A little about poisoning

Carbon Dioxide Poisoning
What is carbon dioxide poisoning? What are the causes and symptoms of carbon dioxide poisoning? Read on to know how to identify if a person is suffering from carbon dioxide poisoning and how to treat him...

Carbon dioxide is a natural by-product of the various reactions that take place inside our body. Exposure to high levels of carbon dioxide can increase the amount of this gas in the blood. The result is carbon dioxide poisoning which is also referred to as hypercapnia or hypercarbia. In our blood, carbon dioxide is in equilibrium with bicarbonates. Hence blood tests in case of hypercapnia may show increased levels of bicarbonates as well.Carbon Dioxide Poisoning - CausesCarbon dioxide is being produced continuously by the cells of our body. Inability of the body in expelling this gas or exposure to air having high concentrations of carbon dioxide leads to carbon dioxide poisoning. Re-breathing exhaled air due to conditions like sleeping in air tight tents or sleeping with heads covered in blankets can cause hypercapnia. Working in confined areas that have poor air circulation as in mines, holds of ships, or underground tunnels and shafts may also raise levels of carbon dioxide in the blood. Breathing in areas with high levels of carbon dioxide such as areas close to a volcano makes one susceptible to such health problems. Scuba divers are particularly at risk. If carbon dioxide is not properly filtered out or in case their breathing equipment malfunctions, divers can suffer from high levels of carbon dioxide in blood. Besides these external conditions, medical conditions like lung diseases, respiratory problems, and neuromuscular disorder can also trigger carbon dioxide poisoning. Carbon Dioxide Poisoning - SymptomsMild carbon dioxide poisoning symptoms are:
Muscle twitching
Reduced neural activity
Flushed skin
High blood pressure
As the severity of hypercapnia increases, the following carbon dioxide poisoning symptoms may be experienced:
Headache
Lethargy
Elevated rate of cardiac output
Irregular heartbeat
Panic
Convulsions
Unconsciousness
Eventually death
Carbon Dioxide Poisoning -Treatment'Prevention is better than cure'. Be alert if working in an environment with high levels of carbon dioxide in the air or if suffering from any medical condition that may make a person susceptible to carbon dioxide poisoning. Knowing the cause will help in the treatment. Be conversant with the symptoms of carbon dioxide poisoning. In case a person is suffering from hypercapnia take him out to an environment where there is proper circulation of air. Individuals exposed to mild levels of carbon dioxide in air should recover fully on their own. However, if it is a case of severe toxicity, caused due to exposure to high levels of carbon dioxide then it is best to call in an ambulance. It is important to ensure that the air passage of the patient is clear of any blockage. In case one has access to continuous positive airway pressure (CPAP) put the mask on the patient's mouth. CPAP helps in restoring normal breathing by providing mechanical ventilation in case the patient's breathing is compromised. Medications to improve lung functions may also help. Ensure that the patient has enough amount of oxygen to breathe. Although such conditions are ideally provided in hospitals, portable oxygen tents or canisters of breathable oxygen can also be of help. Emergency supportive care, such as endotracheal intubation and hemodynamic support can also be administered. However, such steps are taken only under the supervision of healthcare professionals. People may also suffer from hypercapnia in case they are working at high altitudes. In such a case, move the patient to a lower altitude where the air has higher levels of oxygen in the atmosphere. The amounts of acid and oxygen in the blood of a patient should be checked regularly to determine the level of carbon dioxide in blood. People working in conditions that do not have proper air circulation need to be aware of carbon dioxide poisoning and its symptoms. Ensure whatever initial help you can provide to the patient. Even if the patient recovers, it is always advisable to take him to the physician and follow the levels of carbon dioxide in blood through proper tests.


Chlorine poisoning

Definition
Chlorine is a chemical that prevents bacteria from growing. Chlorine poisoning occurs when someone swallows or breathes in (inhales) chlorine.
Poisonous Ingredient
· Chlorine, which reacts with water in and out of the body to form hydrochloric acid and hypochlorous acid. Both are extremely poisonous.
Where Found
· Gas released when mixing bleach with some of the powdered cleansing products and ammonia (chloramine gas)
· Gas released when opening a partially filled industrial container of chlorine tablets that have been sitting for several months (for example, the first opening of a container after a pool has been closed all winter)
· Mild cleaners
· Some bleach products
· Swimming pool water (and tablets used in swimming pool water)
Note: This list may not include all uses of chlorine.
Symptoms
· Airways and lungs
· Breathing difficulty (from breathing in the chlorine)
· Throat swelling (may also cause breathing difficulty)
· Water filling the lungs (pulmonary edema)
· Blood
· Severe change in acid levels of the blood (pH balance) which leads to damage in all of the body organs
· Eyes, ears, nose, and throat
· Loss of vision
· Severe pain in the throat
· Severe pain or burning in the nose, eyes, ears, lips, or tongue
· Gastrointestinal
· Blood in the stool
· Burns of the food pipe (esophagus)
· Severe abdominal pain
· Vomiting
· Vomiting blood
· Heart and blood vessels
· Collapse
· Low blood pressure that develops rapidly
· Skin
· Burns
· Holes (necrosis) in the skin or tissues underneath
· Irritation
Home Care
Seek immediate medical help. Do NOT make a person throw up unless told to do so by poison control or a health care professional.
If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.
If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. Do NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.
If the person breathed in the poison, immediately move him or her to fresh air.
Before Calling Emergency
Determine the following information:
· Patient's age, weight, and condition
· Name of the product (ingredients and strengths, if known)
· Time it was swallowed
· Amount swallowed
Poison Control

What to Expect at the Emergency Room
The health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:
· Activated charcoal
· Breathing tube
· Bronchoscopy -- camera down the throat to see burns in the airways and lungs
· Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
· Fluids
· Medicine (antidote) to reverse the effect of the poison
· Oxygen
· Surgical removal of burned skin (skin debridement)
· Tube through the mouth into the stomach to empty the stomach (gastric lavage)
· Washing of the skin (irrigation) -- perhaps every few hours for several days
You may be admitted to the hospital if the poisoning is severe.
Instructions
1. Step 1
Identify the symptoms of chlorine poisoning. Inhaling chlorine commonly causes respiratory difficulties, along with severe burning of the eyes, ears, nose and throat. It may also produce swelling in the throat and fluid in the lungs. Ingesting chlorine results in gastrointestinal problems such as abdominal pain, burning in the esophagus and vomiting.
2. Step 2
Treat exposure of the skin or eyes to chlorine by flushing with plenty of water for at least 15 minutes. Move the patient into fresh air in cases involving inhaled chlorine.
3. Step 3
Administer water or milk for cases of ingested chlorine if the patient is able to swallow without difficulty. Ingesting chlorine can cause convulsions, vomiting and reduced alertness.
4. Step 4
Handle chlorine poisoning by ingestion in an emergency room setting. Insert a nasograstic tube through the nose to perform a gastric lavage. Activated charcoal also is effective in absorbing chlorine. Remove the patient's clothing if is contaminated with liquid chlorine.
5. Step 5
Provide treatment for inhaled chlorine in the emergency room. Provide supplemental oxygen and administer beta agonists, such as albuterol and ipratropium at first. Non-responsive patients also should receive aminophylline or terbutaline. Use a 4-percent solution of nebulized lidocaine as an analgesic agent and to reduce coughing.

chloroform

Instructions
1. Step 1
Know the symptoms. Chloroform was once used as a general anesthetic and as one might expect, the most obvious symptom is depression of the central nervous system. Small amounts can cause loss of consciousness and death due to cardiac or respiratory arrest may occur within a few minutes of heavy exposure.
2. Step 2
Seek treatment in a hospital for chloroform poisoning. Contaminated clothing should be removed and washed.
3. Step 3
Clean up spills while wearing breathing apparatus and gloves. Apply a dispersing agent if available, otherwise absorb the spillage using sand and a shovel. Unprotected people should keep a safe distance as chloroform is both powerful and fast-acting. The work atmosphere should not contain more than 10 parts per million of chloroform.
4. Step 4
Administer supportive treatment and monitor cardiac and respiratory functioning. Respiratory assistance and cardiac defibrillation is often needed. Gastric decontamination is not helpful as chloroform is absorbed rapidly.
5. Step 5
Treat long-term effects from severe chloroform poisoning. Treat kidney or liver failure with dialysis and replace fluids as needed. Patients may exhibit nerve damage in the form of tremors or shaking in the limbs. This frequently disappears after a few days without any treatment.
Chloroform Poisoning
This liquid is much used in Europe, but less than ether in this country, as an anaesthetic, by being breathed to annul the pain of surgical operations. It is more dangerous, by far, than ether or nitrous oxide, in this mode of employment; and, of course, it should never be taken or given in this way by an unprofessional person. Symptoms of chloroform poisoning are those of stupor, from which the patient cannot be roused. This may be preceded by signs of great irritation of the stomach; as chloroform is very pungent and heating when swallowed. Treatment requires an emetic at once (see Aconite, Treatment) ; and then, as there is no chemical antidote, dashing cold water on the face and chest, and, if it can be obtained, the galvanic battery ; as a last resort, artificial respiration.

