Diabetic Peripheral Neuropathy – Rueppel

Acute reversible neuropathy - associated with hyperglycemia and rapid correction of hyperglycemia.  Ex: DKA.  Improvement is ~50% chance, and can take up to a year to resolve. Pathophysiology:  involves deposition of sorbitol?   Chronic persistent neuropathy: Systemic polyneuropathy:  classic stocking-glove neuropathy; reduced or lost sensation on monofilament testing; burning or tingling. Autonomic neuropathy:  smooth muscle;… Continue reading Diabetic Peripheral Neuropathy – Rueppel

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New-Onset Seizure Evaluation in Children – Matelich

HISTORY Talk to witnesses and the patient.  Knowing events surrounding the seizure is key! Mime or description of observed physical actions during the seizure. Brief, focal symptoms prior to the dramatic event can be easily missed on a cursory history. Developmental, family and past medical histories should be covered - inherited seizure disorders, plateaus in… Continue reading New-Onset Seizure Evaluation in Children – Matelich

Dementia Overview – Allison-McNutt

Overview: Gradual increase in incidence as you age 50% change after age 85 Annual screening over age 70 (AAN recommendation) 60% of dementia is Alzheimers Lewy Body Dementia (psychiatric/visual hallucinations with Parkinson's symptoms) is as prevalent as vascular dementia  5% Parkinson's < 5% frontotemporal dementia Dementia is generally progressive and acquired; increased risk when patients… Continue reading Dementia Overview – Allison-McNutt

Pediatric Headaches – Turner

Majority of children are diagnosed with viral illness or migraine in the ED/UC setting. DDx: Infection:  viral meningitis, bacterial meningitis, orbital or cerebral abscess. Tumor:  isolated headache is a rare manifestation of a brain tumor. Intracranial hemorrhage:  non-traumatic (not typically HA alone) Carbon monoxide poisoning Hypertension:  essential, pheo Common secondary causes: fever viral meningitis pharyngitis… Continue reading Pediatric Headaches – Turner

Doxepin for Sleep Maintenance Insomnia

Excerpt from BMJ Clinical Review article: "Doxepin is a selective histamine receptor antagonist (fig 3⇑).130 At doses above 25 mg, doxepin has unpleasant anticholinergic and antiadrenergic side effects, but at doses of 6 mg or less its predominant mechanism of action is blockade of the wake promoting effects of histamine through histamine H1 receptor antagonism.130… Continue reading Doxepin for Sleep Maintenance Insomnia