonly called "pseudohyponatremia," is caused by measurement error due to
l d ( bl d l d l l )Hypertriglyceridemia (massive increases in blood triglyceride levels) (most common) or paraproteinemiaHyperglycaemia or Hypertonic hyponatremia, caused by resorption of water drawn by molecules such as glucosey g
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increased protein catabolismUrea ↑, Creatinine normal purinary tract obstructiongastrointestinal bleedingsteroid therapy
↑,
muscle injury (crush a injury) or rhabdomyolysis
Urea normal, Crea nine↑
drugs that block the excretion of creatinine:‐ trimethoprimAntiarrhythmic: dronedaroneAntiarrhythmic: dronedarone‐ H2‐blockers: cimetidine, Ranitidine and famotidine‐ TenofovirInterference with the test:‐ acetoacetate (in diabetic ketoacidosis)‐ Cefoxitin and flucytosineconsumption of a large meal of meatconsumption of a large meal of meat
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1‐ Hypoparathyroidism2‐ renal failure
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In renal failure states, phosphate excretion is reduced, this leads to hyperphosphatemia and chelating and depositing calcium
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For evaluation of insolinoma in a patient with unreasonable hypoglycaemia, after 72 fasting serum glucose, insulin and c peptide is measured.
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Hyperinsulinemiarelated hypergonadotropichypogonadism:by directly reducing testicular testosterone levelstestosterone levels
Hypogonadism↕↕
Insulinemia
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In nephrotic syndrome lipoproteins tend to increase
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sensitivity of the test strip is p
10 mg protein/dL
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I i d Gl T lImpaired Glucose Tolerance
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FBS ↑ N N ↑
2hPP ↑ ↑ ↑ ↑
HbA1c
↑ ↑ N N
Steatohepatitis
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Low urinary citrate excretion is a risk factor for the development of kidney stones
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Hypertonic hyponatremia
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In fatty liver disease other liver function test are normal
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Diuretic use or diarrhea
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Two possibilities:If Ca is normal → Secondary hyperparathyroidism (low phosphate are seen in 50% cases)2‐ if Ca is high→ tertiary hyperparathyroidism,2 if Ca is high → tertiary hyperparathyroidism,