Heart Blocks

Heart BlockThe heart has four chambers. The top two are called the atria. The bottom two are called the ventricles.
The heart's "natural" pacemaker is called the sinoatrial (SA) node or sinus node. It's a small mass of specialized cells in the heart's right atrium. It produces electrical impulses that make your heart beat. For your heart to beat properly, the signal must travel from the SA node down a specific path to reach the ventricles. As the signal goes from the atria to the ventricles, it passes through specialized conducting tissue called the atrioventricular (A'tre-o-ven-TRIK'u-ler) (AV) node.
On an electrocardiogram (e-lek"tro-KAR'de-o-gram) (ECG), a portion of the graph called the P wave shows the impulse passing through the atria. Another portion of the graph, the QRS wave, shows the impulse passing through the ventricles. As long as the impulse is transmitted normally, the heart pumps and beats at a regular pace.
What is heart block?
Sometimes the signal from the heart's upper to lower chambers is impaired or doesn't transmit. This is "heart block" or "AV block." This does not mean that the blood flow or blood vessels are blocked.
Heart block is classified according to the level of impairment — first-degree heart block, second-degree heart block or third-degree (complete) heart block.
What is first-degree heart block?
First-degree heart block, or first-degree AV block, is when the electrical impulse moves through the AV node more slowly than normal. The time it takes for the impulse to get from the atria to the ventricles (the PR interval) should be less than about 0.2 seconds. If it takes longer than this, it's called first-degree heart block.
Heart rate and rhythm are normal, and there may be nothing wrong with the heart.
Certain heart medicines such as digitalis (DIJ'ih-TAL'is) can slow conduction of the impulse from the atria to the ventricles and cause first-degree AV block. Also, well-trained athletes may have it.
Generally, no treatment is necessary for first-degree heart block.
What is second-degree heart block?
In this condition, some signals from the atria don't reach the ventricles. This causes "dropped beats." On an ECG, the P wave isn't followed by the QRS wave, because the ventricles weren't activated. There are two types:
Type I second-degree heart block, or Mobitz Type I, or Wenckebach's AV block. Electrical impulses are delayed more and more with each heartbeat until a beat is skipped. This condition is not too serious but sometimes causes dizziness and/or other symptoms.
Type II second-degree heart block, or Mobitz Type II. This is less common than Type I but generally more serious. Because electrical impulses can't reach the ventricles, an abnormally slow heartbeat may result. In some cases a pacemaker is needed.
What is third-degree or complete heart block?
Complete heart block (complete AV block) means that the heart's electrical signal doesn't pass from the upper to the lower chambers. When this occurs, an independent pacemaker in the lower chambers takes over. The ventricles can contract and pump blood, but at a slower rate than that of the atrial pacemaker.
These impulses are called functional or ventricular scope beats. They're usually very slow and can't generate the signals needed to maintain full functioning of the heart muscle. On the ECG, there's no normal relationship between the P and the QRS waves.
Complete heart block is most often caused in adults by heart disease or as a side effect of drug toxicity. Heart block also can be present at — or even before — birth. (This is called congenital heart block.) It also may result from an injury to the electrical conduction system during heart surgery. Complete heart block may be a medical emergency with potentially severe symptoms and a serious risk of cardiac arrest (sudden cardiac death). If a pacemaker can't be implanted immediately, a temporary pacemaker might be used to keep the heart pumping until surgery can be performed.

Diabetes

Diabetes Type 1:

In type 1, the pancreas stop producing insulin due to autuimmune response or possibly viral attack on pancreas. In absence of insulin, body cells don’t get the required glucose for producing ATP (Adenosin Triphosphate) units which results into primary symptom in the form of nausea and vomiting. In later stage, which leads to ketoacidosis, the body starts breaking down the muscle tissue and fat for producing energy hence, causing fast weight loss. Dehydration is also usually observed due to electrolyte disturbance. In advanced stages, coma and death is witnessed.

Diabetes Type 2:
• Increased fatigue : Due to inefficiency of the cell to metabolize glucose, reserve fat of body is metabolized to gain energy. When fat is broken down in the body, it uses more energy as compared to glucose, hence body goes in negative calorie effect, which results in fatigue.
• Polydipsia : As the concentration of glucose increases in the blood, brain receives signal for diluting it and, in its counteraction we feel thirsty.
• Polyuria: Increase in urine production is due to excess glucose present in body. Body gets rid of the extra sugar in the blood by excreting it through urine. This leads to dehydration because along with the sugar, a large amount of water is excreted out of the body.
• Polyphegia : The hormone insulin is also responsible for stimulating hunger. In order to cope up with high sugar levels in blood, body produces insulin which leads to increased hunger.
• Weight flactuation : Factors like loss of water (polyuria), glucosuria , metabolism of body fat and protein may lead to weight loss. Few cases may show weight gain due to increased appetite.
• Blurry vision : Hyperosmolar hyperglycemia nonketotic syndrome is the condition when body fluid is pulled out of tissues including lenses of the eye, which affects its ability to focus, resulting blurry vision.
• Irritability : It is a sign of high blood sugar because of the inefficient glucose supply to the brain and other body organs, which makes us feel tired and uneasy.
• Infections : The body gives few signals whenever there is fluctuation in blood sugar (due to suppression of immune system) by frequent skin infections like fungal or bacterial or UTI (urinary tract infection).
• Poor wound healing : High blood sugar resists the flourishing of WBC, (white blood cell) which are responsible for body immune system. When these cells do not function accordingly, wound healing is not at good pace. Secondly, long standing diabetes leads to thickening of blood vessels which affect proper circulation of blood in different body parts.








Type 1 diabetes

Type 1 Diabetes is autoimmune disease that affects 0.3% on average. It is result of destruction of beta cells due to aggressive nature of cells present in the body. Researchers believe that some of the Etiology and Risk factors which may trigger type 1 diabetes may be genetic, poor diet (malnutrition) and environment (virus affecting pancreas). Secondly, in most of the cases, diabetes occurs because there is abnormal secretion of some hormones in blood which act as antagonists to insulin. Example- Adrenocortical hormone, Adrenaline hormone and Thyroid hormone.

Type 2 diabetes

Type 2 Diabetes is also called non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. It occurs when the body produces enough insulin but cannot utilize it effectively. This type of diabetes usually develops in middle age. A general observation says that about 90-95 % of people suffering with diabetes are type 2; about 80 percent are overweight. It is more common among people who are older; obese; have a family history of diabetes; have had gestational diabetes. There are number of risk factors found to be responsible for type 2 diabetes like, the more the Etiology and Risk factors carried by an individual, the higher the risk for developing diabetes.
Following are the Causes of Diabetes
• Hereditary or Inherited Traits : It is strongly believed that due to some genes which passes from one generation to another, a person can inherit diabetes. It depends upon closeness of blood relationship as mother is diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the previous case and if both the parents are diabetic, the child has much greater risk for diabetes.
• Age : Increased age is a factor which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50 year, incidences increase with the age factor.
• Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber intake, high intake of refined products are the expected reasons for developing diabetes.
• Obesity and Fat Distribution : Being overweight means increased insulin resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35 inches in women or 40 inches in males.
• Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at low risk of falling prey to diabetes.
• Stress : Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease.
• Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and ziprasidone (Geodon) are known to induce this lethal disease.
• Infection : Some of the strephylococci is suppose to be responsible factor for infection in pancreas.
• Sex : Diabetes is commonly seen in elderly especially males but, strongly in women and those females with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome.
• Hypertension : It had been reported in many studies that there is direct relation between high systolic pressure and diabetes.
• Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is related to high blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in circulating blood.

Diet plays a significant role in controlling the diabetes. The diabetic diet may be used alone or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight, age, sex, physical activity and nature of diabetes. While planning diet, the dietician has to consider complications such as high blood pressure, high cholesterol levels.

With respect to the above factors, a dietician will assess calories to be given, like scheming the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber and so on.

Exchange meal plan is a diet program which balances the amount of carbohydrate that we intake per day. Glucose is a sugar released from carbohydrate so, if we want to control blood sugar we have to limit the consumption of simple carbohydrate. Carbohydrate foods are given as value per portion, known as the exchange. This plan helps us to decide on the type of food to be taken, the amount of food and also the time to eat. You can plan for more flexible meals as you get more knowledge about the diet for a diabetic, may be like the counting carbohydrate meal plan or constant carbohydrate. But there is no common diet that works for everyone. Nor is there any particular diet that works perfectly for any diabetic over a long period. While planning diabetes diet we should adhere to certain important factors, they are as follows:
• Fiber should be at least 1.4 oz / day
• Instead of 3 heavy meals, we should go for 4-5 small mid intervals
• Replace bakery products and fast foods by simple whole cooked cereals, and don't eat carbohydrates 2 hours before bedtime
• Consume fresh fruit and vegetables at least 5 exchange/ day
Diabetics always need to take care of their diet and also about the food they eat. Care has to be taken because all foods contain not only carbohydrate, but also some energy value. Protein and fat available in the food are converted to glucose in the body. This glucose has some effect on the blood sugar level, which has to be taken care of. Furthermore, you needn’t have to eat only the bland boring diet. Instead, you can eat more fruits, vegetables and whole grains. All it means is that you need to select foods that are high in nutrition and low in calories.

Fats (Limit to 1 serving per meal) A serving can be:-
• 10 Peanuts.
• 1 Tbsp Salad Dresssing
• 2 Tbsp light salad dressing or saur cream.
• 1 Tsp margarine, Oil or mayonnaise.
• 1/8 Avocado.
Sweets (Substitute for starch or fruit serving occasionally) A serving can be:-
• 2 Small Cookies.
• 1 Small Cupcake or Muffin
• ½ Cup Ice cream.
• 1/3 Cup Frozen Yoghurt.
• ¼ Cup Sherbet.
• 1 tsp Syrup or Honey.
Milk (2-3 Servings per day) A serving can be:
• 1 cup Milk.
• 1 Cup Low Fat.
• 1 Cup Artificially Sweetened yogurt (No sugar)
Meat / Fish/Chicken (2-3 Serving per day) A serving can be:
• 2 oz Cooked Lean Meat/Poultry/Fish.
• ½ - ¾ Cup Tuna or Cottage Cheese.
• 1 Egg or 4 oz Tofu or 1 oz cheese.
• 2 Tbsp peanut Butter.
Vegetables (3-5 Serving Per day) A Serving can be:
• 1 Cup Raw Vegetables.
• ½ Cup Cooked Vegetables.
• ½ Cup Tomato or Vegetable Juice.
Fruits (3 Serving per Day) A Serving Can be:
• 70 gm small fruit.
• ½ Cup canned fruit.
• ¼ cup Dried Fruit.
• ½ Cup Fruit Juice. (No sugar)
Grains, Starchy Vegetables and Beans. (6 plus Servings Per Day) A Serving Can be:-
• 1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5 Crackers or 1 Granola bar.
• ½ Hamburger or Hot dog Bun or a tortilla of 6 inch or 2 tacos.
• ½ Cup Cooked Cereal, Cooked beans, Lentils, Corn, Peas, S. Potato, Potato or Pasta.
• 1 Cup winter Squash, 1 Cup Soup.
• 1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free)
Most of the food items contain carbohydrate, protein and fat. Cereals are rich in carbohydrate, lentils, lean meat, chicken and fish are rich in protein while oils, nuts and milk creams are rich in fat. Fat foods are high in calories; 1g of it provides 9 calories, while 1g carbohydrate or 1g protein gives only 4 calories.

