May 1, 2005

Diabetic ketoacidosis occurs when a patient’s plasma glucose concentration is above 250 mg per dL, pH level is less than 7.30, and bicarbonate level is 15 mEq per L orless. Treatment involves fluids, insulin, and monitoring electrolyte levels.

Hyperosmolar hyperglycemic state is a life-threatening emergency caused by infections,certain medications, noncompliance, undiagnosed diabetes, substance abuse,and coexisting diseases. Vigorous correction of dehydration followed by potassiumand insulin replacement is crucial.

A thorough clinical breast examination, imaging, and tissue sampling are neededfor definitive diagnosis of breast masses. Fine-needle aspiration can differentiatesolid and cystic masses. Core-needle biopsy allows histologic diagnosis and differentiatesin situ and invasive…

Dementia is a common disorder in older patients. The initial evaluation of apatient with suspected dementia includes the Mini-Mental State Examination,blood chemistry profiles, and structural neuroimaging.

Receiving AFP on your desk is routine; you probably never even think about how it gets there. Perhaps you have written a manuscript for AFP and have wondered why it takes time process that involves many people in several states. First, submitted manuscripts are evaluated by the…

Physicians May See Decrease in Medicare Payments in 2006 | AAFP Backs Effort to Give FDA Regulatory Control of Tobacco Products | HHS Begins Initiative to Reduce Obesity in Blacks | ChiT Web Site Offers Mentoring for Electronic Health Records | National Initiative Underway to…

Is beer beneficial to the brain? The Washington Post reports on a recent study that found women who drank light to moderate amounts of beer or wine daily for four years were about 20 percent less likely to experience mental impairment in old age. The study, published in BMJ…

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are serious metabolic emergencies that affect patients with type 1 and type 2 diabetes. DKA and HHS are responsible for about 100,000 hospital admissions per year,1 and account for one of every four dollars…

“Doesn’t his face look unusually red?” Otis’s wife asked. Her 54-year-old husband had hypertension treated with sustained-release verapamil. He didn’t smoke cigarettes or consume alcohol. His wife was right; Otis had a ruddy face. Otis reported feeling tired and experiencing…

Good evidence supports the use of anticonvulsants as a class with overall reduction in number of headaches per month and overall increase in patients achieving 50 percent reduction of headache frequency. Of the medications within this heterogeneous group, valproic acid and…

In adults, medications may improve the symptoms of social phobia in the short term, but their usefulness may be overstated because of publication bias. