Kawasaki's Disease

Today was a very interesting day. Saw lot of interesting patients. One of them is a patient with Kawasaki's Disease. It is the most commonly diagnosed pediatric vasculitis in the world. Following diagram sum up the clinical features of a patient with Kawasaki's Disease.

Main aim of treatment is to reduce inflammatory response and to prevent platelet activation, thus to prevent formation of coronary artery aneurysms and coronary artery disease. Treatment is commenced with Intravenous Immunoglobulines and high dose aspirin for variable periods of time.

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Gastroenteritis - Common but dreadful if taken lightly

Two weeks back i had a patient who is a 4 years old child, presenting with no urine out put after having had three days of diarrhea and vomiting. At the time he had only passed about 50ml of urine for the past 24 hours. Child looked very ill and irritable. He did not have signs of severe dehydration like sunken eyes, dry mouth, increased skin turger or prolonged capillary refilling time. In other words there was no circulatory volume depletion. But child had a mild generalized edema and high blood pressure suggestive of volume over load. 

This led to thinking of the possibility of Hemolytic uremic syndrome, a dreaded complication of gastroenteritis which manifest as acute renal failure, hemolytic anemia and thrombocytopenia. But fortunately the child did not show bleeding manifestations suggestive of thrombocytopenia or clinical manifestations of hemolysis. Fortunately child gradually responded well to a high dose of furosimide by next day morning. Thus child had been in pre-renal renal failure due to initial volume depletion of diarrhea and vomiting. If the renal failure had progressed, child could have ended up having to undergo dialysis.

In the perspective of a medical practitioner, this tells us that we should not be complacent when treating common conditions like gastroenteritis, taking into account the dreaded complications they may give rise to. Identifying complications early and expecting them could prevent unfortunate incidents from unfolding.

Following are a list of possible complications of gastroenteritis, which we have to keep in mind.

•  Volume depletion - shock
•  Pre-renal renal failure
•  Septicemia
•  Electrolyte Imbalances - seizures, paralytic illeus, hypernataemia, hypokalaemia, hyperkalaemia
•  Acid-base disturbances
•  Meningitis, Encephalitis - seizures
•  GI ulceration, Perforations
•  Rectal prolapse (with shigella)
•  Post Gastroenteritis syndrome
•  HUS - Haemolytic uremic syndrome (with shigella, E-coli 0157H7, salmonella)

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Happy New year 2012

Hi everyone, Wish you all a happy and phosphorus new year. Well this year is going to be a real exciting year for me as i am approaching the final days of my medical student life.

Well i had lot of doubts as to if i am going to continue maintaining this website since i only had two posts for the whole two years of life span of this site. ;) Well i have renewed for the 3rd year and this is going to continue for a long time. Thin as it is now, hope it will have it's thick days ahead.

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Diabetes and Diet

Hello again. In previous two posts we have tried to understand what diabetes as simple as possible. Now as you already know one of the main causative factors for developing type two diabetes is your diet. So if we understand how to take a good adequate diet most of these metabolic problems will never come to you and you will have great looks and a better self confidence.

Now let's see how you can plan your diet. The average amount of energy needed for an adult per day is around 35kcal / Kg. But this varies with each and every individual's daily activity level. Say you walk every day for few Kilometers and another person sits on a chair all day and doesn't walk beyond few meters a day. These two people's energy demands are certainly different. So what you really want to do is to supply the demand and not give more or less.

Following are some values that help you decide your energy requirement per day. (This calculations are done according to harris benedict principle.)

First of all we need to calculate your Basal Metabolic Rate (BMR). This gives the amount of energy burned out when you are in the resting state. It depends on your weight, height and your gender.

BMR calculation for men (metric)	BMR = 66.5 + ( 13.75 x weight in kg ) + ( 5.003 x height in cm ) – ( 6.755 x age in years )
BMR calculation for women (metric)	BMR = 655.1 + ( 9.563 x weight in kg ) + ( 1.850 x height in cm ) – ( 4.676 x age in years )

So if we take a 40 years old women who is 65Kg in weight and 160cm in height. We get a Basal Metabolic rate of,

BMR = 655.1 + (9.563 x 65) + (5.003 x 160) - ( 6.755 x 40 ) = 1806.9 kcal

Once we have calculated the BMR we need to decide on the activity factor of this person. Check out the following table of values.

Little to no exercise	Daily calories needed = BMR x 1.2
Light exercise (1–3 days per week)	Daily calories needed = BMR x 1.375
Moderate exercise (3–5 days per week)	Daily calories needed = BMR x 1.55
Heavy exercise (6–7 days per week)	Daily calories needed = BMR x 1.725
Very heavy exercise (twice per day, extra heavy workouts)	Daily calories needed = BMR x 1.9

Now with this information, let's say this person does some moderate exercise. Then the BMR value needs to be multiplied by 1.55. Thus,

Daily energy requirement = 1806.9 x 1.55 = 2800.8kcal

Ok, now we have done the hard part. Next step is to decide on what food to take and how much of these foods should you take.

In a balanced diet, only 55 - 60% of the energy should come from carbohydrates. All the rest should come from proteins, fat, ect.

So the amount of energy from carbohydrates per day = (2800/100) x 55 = 1540 kcal

In the next post we'll see how to decide on the type and the amount of food. At the end of this post you should have the amount of calories you require per day and the amount of calories required from carbohydrates. 

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Diabetes Information Video

I came a cross this really cool video on you tube describing diabetes. Check it out. But it is as if they have made it for kids.. :)

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Diabetes

We have all heard about it and at least one member of our families are suffering from it or taking medication for diabetes. The incidence of diabetes is on the rise, so it's important that all of us are aware  of it's consequences and how to prevent diabetes.

Diabetes is a Metabolic disorder where body can not control the amount of blood sugar level with in the normal range. Diabetes is caused by either resistance to insulin produced by endocrine cells of pancreas or by inadequate production of insulin in the body.

The most common form is development of resistance to insulin. In other words body produces enough insulin but organs can not utilize this hormone. This condition is termed type II diabetes. Commonest causative factor for type II diabetes is sedentary life style and unhealthy diet practices. Even though we should talk about other types of diabetes, talking about type II diabetes is important since it is more common and because it is preventable. Also when you develop it, it is of utmost importance to detect the condition early and to prevent the disease progression.

Following video further describes what is diabetes.

If you have been diagnosed with type II diabetes, there's no need to panic. But you should try your best to change your life style according to your health care practitioner's advice and make sure your blood sugar levels are controlled with medication or life style changes or both.

This is the first of a series of blogs on diabetes. I am looking forward to dedicate this month of January for lot of informative articles on preventing and controlling as well as living with diabetes.

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