Carbohydrate is easily digested than fat and protein. The rise in blood glucose after a meal is due to absorption of glucose from a carbohydrate digestion and increase in production of glucose by liver. Sucrose (cane sugar), sweets and syrups cause a rapid rise in blood glucose than whole cereals like finger millet and wheat products.

In people with no diabetes, the rise in blood glucose after a meal comes down to the pre-meal level with in 2 hrs. In diabetes, the rise in blood glucose after a meal is not only higher but the fall to pre-meal level is slower (3-4 hrs). Therefore, snacks in between meals or frequent meals at short intervals tend to cause progressive increase in blood glucose in people with diabetes.

Glucose is constantly needed to provide ready energy for the proper functioning of brain, heart, kidneys, liver and blood cells. When glucose is not available from ingested food, our liver produces from its store of carbohydrate (glycocen) and body stores of fats and proteins. The liver produces about 0.1058 oz of glucose/lbs body weight in a day. For example the liver of a man or woman weighing 154 lbs produces 7.0547 oz of glucose in a day. The production of glucose by the liver is kept in a check by small amounts of insulin secreted by the pancreas.

These considerations and the modality of your treatment (tablets/insulin) are taken into account for formulating your diet management during diabetes and meal timings. The dietician would give your information on your diet.
The general guidelines on diet are:
In a typical day’s meals and snacks, you should have 1500-1800 calories with – 60% contribution from the carbohydrate, 20% from fat and 20% from proteins. You may need extra weight reduction. If you are on calorie-restricted diet, make sure to take 50-60% of calories as complex carbohydrate (whole cereals) to prevent any feeling of weakness.
• You should eat a variety of food items everyday. Do not skip meals. Avoid snacks, unless you are advised to (example during insulin treatment). Don’t over eat.
• Eat fruits and vegetables. Use less oil in cooking. Avoid fried foods, milk cream or food items cooked in coconut milk.
• Avoid ready to eat food preparations, sweets and sugary drinks (canned beverages) that provide empty calories (no vitamin or essential minerals).
• Keep a regular check on your weight – maintain it within the estimated limit.
• Check your hemoglobin and proteins in blood samples at 6 months or 1 year’s interval, Suitable correction in diet format or supplementation may become necessary.
• Despite a good control of blood glucose, if your blood lipids are high, you will need lipid lowering drugs regularly. Some times your doctor may advice you lipid-lowering drugs from the beginning of your diabetes treatment.
• Match your mealtime to the form of insulin and insulin injection schedules as explained by your doctor or the diabetes nurse.
Once we have crossed the reversible stage of prediabetes and enter diabetes stage, certain changes start developing in our body. These changes occur due to high blood sugar level with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms.
Symptoms of the Diabetes Complications
• Diabetic retinopathy shows symptoms of pain in the eyes and may even result in loss of vision.
• Renal (kidney) disease shows symptoms of swelling (edema) in the feet and legs. It then passes over total body and as the disease progresses, blood pressure also increases.
• Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night. Digestive problems also occur if, the nerves controlling internal organs get damaged (autonomic neuropathy).
• You may have scanty or profuse sweating, difficulty of sensing when your bladder is full, when there is a low blood sugar, increased sexual problems, weakness, dizziness, and fainting.
• Chest pain (angina) or shortness of breath dizziness or light headache, shoulder or stomach pain, fast heartbeat. You might not show any symptoms until having a heart attack or stroke.
When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin. The physiology for each and every affected organ is explained one by one.
Nerves depend on multiple tiny vessels which carry nutrients and oxygen to keep intact all the segments of these very long nerves. Damage to one small segment can result in loss of feeling, pain or burning sensations that bother the foot and leg.

Feet:- Diabetes can decrease the blood supply to the foot and gradually damages the nerves which carry sensation. A second micro vascular disease is diabetic foot or diabetic peripheral neuropathy or distal symmetric neuropathy. Neuropathy is the common complication of diabetes, and due to high blood sugar, chemical changes occur in the nerves. It always starts in the feet as they are the longest nerves and fed with longest blood vessels of the body. Generally it is seen in the obese people with high blood sugar levels and age more than 40 years. Neuropathy can develop within a span of first few years and it affects approximately 60% of diabetics.
Signs and symptoms of Diabetic Neuropathy
• Decrease or no sweating i.e. dry scaly skin with callus formation.
• Numbness, tingling, and some sort of burning sensation.
• Weakness and loss of reflexes.
• Decrease sensation to the slight change in temperature.
Diabetics need to take care of their feet especially the area between toes, and must not overlook if there is any kind of blisters, ulcer, redness or soreness or formation of callus etc. If any suspicion or doubt arises for the foot then it should be followed by immediate physical examination. The clinical examination will show the sensation in the feet and determine if it is normal or diminished.

Blood flow may be improved with good sources of vitamin E intake along with blood pressure medicine (ACE inhibitors). Although amputations are common with diabetes, about half can be prevented with simple steps that protect the feet.
The failure to make insulin or insufficiency of insulin is termed as Diabetes mellitus. Insulin is a natural hormone which controls the level of the sugar glucose in the blood. Insulin allows cells to use glucose for energy. Cells cannot utilize glucose without insulin. Excess glucose builds up in the bloodstream, increasing the risk of diabetes. Glucose is the body's primary source of fuel. Insulin enables the body cells to take glucose from the bloodstream. The cells might use glucose for production of energy if required, or it is sent to the liver to preserve it, in the form of glycogen.
Functions of Insulin
In addition to its role of regulating glucose metabolism, insulin also
• Stimulates lipogenesis
• Diminishes lipolysis
• Increases amino acid transport into cells
• Modulates transcription
• Altering the cell content of numerous mRNAs
• Stimulates growth
• DNA synthesis
Cell replication Insulin resistance comes in picture when the total amount of insulin produced by the body (pancreas), proves to be insufficient to maintain normal blood glucose level. Extra insulin may need to break down glucose in order to release energy. In about 1/3 of the cases blood cells resist to even high level of insulin. Insulin resistance is mostly associated with high Triglycerides and low HDL, hypertension, cardiovascular disease and other such abnormalities. It is in these abnormalities that we find the insulin resistance syndrome. Few people sometimes suffer from various symptoms and conditions. It is thus believed that diabetes and other problems go hand in hand.
If one of your siblings or parents has been diagnosed with diabetes, or there is a previous history of diabetes during pregnancy, history of polycystic ovary syndrome, diabetes that is not high enough than the blood sugar level, overweight or obese can be causes of diabetes. Insulin resistance can be often seen in the following conditions like the metabolic syndrome, obesity, pregnancy, infection or severe illness, stress during steroid use.
Insulin resistance tends to run in families and ethnicity, which makes us know that genes are partly responsible. Excess weight also contributes to insulin resistance because too much fat interferes with muscles ability to use insulin. It is seen that a sedentary lifestyle, such as excessive caloric intake and inadequate exercise is the most important factor which can be controlled out. In most cases, the effect of insulin resistance on the body is subtle and takes many years in developing further. It first begins with hyperglycemia and over time, hyperglycemia can progress and become diabetes type 2
Diabetes is an insidious disease. In fact, moderately high levels of blood glucose (180-200 mg/dl) produce no symptom and may go unnoticed for many months or even years. Most patients with Type 1 diabetes pass large volumes of urine, experience an increase in the frequency of urination, undue thirst and hunger, and rapid weight loss. These symptoms provide clues to the diagnosis of diabetes.

Men and women with Type-2 diabetes may not have the above symptoms. Some of them may experience an increase in the frequency of urination and abnormal thirst. They may however feel tired, irritable, lack concentration at work, proneness to infection, delay in wound healing, intense itching and need for frequent change of eye glasses.

At the age of 45yrs or later, if you foresee the risk of developing diabetes, get your fasting blood glucose test, 2-hrs after a drink of 3.527 oz of glucose, at least once a year. Blood glucose values of 200mg/dl and higher would suggest the diagnosis of diabetes mellitus.

Can diabetes be cured?

Diabetes cannot be cured completely, but can be effectively controlled. People with diabetes can lead a healthy life if, their blood glucose level is under control. The decrease in life span of a diabetic is restored to normal by maintaining good blood glucose control (90-130 mg/dl at fasting and with less than 180 mg/dl 2hrs after meals).

Sometimes, patients may not need any tablet/insulin or, even diet control to keep their blood glucose in control. This period is called honeymoon phase (in Type-1 diabetes). The duration may vary from a few days to over six months. Some patients mistake this for cure of diabetes.

Cardiovascular disease accounts for 70-75% deaths in diabetic people with acute myocardial infarction being responsible for 30% mishaps. Diabetes typically doubles heart attack risk in men and triples in women. Diabetes causes more extensive coronary atherosclerosis with triple vessel involvement. Long-duration diabetes and diabetes in elderly people is more likely to cause silent heart attack (painless MI) with increased chances of death.
What is the link between diabetes and CVD?
It had been observed that diabetes changes the chemical composition of some substances found in the blood and leads to blood vessels narrowing or sometimes clogging up completely. This is nothing but atherosclerosis, or hardening of the arteries, and diabetes increases the pace of it. Heart disease occurs twice frequently in those suffering with diabetes than in people without diabetes. Cardiovascular complications occur early in diabetics, and often result in premature death.

What is needed to “break the link” between diabetes and CVD?

Preventive management includes life style modification (quit smoking, regular exercise, and limitation of fat and energy intake) to control blood sugar, lipids and hypertension.

Target ranges are:
A HBA1C<7 percent Check twice a year
B Blood pleasure < 130/80 mmHg Check twice a year
C Cholesterol-LDL < 100mg/dl Check twice a year

Diabetics learn and practice the skills necessary to control their blood glucose, blood pressure and cholesterol levels, and it is very essential to receive customary checkups from their physicians. Smokers should give up smoking and overweight diabetics should follow a practice of moderate exercise regimen.

Whether your treatment consists of diet alone, diet and tablets or diet and insulin, you need regular blood tests to keep a check on your blood sugar. Urine sugar test is not a reliable indicator of diabetes control.

When blood glucose remains higher than 200mg/dl for 8-10 weeks, the concentration of glycosylated hemoglobin (HbA1c) arises. A (HbA1c) measurement therefore reflects the blood glucose control over a preceding 2-3 months period, while the estimates of blood glucose indicate the glucose value at the time of blood test. HbA1c values between 6-7% indicate very good control on diabetes. You should aim at keeping your blood glucose in the normal range i.e. between 90-130 mg/dl while fasting and less than 180 mg/dl after meals and HbA1c around 7%. Frequent tests for blood glucose are necessary when starting treatment with insulin.

If you are doing capillary blood glucose test using a hand held glucometer, do not squeeze the finger to bring out a sample after you have picked. This invariably gives a low glucose value. Ask your diabetes nurse for a demonstration of capillary blood glucose test.

Urine test for sugar is not reliable indicator of diabetes control. Although spillage of sugar in urine occurs when the blood glucose exceeds 180 mg/dl in the majority of healthy persons, this is not always so in a patient with diabetes. Most patients with diabetes of many years acquire an increase in the renal threshold for glucose (capacity to prevent spillage of glucose into urine). Hence urine test for glucose is not helpful for assessing control of diabetes. In the presence of urinary infections, the bacteria eats up the sugar present in urine, thereby making urine test for sugar unreliable. Prevention is proven to be one of the most effective and powerful methods to fight diabetes. More than 50% of diabetes is caused due to inappropriate lifestyle. Regulating lifestyle can prove to be advantageous in downfall of probability of contracting diabetes in one’s life. Loss of weight not only helps in fitness but also in control of blood sugar levels. Losing 10% of initial body weight and regular exercise can immensely reduce the risk of diabetes. Physical activities play a key role in reducing the body weight and on the other also the extra blood sugar is broken down. It also helps to uphold the blood sugar in the normal range. You are more liable to diabetes if you are overweight (may also lead to obesity), are having genetic or hierarchal means of predisposition along with proper physical activity.
Food choices: Foodstuffs containing low glycemic carbohydrates, proteins or fats can initially help to lose body weight and maintain dancing blood sugar level. Prefer healthy foods which are low in fats and calories such as lean fish, lean chicken, turkey and fruits and vegetables. Go slow on fast and fried foodstuffs for prevention of diabetes. Avoid processed carbohydrates as much as possible. Try to increase high-protein food in your diet. And reduce eating refined flour i.e. white flour, bleached flour, treated flour and other kind of white flour.
The Fundamentals to prevent diabetes: Diabetes can be prevented by good production of the insulin and keeping the body fat percent low. Insulin and fats helps to maintain body weight and control sugar level. Consumption of meals to a small fraction instead of heavy food also helps to control diabetes. Also avoid eating carbohydrates few hours before you go to sleep. Taking in high-protein breakfast and 5 or 6 small meals a day also helps you to maintain the body weight. This will also help to control excess consumption of fats and carbohydrates
Are you tired of taking insulin pills and injections for maintaining your blood sugar levels? Have you ever thought about the health advantages that can be derived from the consumption of food supplements? If not, think about it! The transition to the diabetic lifestyle will be much easier.

Diabetes is one of the most prevalent chronic diseases in the world. It prevents the body from using glucose in our food for taking care of its energy needs. This glucose gets accumulated in our blood, thereby risking the well-being of our heart, eyes, kidneys and nerves.
Nutritional Supplements for Diabetics
Recent researches carried out by food industries and health experts conclude that herbal supplements such as bitter melon, goat’s rue, nopal cactus, fenugreek, bilberry, gurmar, onions and garlic are quite effective in lowering the blood glucose level, thereby helping the patients to undergo less treatment distress.

Diabetics must be always cautious about the source of their calorie intake. Non starchy veggies, skimmed milk, lean chicken, high fiber fruits and low glycemic food products are smart choices for an informed diabetic. Oil low in saturated fats content should be preferred. It had been proved that a balanced diabetic diet contains some important nutrients and useful supplements to help control dancing blood sugar. Let’s see few useful diabetic nutritional supplements we receive from our food, and their action in controlling diabetes.
• Biotin – It helps the body in metabolizing carbohydrates, proteins and fats.
• Vitamin C – It prevents sugar from getting attached to proteins. Insulin deficiency hinders effective metabolism and transport of Vitamin C, making its increased intake all the more important. Here, ascorbates like EmergenC is more preferred as compared to ascorbic acid.
• Chromium – It aids the metabolism of glucose. It is most effective if consumed as niacin.
• Vitamin E – It helps in improving insulin sensitivity.
• Magnesium – It helps in lowering blood pressure and reducing heart-attack risks by relaxing the muscle tissues.
• CLA – It helps in protecting cells from becoming diabetic or getting damaged by atherosclerosis, colon cancer and chronic inflammation.
• Omega 3 and Alpha Lipoic Acids - They are effective building blocks and anti-oxidants respectively. They reduce the risks associated with nerve damages by aiding balancing of blood sugar.
• Vitamin B6 – It helps in preventing neuropathy.
• Vitamin D – It helps in reducing insulin resistance and averting the risks of cataract.
• Zinc – It helps in improving the action of insulin.
Diabetics have greater needs of nutritional supplements for fulfilling the antioxidant and metabolic requirements of the body. Design your food intake as per the above necessities and living the diabetic lifestyle will be a much easier road to travel upon.

Oxygen toxicity

Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen (O2) at elevated partial pressures. It is also known as oxygen toxicity syndrome, oxygen intoxication, and oxygen poisoning. Historically, the central nervous system condition was called the Paul Bert effect, and the pulmonary condition the Lorrain Smith effect, after the researchers who pioneered its discovery and description in the late 19th century. Severe cases can result in cell damage and death, with effects most often seen in the central nervous system, lungs and eyes. Oxygen toxicity is a concern for scuba divers, those on high concentrations of supplemental oxygen (particularly premature babies), and those undergoing hyperbaric oxygen therapy.
The result of breathing elevated concentrations of oxygen is hyperoxia, an excess of oxygen in body tissues. The body is affected in different ways depending on the type of exposure. Central nervous system toxicity is caused by short exposure to high concentrations of oxygen at greater than atmospheric pressure. Pulmonary and ocular toxicity result from longer exposure to elevated oxygen levels at normal pressure. Symptoms may include disorientation, breathing problems, and vision changes such as myopia. Prolonged or very high oxygen concentrations can cause oxidative damage to cell membranes, the collapse of the alveoli in the lungs, retinal detachment, and seizures. Oxygen toxicity is managed by reducing the exposure to elevated oxygen levels. Studies show that, in the long term, a robust recovery from most types of oxygen toxicity is possible.
Protocols for avoidance of hyperoxia exist in fields where oxygen is breathed at higher-than-normal partial pressures, including scuba diving, hyperbaric medicine, neonatal care and human spaceflight. These protocols have resulted in the increasing rarity of seizures due to oxygen toxicity, with pulmonary and ocular damage being mainly confined to the problems of managing premature infants.
In recent years, oxygen has become available for recreational use in oxygen bars. The U.S. Food and Drug Administration has warned those suffering from problems such as heart or lung disease not to use oxygen bars. Scuba divers use breathing gases containing up to 100% oxygen, and should have specific training in using such gases.
•
[edit] Classification

The effects of oxygen toxicity may be classified by the organs affected, producing three principal forms:[2][3][4]
• Central nervous system, characterised by convulsions followed by unconsciousness, occurring under hyperbaric conditions;
• Pulmonary (lungs), characterised by difficulty in breathing and pain within the chest, occurring when breathing elevated pressures of oxygen for extended periods;
• Ocular (retinopathic conditions), characterised by alterations to the eyes, occurring when breathing elevated pressures of oxygen for extended periods.
Central nervous system oxygen toxicity can cause a seizure, a brief period of rigidity followed by convulsions and unconsciousness, and is of concern to divers who encounter greater than atmospheric pressures. Pulmonary oxygen toxicity results in damage to the lungs, causing pain and difficulty in breathing. Oxidative damage to the eye may lead to myopia or partial detachment of the retina. Pulmonary and ocular damage are most likely to occur when supplemental oxygen is administered as part of a treatment, particularly to newborn infants, but are also a concern during hyperbaric oxygen therapy.
Oxidative damage may occur in any cell in the body but the effects on the three most susceptible organs will be the primary concern. It may also be implicated in red blood cell destruction (hemolysis),[5][6] damage to liver (hepatic),[7] heart (myocardial),[8] endocrine glands (adrenal, gonads, and thyroid),[9][10][11] or kidneys (renal),[12] and general damage to cells.[2][13]
In unusual circumstances, effects on other tissues may be observed: it is suspected that during spaceflight, high oxygen concentrations may contribute to bone damage.[14] Hyperoxia can also indirectly cause carbon dioxide narcosis in patients with lung ailments such as chronic obstructive pulmonary disease or with central respiratory depression.[14] Oxygen toxicity is not associated with hyperventilation, because breathing air at atmospheric pressure always has a partial pressure of oxygen (ppO2) of 0.21 bar (21 kPa) and the lower limit for toxicity is more than 0.3 bar (30 kPa).[15]
[edit] Signs and symptoms
Oxygen Poisoning at 90 ft (27 m) in the Dry in 36 Subjects in Order of Performance – K W Donald[1]

Exposure (mins.) Num. of Subjects Symptoms
96 1 Prolonged dazzle; severe spasmodic vomiting
60–69 3 Severe lip-twitching; Euphoria; Nausea and vertigo; arm twitch
50–55 4 Severe lip-twitching; Dazzle; Blubbering of lips; fell asleep; Dazed
31–35 4 Nausea, vertigo, lip-twitching; Convulsed
21–30 6 Convulsed; Drowsiness; Severe lip-twitching; epigastric aura; twitch L arm; amnesia
16–20 8 Convulsed; Vertigo and severe lip twitching; epigastric aura; spasmodic respiration;
11–15 4 Inspiratory predominance; lip-twitching and syncope; Nausea and confusion
6–10 6 Dazed and lip-twitching; paraesthesiae; vertigo; "Diaphragmatic spasm"; Severe nausea
[edit] Central nervous system
Central nervous system oxygen toxicity manifests as symptoms such as visual changes (especially tunnel vision), ringing in the ears (tinnitus), nausea, twitching (especially of the face), irritability (personality changes, anxiety, confusion, etc.), and dizziness. This may be followed by a tonic–clonic seizure consisting of two phases: intense muscle contraction occurs for several seconds (tonic); followed by rapid spasms of alternate muscle relaxation and contraction producing convulsive jerking (clonic). The seizure ends with a period of unconsciousness (the postictal state).[16][17] The onset of seizure depends upon the partial pressure of oxygen (ppO2) in the breathing gas and exposure duration. However, exposure time before onset is unpredictable, as tests have shown a wide variation, both amongst individuals, and in the same individual from day to day.[16][18][19] In addition, many external factors, such as underwater immersion, exposure to cold, and exercise will decrease the time to onset of central nervous system symptoms.[1] Decrease of tolerance is closely linked to retention of carbon dioxide.[20][21][22] Other factors, such as darkness and caffeine, increase tolerance in test animals, but these effects have not been proven in humans.[23][24]
[edit] Pulmonary
Pulmonary toxicity symptoms result from an inflammation that starts in the airways leading to the lungs and then spreads into the lungs (tracheobronchial tree). The symptoms appear in the upper chest region (substernal and carinal regions).[25][26][27] This begins as a mild tickle on inhalation and progresses to frequent coughing.[25] If breathing elevated partial pressures of oxygen is not discontinued, patients experience a mild burning on inhalation along with uncontrollable coughing and occasional shortness of breath (dyspnea).[25] Physical findings related to pulmonary toxicity have included bubbling sounds heard through a stethoscope (bubbling rales), fever, and increased blood flow to the lining of the nose (hyperemia of the nasal mucosa).[27] The radiological finding from the lungs shows inflammation and swelling (pulmonary edema).[25][26] Pulmonary function measurements are reduced, as noted by a reduction in the amount of air that the lungs can hold (vital capacity) and changes in expiratory function and lung elasticity.[27][28] Tests in animals have indicated a variation in tolerance similar to that found in central nervous system toxicity, as well as significant variations between species. When the exposure to oxygen above 0.5 bar (50 kPa) is intermittent, it permits the lungs to recover and delays the onset of toxicity.[29]
[edit] Ocular
In premature babies, signs of damage to the eye (retinopathy of prematurity, or ROP) are observed via an ophthalmoscope as a demarcation between the vascularized and non-vascularised regions of an infant's retina. The degree of this demarcation is used to designate four stages: (I) the demarcation is a line; (II) the demarcation becomes a ridge; (III) growth of new blood vessels occurs around the ridge; (IV) the retina begins to detach from the inner wall of the eye (choroid).[30]
[edit] Causes
Oxygen toxicity is caused by exposure to oxygen at partial pressures greater than those to which the body is normally exposed. This occurs in three principal settings: underwater diving, hyperbaric oxygen therapy and the provision of supplemental oxygen, particularly to premature infants. In each case, the risk factors are markedly different.
[edit] Central nervous system toxicity
See also: Technical diving
Exposures, from minutes to a few hours, to partial pressures of oxygen above 1.6 bars (160 kPa)—about eight times the atmospheric concentration—are usually associated with central nervous system oxygen toxicity and are most likely to occur among patients undergoing hyperbaric oxygen therapy and divers. Since atmospheric pressure is about 1 bar (100 kPa), central nervous system toxicity can only occur under hyperbaric conditions, where ambient pressure is above normal.[31][32] Divers breathing air at depths greater than 60 m (200 ft) face an increasing risk of an oxygen toxicity "hit" (seizure). Divers breathing a gas mixture enriched with oxygen, such as nitrox, can similarly suffer a seizure at shallower depths, should they descend below the maximum depth allowed for the mixture.[33]
[edit] Pulmonary toxicity
The lungs, as well as the remainder of the respiratory tract, are exposed to the highest concentration of oxygen in the human body and are therefore the first organs to show toxicity. Pulmonary toxicity occurs with exposure to concentrations of oxygen greater than 0.5 bar (50 kPa), corresponding to an oxygen fraction of 50% at normal atmospheric pressure. Signs of pulmonary toxicity begins with evidence of tracheobronchitis, or inflammation of the upper airways, after an asymptomatic period between 4 and 22 hours at greater than 95% oxygen,[34] with some studies suggesting symptoms usually begin after approximately 14 hours at this level of oxygen.[35]
At partial pressures of oxygen of 2 to 3 bar (200 to 300 kPa)—100% oxygen at 2 to 3 times atmospheric pressure—these symptoms may begin as early as 3 hours after exposure to oxygen.[34] Experiments on rats show pulmonary manifestations of oxygen toxicity are not the same for normobaric conditions as they are for hyperbaric conditions.[36] Evidence of decline in lung function as measured by pulmonary function testing can occur as quickly as 24 hours of continuous exposure to 100% oxygen,[35] with evidence of diffuse alveolar damage and the onset of acute respiratory distress syndrome usually occurring after 48 hours on 100% oxygen.[34] Breathing 100% oxygen also eventually leads to collapse of the alveoli (atelectasis), while—at the same partial pressure of oxygen—the presence of significant partial pressures of inert gases, typically nitrogen, will prevent this effect.[37]
Preterm newborns are known to be at higher risk for bronchopulmonary dysplasia with extended exposure to high concentrations of oxygen.[38] Other groups at higher risk for oxygen toxicity are patients on mechanical ventilation with exposure to levels of oxygen greater than 50%, and patients exposed to chemicals that increase risk for oxygen toxicity such the chemotherapeutic agent bleomycin.[35] Therefore, current guidelines for patients on mechanical ventilation in intensive care suggests keeping oxygen concentration less than 60%.[34] Likewise, divers who undergo treatment of decompression sickness are at increased risk of oxygen toxicity as treatment entails exposure to long periods of oxygen breathing under hyperbaric conditions, in addition to any oxygen exposure during the dive.[31]
[edit] Ocular toxicity
See also: Retinopathy of prematurity
Prolonged exposure to high inspired fractions of oxygen causes damage to the retina.[39][40][41] Damage to the developing eye of infants exposed to high oxygen fraction at normal pressure has a different mechanism and effect from the eye damage experienced by adult divers under hyperbaric conditions.[42][43] Hyperoxia may be a contributing factor for the disorder called retrolental fibroplasia or retinopathy of prematurity (ROP) in infants.[42][44] In preterm infants, the retina is often not fully vascularised. Retinopathy of prematurity occurs when the development of the retinal vasculature is arrested and then proceeds abnormally. Associated with the growth of these new vessels is fibrous tissue (scar tissue) that may contract to cause retinal detachment. Supplemental oxygen exposure, while a risk factor, is not the main risk factor for development of this disease. Restricting supplemental oxygen use does not necessarily reduce the rate of retinopathy of prematurity, and may raise the risk of hypoxia-related systemic complications.[42]
Hyperoxic myopia has occurred in closed circuit oxygen rebreather divers with prolonged exposures.[43][45][46] It also occurs frequently in those undergoing repeated hyperbaric oxygen therapy.[40][47] This is due to an increase in the refractive power of the lens, since axial length and keratometry readings do not reveal a corneal or length basis for a myopic shift.[47][48] It is usually reversible with time.[40][47]
[edit] Mechanism
Main articles: Reactive oxygen species and Oxidative stress


The lipid peroxidation mechanism shows a single radical initiating a chain reaction which converts unsaturated lipids to lipid peroxides,
The biochemical basis for the toxicity of oxygen is the partial reduction of oxygen by one or two electrons to form reactive oxygen species,[49] which are natural by-products of the normal metabolism of oxygen and have important roles in cell signalling.[50] One species produced by the body, the superoxide anion (O2–),[51] is possibly involved in iron acquisition.[52] Higher than normal concentrations of oxygen lead to increased levels of reactive oxygen species.[53] Oxygen is necessary for cell metabolism, and the blood supplies it to all parts of the body. When oxygen is breathed at high partial pressures, a hyperoxic condition will rapidly spread, with the most vascularised tissues being most vulnerable. During times of environmental stress, levels of reactive oxygen species can increase dramatically, which can damage cell structures and produce oxidative stress.[19][54]
While all the reaction mechanisms of these species within the body are not yet fully understood,[55] one of the most reactive products of oxidative stress is the hydroxyl radical (•OH), which can initiate a damaging chain reaction of lipid peroxidation in the unsaturated lipids within cell membranes.[56] High concentrations of oxygen also increase the formation of other free radicals, such as nitric oxide, peroxynitrite, and trioxidane, which harm DNA and other biomolecules.[19][57] Although the body has many antioxidant systems such as glutathione that guard against oxidative stress, these systems are eventually overwhelmed at very high concentrations of free oxygen, and the rate of cell damage exceeds the capacity of the systems that prevent or repair it.[58][59][60] Cell damage and cell death then result.[61]
[edit] Diagnosis
Diagnosis of central nervous system oxygen toxicity in divers prior to seizure is difficult as the symptoms of visual disturbance, ear problems, dizziness, confusion and nausea can be due to many factors common to the underwater environment such as narcosis, congestion and coldness. However, these symptoms may be helpful in diagnosing the first stages of oxygen toxicity in patients undergoing hyperbaric oxygen therapy. In either case, unless there is a prior history of epilepsy or tests indicate hypoglycemia, a seizure occurring in the setting of breathing oxygen at partial pressures greater than 1.4 bar (140 kPa) suggests a diagnosis of oxygen toxicity.[62]
Diagnosis of bronchopulmonary dysplasia in new-born infants with breathing difficulties is difficult in the first few weeks. However, if the infant's breathing does not improve during this time, blood tests and x-rays may be used to confirm bronchopulmonary dysplasia. In addition, an echocardiogram can help to eliminate other possible causes such as congenital heart defects or pulmonary arterial hypertension.[63]
The diagnosis of retinopathy of prematurity in infants is typically suggested by the clinical setting. Prematurity, low birth weight and a history of oxygen exposure are the principal indicators, while no hereditary factors have been shown to yield a pattern.[64]
[edit] Prevention


The label on the diving cylinder shows that it contains oxygen-rich gas (36%) and is boldly marked with a maximum operating depth of 28 metres.
The prevention of oxygen toxicity depends entirely on the setting. Both underwater and in space, proper precautions can eliminate the most pernicious effects. Premature infants commonly require supplemental oxygen to treat complications of preterm birth. In this case prevention of bronchopulmonary dysplasia and retinopathy of prematurity must be carried out without compr
oxygen toxicity
n.
A condition resulting from breathing high partial pressures of oxygen, characterized by visual and hearing abnormalities, unusual fatigue, muscular twitching, anxiety, confusion, incoordination, and convulsions.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.
________________________________________
oxygen toxicity,
a condition of oxygen overdosage that can result in pathologic tissue changes, such as retinopathy of prematurity or bronchopulmonary dysplasia. It can also decrease CO2 drive to breathe.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
________________________________________
oxygen
a chemical element, atomic number 8, atomic weight 15.999, symbol O. See Table 6. It is a colorless and odorless gas that makes up about 20% of the atmosphere. In combination with hydrogen, it forms water; by weight, 90% of water is oxygen. It is the most abundant of all the elements of nature. Large quantities of it are distributed throughout the solid matter of the earth, because the gas combines readily with many other elements. With carbon and hydrogen, oxygen forms the chemical basis of much organic material. Oxygen is essential in sustaining all kinds of life.
omising a supply of oxygen adequate to preserve the infant's life.

Toxicity
See also: Carbon dioxide poisoning


Main symptoms of Carbon dioxide toxicity, by increasing volume percent in air.[2][42].
Carbon dioxide content in fresh air (averaged between sea-level and 10 hPa level, i.e. about 30 km altitude) varies between 0.036% (360 ppm) and 0.039% (390 ppm), depending on the location[43].
Prolonged exposure to moderate[clarification needed] concentrations can cause acidosis and adverse effects on calcium phosphorus metabolism resulting in increased calcium deposits in soft tissue. Carbon dioxide is toxic to the heart and causes diminished contractile force.[42]
Toxicity and its effects increase with the concentration of CO2, here given in volume percent of CO2 in the air:
• 1%, as can occur in a crowded auditorium with poor ventilation, can cause drowsiness with prolonged exposure.[2]
• At 2% it is mildly narcotic and causes increased blood pressure and pulse rate, and causes reduced hearing.[42]
• At about 5% it causes stimulation of the respiratory centre, dizziness, confusion and difficulty in breathing accompanied by headache and shortness of breath.[42]. In addition at this concentration panic attacks may occur.[44][45]
• At about 8% it causes headache, sweating, dim vision, tremor and loss of consciousness after exposure for between five and ten minutes.[42]
A natural disaster linked to CO2 intoxication occurred during the limnic eruptions in the CO2-rich lakes of Monoun and Nyos in the Okun range of North-West Cameroon: the gas was brutally expelled from the mountain lakes and leaked into the surrounding valleys, killing most animal forms. During the Lake Nyos tragedy of 1988, 1700 villagers and 3500 livestock died.
Due to the health risks associated with carbon dioxide exposure, the U.S. Occupational Safety and Health Administration says that average exposure for healthy adults during an eight-hour work day should not exceed 5,000 ppm (0.5%). The maximum safe level for infants, children, the elderly and individuals with cardio-pulmonary health issues is significantly less. For short-term (under ten minutes) exposure, the U.S. National Institute for Occupational Safety and Health (NIOSH) and American Conference of Government Industrial Hygienists (ACGIH) limit is 30,000 ppm (3%). NIOSH also states that carbon dioxide concentrations exceeding 4% are immediately dangerous to life and health[46] although physiological experiments show that such levels can be tolerated for some time [47].
Adaptation to increased levels of CO2 occurs in humans. Continuous inhalation of CO2 can be tolerated at three percent inspired concentrations for at least one month and four percent inspired concentrations for over a week. It was suggested that 2.0 percent inspired concentrations could be used for closed air spaces (e.g. a submarine) since the adaptation is physiological and reversible. Decrement in performance or in normal physical activity does not happen at this level.[47][48] However, it should be noted that submarines have carbon dioxide scrubbers which reduce a significant amount of the CO2 present.[49]
These figures are valid for pure carbon dioxide. In indoor spaces occupied by people the carbon dioxide concentration will reach higher levels than in pure outdoor air. Concentrations higher than 1,000 ppm will cause discomfort in more than 20% of occupants, and the discomfort will increase with increasing CO2 concentration. The discomfort will be caused by various gases coming from human respiration and perspiration, and not by CO2 itself. At 2,000 ppm the majority of occupants will feel a significant degree of discomfort, and many will develop nausea and headaches. The CO2 concentration between 300 and 2,500 ppm is used as an indicator of indoor air quality.
Acute carbon dioxide toxicity is sometimes known by the names given to it by miners: blackdamp (also called choke damp or stythe). Backdamp is primarily nitrogen and carbon dioxide and kills via suffocation (having displaced oxygen). Miners would try to alert themselves to dangerous levels of blackdamp and other gasses in a mine shaft by bringing a caged canary with them as they worked. The canary is more sensitive to environmental gasses than humans and as it became unconscious would stop singing and fall off its perch. The Davey lamp could also detect high levels of blackdamp (which collect near the floor) by burning less brightly, while methane, another suffocating gas and explosion risk would make the lamp burn more brightly).
Carbon dioxide ppm levels (CDPL) are a surrogate for measuring indoor pollutants that may cause occupants to grow drowsy, get headaches, or function at lower activity levels. To eliminate most indoor air quality complaints, total indoor CDPL must be reduced to below 600. NIOSH considers that indoor air concentrations that exceed 1,000 are a marker suggesting inadequate ventilation. ASHRAE recommends they not exceed 1,000 inside a space.

This is what it is

Never, put your banana in the refrigerator!!!
This is interesting.
After reading this, you'll never look at a banana in the same way again.

Bananas contain three natural sugars - sucrose, fructose and glucose combined with fiber. A banana gives an instant, sustained and substantial boost of energy.

Research has proven that just two bananas provide enough energy for a strenuous 90-minute workout. No wonder the banana is the number one fruit with the world's leading athletes.

But energy isn't the only way a banana can help us keep fit. It can also help overcome or prevent a substantial number of illnesses and conditions, making it a must to add to our daily diet.

Depression: According to a recent survey undertaken by MIND amongst people suffering from depression, many felt much better after eating a banana. This is because bananas contain tryptophan, a type of protein that the body converts into serotonin, known to make you relax, improve your mood and generally make you feel happier.

PMS: Forget the pills - eat a banana. The vitamin B6 it contains regulates blood glucose levels, which can affect your mood.

Anemia : High in iron, bananas can stimulate the production of hemoglobin in the blood and so helps in cases of anemia.

Blood Pressure: This unique tropical fruit is extremely high in potassium yet low in salt, making it perfect to beat blood pressure. So much so, the US Food and Drug Administration has just allowed the banana industry to make official claims for the fruit's ability to reduce the risk of blood pressure and stroke.

Brain Power: 200 students at a Twickenham (Middlesex) school ( England ) were helped through their exams this year by eating bananas at breakfast, break, and lunch in a bid to boost their brain power. Research has shown that the potassium-packed fruit can assist learning by making pupils more alert.

Constipation: High in fiber, including bananas in the diet can help restore normal bowel action, helping to overcome the problem without resorting to laxatives.

Hangovers: One of the quickest ways of curing a hangover is to make a banana milkshake, sweetened with honey.. The banana calms the stomach and, with the help of the honey, builds up depleted blood sugar levels, while the milk soothes and re-hydrates your system.
< BR>Heartburn: Bananas have a natural antacid effect in the body, so if you suffer from heartburn, try eating a banana for soothing relief.

Morning Sickness: Snacking on bananas between meals helps to keep blood sugar levels up and avoid morning sickness.

Mosquito bites: Before reaching for the insect bite cream, try rubbing the affected area with the inside of a banana skin. Many people find it amazingly successful at reducing swelling and irritation.

Nerves: Bananas are high in B vitamins that help calm the nervous system.


Overweight and at work? Studies at the Institute of Psychology in Austria found pressure at work leads to gorging on comfort food like chocolate and chips. Looking at 5,000 hospital patients, researchers found the most obese were more likely to be in high-pressure jobs. The report concluded that, to avoid panic-induced food cravings, we need to control our blood sugar levels by snacking on high carbohydrate foods every two hours to keep levels steady.

Ulcers: The banana is used as the dietary food against intestinal disorders because of its soft texture and smoothness. It is the only raw fruit that can be eaten without distress in over-chronicler cases. It also neutralizes over-acidity and reduces irritation by coating the lining of the stomach.

Temperature control: Many other cultures see bananas as a "cooling" fruit that can lower both the physical and emotional temperature of expectant mothers. In Thailand , for example, pregnant women eat bananas to ensure their baby is born with a cool temperature.

Seasonal Affective Disorder (SAD): Bananas can help SAD sufferers because they contain the natural mood enhancer tryptophan.

Smoking &Tobacco Use: Bananas can also help people trying to give up smoking. The B6, B12 they contain, as well as the potassium and magnesium found in them, help the body recover from the effects of nicotine withdrawal.

Stress: Potassium is a vital mineral, which helps normalize the heartbeat, sends oxygen to the brain and regulates your body's water balance. When we are stressed, our metabolic rate rises, thereby reducing our potassium levels. These can be rebalanced with the help of a high-potassium banana snack.

Strokes: According to research in The New England Journal of Medicine, eating bananas as part of a regular diet can cut the risk of death by strokes by as much as 40%!

Warts: Those keen on natural alternatives swear that if you want to kill off a wart, take a piece of banana skin and place it on the wart, with the yellow side out. Carefully hold the skin in place with a plaster or surgical tape!

So, a banana really is a natural remedy for many ills. When you compare it to an apple, it has four times the protein, twice the carbohydrate, three times the phosphorus, five times the vitamin A and iron, and twice the other vitamins and minerals. It is also rich in potassium and is one of the best value foods around So maybe its time to change that well-known phrase so that we say, "A banana a day keeps the doctor away!"

PASS IT ON TO YOUR FRIENDS
PS: Bananas must be the reason monkeys are so happy all the time! I will add one here; want a quick shine on our shoes?? Take the INSIDE of the banana skin, and rub directly on the shoe...polish with dry cloth. Amazing fruit !!!

ARTERIAL BLOOD-GAS ANALYSIS

ARTERIAL BLOOD-GAS ANALYSIS
is a blood test which gives 2 sets of information..

1. Acid-Base balance
(pH, CO2, HCO3)‏


2. Blood Oxygenation
(pO2, sO2 )‏
PURPOSE
Evaluation of
lung
kidney functions.

Indicates
Their interaction with each other so as to maintain a normal pH
(Acid-Base balance ).
THE CANDIDATE
Significant respiratory distress sec. to an acute or chronic respiratory,cardiac or hematological problem.
Unconscious person & /on Ventilators
Renal problems.
Critical and Unstable patients.

HOW TO COLLECT SAMPLE?
Perform Modified Allen”s test.

Clean the site. (LA is optional).
Flush the syringe(21 gauge)with Heparin.
Palpate artery with one hand and enter skin at 45 degree angle.
Obtain 2-4mL of arterial blood, preferably without aspiration.
After withdrawal of syringe,apply firm pressure at puncture site.

SPECIAL PRECAUTIONS..
Low friction syringe under arterial pressure.
Avoid pulling (suction) of syringe.. PaO2 and PaCO2 will get reduced.
Avoid excess heparin .. May dilute sample.
Air-bubbles must be tapped to the surface and pushed out… may increase PaO2 and decrease PaCO2.
If lab analysis will be delayed, REFRIGERATE (Place capped syringe in a glass of ice water).. Normal temperature may acidify the sample.

RISKS..
Prolonged bleeding

Bruising

Rarely, arterial thrombotic occlusion.

ABG Interpretation
ABG and Serum electrolytes should be performed simultaneously.

Follow “The SIX STEP method”.
SIX STEP APPROACH
Analyze pH,
Analyze pCO2, HCO3.
Match CO2 and HCO3 with pH
Look for Compensation.
Look for Mixed disorders.
Analyze pO2 and sO2.
Co-relate clinically and establish etiological diagnosis.


pH
Normal value: 7.35 – 7.45
Low pH (<7.35)>7.45) ..ALKALOSIS.
pH is determined by and INVERSELY related to H+ conc.
H+ falls by 20% for each 0.1pH unit increment.
H+ =24 X (PaCO2 / HCO3)‏

BICARBONATES (HCO3)‏
Normal :24 (22 – 26 meqv/l)‏

LOW (<22>26 meqv/l)..MET ALKALOSIS
.
NORMAL HCO3 DOES NOT EXCLUDE ACID BASE DISORDERS.. MIXED DISORDERS CAN GIVE NORMAL HCO3.
PaCO2
NORMAL: 40 (35-45 mm of Hg)‏

High (>45)..resp. acidosis

Low (<35)..resp. style="font-weight: bold; font-style: italic; color: rgb(0, 102, 0);">
ANION GAP(AG)‏ Na –(Cl +HCO3) = 12 +/-2meqv/l
Important unmeasured anions : proteins,phosphate, sulphate and organic acids. Important unmeasured cations: calcium, magnesium and potassium.
ANION GAP- SIGNIFICANCE TO ESTABLISH ETIOLOGICAL DIAGNOSIS of METABOLIC ACIDOSIS. MIXED DISORDERS. PULSE OXIMETRY Measures O2 Saturation of arterial Hb. Normal : 96 – 100% LESS THAN 90% Saturation suggests marked TISSUE HYPOXIA (<60% Pao2). Useful for Hypoxemia screening but Tells Nothing About PaCo2. Hypercapnoea can occur even with 100% O2 saturation. Hypoxia…Hypoxemia HYPOXIA refers to reduced oxygen pressure in the alveolus. HYPOXEMIA refers to low arterial oxygen pressure. NORMAL PaO2 :75 – 100 mm Hg SaO2 :94 – 100 % Oxygen content (O2 CT) :15 – 23% PAO2 and PaO2 PaO2 = 104.2 - (0.27 X AGE)‏ A normal gradient of 10mm of Hg exists between PAO2 AND PaO2 P (A-a) O2 = 10 mm of Hg NO gradient between PACO2 AND PaCO2. BASICS OF ACID-BASE  DISORDERS.. IF the initial disturbance affects HCO3.. Fall - METABOLIC ACIDOSIS Rise - METABOLIC ALKALOSIS IF the initial disturbance affects PaCO2.. Rise - RESPIRATORY ACIDOSIS Fall - RESPIRATORY ALKALOSIS WHEN YOU SEE “METABOLIC”, THINK OF HCO3. WHEN YOU SEE “RESPIRATORY”, THINK OF PaCO2. COMPENSATION The body responds to neutralize the effect of the initial insult on pH homeostasis. HENDERSON-HASSELBACH EQN. pH is maintained by…HCO3/PaCO2. compensation Metabolic acidosis (fall in HCO3) leads to low pH which stimulates the respiratory centre causing hyperventilation. Hyperventilation leads to CO2 washout and decreased PaCO2. PaCO2/HCO3 ratio returns towards normal. This compensation keeps the pH within normal range,as far as possible.
SAME DIRECTION RULE The compensatory changes are in the same direction as the primary change. HCO3 LEADS TO PaCO2 HCO3 LEADS TO PaCO2. PREDICTION OF COMPENSATION METABOLIC ACIDOSIS ( HCO3)‏ PaCO2=(1.5 X HCO3) + 8 PaCO2= HCO3 + 15 METABOLIC ALKALOSIS ( HCO3)‏ PaCO2 = 0.75 X HCO3 COMPENSATION- SIGNIFICANCE Differentiates simple from Mixed disorder. If expected change = actual change, disorder is simple. If actual change is more or less than predicted, disorder is mixed. Compensation follows “same direction rule”. If changes are in opposite direction, think of mixed disorder.

PREDICTION…RESPIRATORYACIDOSIS : ACUTE (6-24hrs)‏ Rise in HCO3 = 0.1 X RISE IN PaCO2 FALL IN pH = 0.01 X RISE IN PaCO2 CHRONIC (24hrs)‏ Rise in HCO3 = 0.4 X rise in PaCO2 Fall in pH = 0.003 x fall in PaCO2 PREDICTION.. RESPIRATORY ALKALOSIS.. ACUTE Fall in HCO3 = 0.2 X Fall in PaCO2 Rise in pH = 0.01 x Fall in PaCO2 CHRONIC Fall in HCO3 = 0.4 X Fall in PaCO2 Rise in pH = 0.002 x Fall in PaCO2 Serum Potassium NORMAL : 3.5 – 5.5 meqv/l LOW (<3.5)..>5.5)..
Metabolic ACIDOSIS due to Renal Failure, Type-4 RTA,DKA or Respiratory ACIDOSIS..
CALCULATION 1…
pH 7.23 (7.38 –7.44)‏
pCO2 7.4 (4.7 – 5.9)‏
PO2 8.9 (11 – 13)‏
HCO3 24 (21 – 28)‏
SaO2 90% (94 - 100)

Calculation 2
pH 7.26 (7.38 – 7.45)‏
pCO2 7.1 (4.7 – 5.9 )‏
Po2 10 (11 – 13)‏
HCO3 37 (21 – 28)‏
SaO2 90% (94 – 100)‏

MIXED DISORDERS
IF THE VALUE IS…

MORE THAN EXPECTED COMPENSATION

DOES NOT OBEY “SAME DIRECTION RULE”

NORMAL pH but changes in PCO2 OR HCO3.
MIXED DISORDER..
a non-anionic gap acidosis or a metabolic alkalosis can co-exist with an anion gap acidosis.
corrected HCO3 = measured HCO3 + (anion gap – 12)‏
if corrected HCO3 >24
..metabolic alkalosis co-exists
if corrected HCO3 <24 hco3 =" Measured" hco3="15," hco3="15" 14 =" 29.."> 20meqv/l)‏
Saline responsive Metabolic  Alkalosis
ECF VOLUME DEPLETION
Vomiting
Diuretics
Hypercapnoea Correction

NO ECF VOLUME DEPLETION
NaHCO3 Infusion
Multiple Transfusions
Saline Resistant METABOLIC  ALKALOSIS
HYPERTENSIVE
Hyper-Aldosteronism
Cushing Syndrome

NORMOTENSIVE
Bartter”s Syndrome
Severe Potassium Depletion.

CASE 1

Pt WITH POORLY CONTROLLED TYPE 1 DM…
pH 7.1 (7.38 – 7.45)‏
HCO3 8 (21 – 28)‏
PaCO2 20 mm of Hg (35 – 45)‏
Na 140 (135 – 150)‏
Cl 106 (95 – 110)‏
Urinary Ketones +++
? ? ?

CLINICAL CONDITIONS…

CNS
COMA … RESP ACIDOSIS/ALKALOSIS
SEIZURES … METABOLIC ACIDOSIS
CVS
CCF … RESP ALKALOSIS
SHOCK …MET ACIDOSIS / RESP ALKALOSIS
RS
TACHYPNOEA … RESP ALKALOSIS
BRADYPNOEA … RESP ACIDOSIS
CLINICAL CONDITIONS…
G I
VOMITING … MET ALKALOSIS
DIARRHOEA … MET ACIDOSIS
ABD PAIN … RESP ALKALOSIS
RENAL
OLIGURIA … MET ACIDOSIS
POLYURIA … MET ACIDOSIS/ ALKALOSIS
ENDOCRINAL
MYXOEDEMA … RESP ACIDOSIS
HYPERTENSION … MET ALKALOSIS

COMMON MIXED DISORDERS…

METABOLIC AND RESP ACIDOSIS
1.CARDIAC ARREST (HYPOVENTILATION + LACTIC ACIDOSIS)‏
2.SHOCK WITH RESPIRATORY FAILURE
3.DKA WITH RESP DISEASE

MIXED DISORDERS…

METABOLIC ACIDOSIS AND RESP ALKALOSIS
1.GRAM NEG SEPSIS
2.LIVER FAILURE

MIXED DISORDERS…

METBOLICALKALOSIS AND RESP ACIDOSIS
1.COPD WITH DIURETICS

MIXED DISORDERS…

METABOLIC ALKALOSIS WITH RESP ALKALOSIS
1. LIVER FAILURE WITH VOMITING
2.Pt ON VENTILATOR WITH CONTINUOUS NASOGASTRIC ASPIRATION
MIXED DISORDERS…

METABOLICACIDOSIS AND METABOLIC ALKALOSIS
1.DKA WITH VOMITING
2. VOMITING WITH SEV VOL DEPLETION CAUSING LACTIC ACIDOSIS
LACTIC ACIDOSIS

TYPE A:IMPAIRED TISSUE OXYGENATION
1.SHOCK (CARDIO/SEPTIC)‏
2.RESP FAILURE
3.CO OR CYANIDE POISONING
4.SEVERE ANAEMIA
MIXED DISORDERS…
RESPIRATORY ACIDOSIS WITH RESPIRATORY ALKALOSIS…
DOES NOT EXIST!
LACTIC ACIDOSIS

TYPE B:NO HYPOXIA. MITOCHONDRIAL RESP IS IMPAIRED
1.DM
2.HEPATIC FAILURE
3.SEV INFECTION
4.TOXINS-ETHANOL, METHANOL
5.DRUGS-BIGUANIDES
Case 1
Expected Compensation, PaCO2 = HCO3 X 1.5 + 8 =8 X 1.5 + 8 = 20

Expected PaCO2 Matches Actual PaCO2 … Simple Acid-base Disorder.

