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Biomedical subjects

M Fulop

Publications and source records attributed to M Fulop.

At least 55 records · Page 3Linked to original sources
PubMed1985

Recurrent diabetic ketoacidosis.

This report presents and analyzes certain clinical and laboratory findings in 17 patients who were hospitalized repeatedly for diabetic ketoacidosis on a municipal hospital medical service during the early 1970s and the early 1980s. The 17 patients had a total of 92 hospitalizations for ketoacidosis during the survey periods. During the 1970s, most of the frequent recurrences occurred in young women, as has often been noted by others. In recent years, however, the number of patients with frequent recurrences hospitalized at Bronx Municipal Hospital Center has declined, and most of the patients have been young men. There is no obvious explanation for the latter trend. The laboratory findings were analyzed in order to learn whether they were similar in each patient during his or her recurrent admissions. In a few patients, blood pH, hemoglobin concentration, serum glucose level, anion gap, and osmolarity tended to be similar during their repeated hospitalizations. In the majority of the patients, however, there was significant variation in most of these laboratory indexes, except for the serum osmolarities and blood hemoglobin concentrations. The similarity of the serum osmolarities and hemoglobin concentrations in sequential episodes in most of the patients suggested that a certain severity of dehydration may have been the main factor that led them to seek hospitalization.

Adolescent↗
PubMed1985

Teaching differential diagnosis to beginning clinical students.

Beginning clinical students cannot construct differential diagnoses the way more experienced students and physicians do because students lack knowledge and experience. Beginning students need a systematic framework for constructing a differential diagnosis. Such a framework can be developed using a two-dimensional grid, one axis being anatomic (referring to organs or structures), and the other listing types of disease (e.g., congenital, metabolic, infectious). Possible diagnoses that can explain major symptoms can then be fitted into the resulting grid. Examples are shown in this report for abdominal pain, chest pain, and edema. Such formulations may seem overly complete, but completeness is actually advantageous for students who are just starting to learn clinical medicine. Then, as they learn more about disease patterns and likelihood of occurrence, and elicit additional information from their patients, they can narrow and refine the diagnostic possibilities.

Abdomen↗
PubMed1984

The treatment of severely uncontrolled diabetes mellitus.

Patients with severely uncontrolled diabetes mellitus must be cared for by physicians and nurses who understand the pathophysiology of ketoacidosis and nonketotic hyperglycemia, who carefully seek and treat precipitating or underlying illnesses, and who can provide the patients with continuous clinical attention and laboratory monitoring. Most patients with diabetic ketoacidosis survive the acute metabolic disorder; the infrequent deaths are usually due to serious underlying illnesses. The latter are more common in patients with nonketotic hyperglycemia, who are usually older than those with ketoacidosis and who usually also have serious underlying chronic diseases. The essential features of treatment for either of the foregoing acute metabolic disorders are administration of insulin (especially gingerly in the older patients with nonketotic hyperglycemia, despite their commonly remarkable hyperglycemia); rehydration with NaCl solutions; and IV administration of K+, usually not until after a few hours of treatment with insulin and NaCl solutions. Administration of NaHCO3 is usually not necessary except in patients with a blood pH less than 7.1. Administration of phosphate has been recommended as part of the treatment for ketoacidosis, but its need is uncertain. Although patients with nonketotic hyperglycemia are often more severely dehydrated and hyperglycemic than those with ketoacidosis, they usually should be given smaller amounts of insulin, NaCl solutions, and K+, and less rapidly.

Adult↗
PubMed1982

Ventilatory response in patients with acute lactic acidosis.

The ventilatory response in acute lactic acidosis was assessed in 39 patients. In 18 patients, the acidosis was associated with phenformin ingestion and in 21, with other causes such as shock and sepsis, but not pulmonary edema. Arterial blood CO2 tensions and plasma bicarbonate concentrations were compared to those previously found in patients with uncomplicated diabetic ketoacidosis. In most of the lactic acidosis patients, arterial blood CO2 fell within the 95% confidence band calculated from the data in the ketoacidotic patients. Only 1 lactic acidotic patient had a triflingly lower CO2 tension. Shock was present in 8 of the 9 lactic acidotic patients whose CO2 tensions were more than 2 torr above the 95% confidence band.

Acidosis↗
PubMed1982

Plasma bicarbonate and CO2 tension.

The relation between plasma bicarbonate concentration ([HCO3-]) and CO2 tension (PCO2) in normal subjects was studied by Madias et al. They calculated these values from measurements of plasma total CO2 content and blood pH using the Henderson-Hasselbalch equation. We calculated the relation between [HCO3-] and PCO2 using values obtained not from measurements, but from total CO2 and pH values chosen either randomly or uniformly within the range found by Madias et al. Both approaches yielded relations between [HCO3-] and PCO2 very similar to those found by Madias et al. Our findings indicate that the equation relating those variables depends mainly on the ranges of total CO2 and pH values, and how [HCO3-] and PCO2 are inherently related by the Henderson-Hasselbalch equation. Therefore, the mathematical relation between those variables should not be used to draw inferences about the physiological processes that relate them.

Adult↗
PubMed1982

Lactic acidosis.

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Acidosis↗