ANION GAP = Na – (Cl + HCO3)
=140 – (106 + 8)‏
= 26 >12… high anion gap

HIGH ANION GAP METABOLIC ACIDOSIS
DUE TO DKA !!!

CASE 2
ABG of a Pt in shock on ventilatory support For 4 Hrs..
pH 7.48 (7.35 – 7.45)‏
HCO3 14 (22 – 26)‏
PaCO2 22 mm of Hg (35 – 45)‏

? ? ?
Case 2
Respiratory alkalosis

Expected acute compensation
= 0.2 x fall in PaCO2
= 0.2 x (40 – 22)‏
= 0.2 X 18 = 3.6 meqv/l
So expected HCO3 24 – 3.6 = 20.4

Actual HCO3 < 20.4 … Additional Metabolic Acidosis (Shock-induced Lactic Acidosis )‏



CALCULATION 3
pH 7.41 (7.38 – 7.45)‏
Pco2 3.8 (4.7 – 5.9)‏
HCO3 20 (21 – 28)‏
SaO2 96% (94 – 100)‏

Smoking <<< think now>>>its never too late

"Smoking Kills" and "Smoking Causes Cancer" are the kind of health warnings that are familiar to millions of smokers. How about this one: "Smoking Boosts the Risk of Suicide"?

The idea is sketched by German researchers, who say an in-depth study among young people in Bavaria found a clear and alarming link between smoking and the desire to kill oneself. The study, done by researchers from Max Planck Institute of Psychiatry in Munich, is based on data from a detailed psychology study launched in 1995 among 3,021 people aged 14-24 who lived in Munich.

They were interviewed again four years later, when 2,548 of the volunteers responded. Around a quarter of these individuals had never smoked.

Of the rest, 40% were defined as occasional smokers, 17% as "non-dependent" regular smokers and 19%as addicted smokers. Among non-smokers, nearly 15%, reported having had suicidal thoughts, defined as making plans to kill himself or herself or spending two weeks or longer with the wish to die.

The rate was around 20% among occasional and non-dependent smokers, but among dependent smokers, suicidal ideation was 30%.

Smoking And Your Health

Most people associate cigarette smoking with breathing problems and lung cancer. But smoking is also a major cause of cardiovascular (heart and blood vessel) disease.

Smoking: the No. 1 cause of preventable disease and death
Smoking and tobacco use are significant risk factors for a variety of chronic disorders.

What's the link between smoking and cardiovascular disease?
Smoking is a major cause of atherosclerosis - a buildup of fatty substances in the arteries. Atherosclerosis occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries. In coronary artery disease, the arteries that supply blood to the heart become severely narrowed, decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.

In peripheral artery disease, atherosclerosis affects the arteries that carry blood to the arms and legs. As a result, the patient may experience painful cramping of the leg muscles when walking (a condition called intermittent claudication). Peripheral artery disease also increases the risk of stroke.

What’s the link between smoking and heart attack?
A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no safe amount of smoking. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than nonsmokers.

What’s the link between smoking and oral contraceptives?
Women who smoke and also use oral contraceptives (birth control pills) increase several times their risk of coronary and peripheral artery diseases, heart attack and stroke, compared with nonsmoking women who use oral contraceptives.

What other medical conditions are linked with smoking?
Cigarettes have multiple poisons, including addictive nicotine, carbon monoxide, “tars” and hydrogen cyanide. There are 4,000 other chemicals of varying toxicity, including 43 known carcinogens.

Smoking causes:

o Decreased oxygen to the heart and to other tissues in the body
o Decreased exercise tolerance
o Decreased HDL (good) cholesterol
o Increased blood pressure and heart rate
o Damage to cells that line coronary arteries and other blood vessels
o Increased risk of developing coronary artery disease and heart attack
o Increased risk of developing peripheral artery disease and stroke
o Increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis and emphysema
o Increased risk of developing diabetes
o Increased risk of developing a variety of other conditions including gum disease and ulcers
o Increase tendency for blood clotting
o Increased risk of recurrent coronary artery disease after bypass surgery
o Increased risk of becoming sick (especially among children: respiratory infections are more common among children exposed to second-hand smoke)

How does cigarette smoke affect others?
Cigarette smoke does not just affect smokers. When you smoke, the people around you are also at risk for developing health problems, especially children. Environmental tobacco smoke (also called passive smoke or second-hand smoke) affects people who are frequently around smokers. Second-hand smoke can cause chronic respiratory conditions, cancer and heart disease.


The benefits of quitting smoking
Now that you know how smoking can be harmful to your health and the health of those around you, here’s how quitting smoking can be helpful. If you quit smoking, you will:

* Prolong your life. According to the American Heart Association, smokers who quit between ages 35-39 add an average of 6-9 years to their lives. Smokers who quit between ages 65-69 increase their life expectancy by 1-4 years.
* Reduce your risk of cardiovascular disease. Quitting smoking reduces the risk of repeat heart attacks and death from heart disease by 50 percent or more. Quitting smoking also reduces your risk of high blood pressure, peripheral artery disease and stroke.
* Reduce your risk of developing a variety of other conditions including diabetes, lung cancer, throat cancer, emphysema, chronic bronchitis, chronic asthma, ulcers, gum disease and many other conditions.
* Feel healthier. After quitting, you won't cough as much, have as many sore throats and you will increase your energy.
* Look and feel better. Quitting can help you prevent face wrinkles, get rid of stained teeth, improve your skin and even get rid of the stale smell in your clothes and hair.
* Improve your sense of taste and smell.
* Save money.

How can I quit?
There's no one way to quit that works for everyone. To quit smoking, you must be ready emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. Plan ahead.

Before you quit:
(Check off the items on this list as you accomplish them)

Pick a date to stop smoking and then stick to it.

Write down your reasons for quitting. Read over the list every day, before and after you quit.

Write down when you smoke, why you smoke and what you are doing when you smoke to learn your smoking "triggers."

Stop smoking in certain situations (such as at your work break or after dinner) before actually quitting.

Make a list of activities you can do instead of smoking.

Visualize yourself as a nonsmoker.

Tell your family and friends about your plans to quit and ask them for their support. Ask your family members who smoke to quit with you.

Ask your health care provider about using smoking cessation aids to help you quit smoking. Nicotine replacement aids include gum, nicotine patches, inhalers, sublingual (under-the-tongue) tablets, lozenges, nasal spray or prescription medications.
Join a smoking cessation support group or program.

When You Quit

* Get rid of all cigarettes.
* Put away all smoking-related objects, such as ashtrays.
* If you live with a smoker, ask that person not to smoke in your presence. Better yet, convince them to quit with you.
* Don’t focus on your cravings. Remember that what you’re feeling is temporary and remind yourself why you want to quit.
* Keep yourself busy! Review your list of activities you can do instead of smoking.
* When you get the urge to smoke, take a deep breath. Hold it for ten seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
* Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer.
* Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
* When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
* Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
* Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.
* Remind yourself you are a nonsmoker. Nonsmokers don't smoke.
* Exercise. Exercising has many benefits and will help you relax.

How will I feel when I quit?

* You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches, have difficulty concentrating or experience constipation. These symptoms of withdrawal occur because your body is used to nicotine, the active addicting agent within cigarettes.
* When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes.
* The withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within 10 to 14 days. Remember that withdrawal symptoms are easier to treat than the major diseases that smoking can cause.
* You may still have the desire to smoke. There are many strong associations with smoking, such as smoking during specific situations, with a variety of emotions or with certain people in their lives. The best way to overcome these associations is to experience them without smoking.

If you smoke again (called a relapse) do not lose hope. Seventy-five percent of those who quit relapse. Most smokers quit three times before they are successful. If you relapse, don’t give up! Review the reasons why you wanted to become a nonsmoker. Plan ahead and think about what you will do next time you get the urge to smoke.

What Happens When You Quit

After 20 minutes
You stop polluting the air
Your blood pressure and pulse decrease
The temperature of your hands and feet increases

After 8 hours
The carbon monoxide level in your blood returns to normal
Oxygen levels in your blood increase

After 24 hours
Your risk of heart attack decreases

After 48 hours
Nerve endings adjust to the absence of nicotine
Your ability to taste and smell begin to return

After 2 weeks to 3 months
Your circulation improves
Your exercise tolerance improves

After 1-9 months
Coughing, sinus congestion, fatigue and shortness of breath decrease
Your overall energy level increases

After 1 year
Your risk of heart disease decreases to half that of a current smoker

After 5-15 years
Your risk of stroke is reduced to that of people who have never smoked

After 10 years
Your risk of dying from lung cancer drops to almost the same rate as a lifelong NON- smoker
You decrease the incidence of other cancers -- of the mouth, larynx, esophagus, bladder, kidney and pancreas

After 15 years
Your risk of heart disease is reduced to that of people who have never smoked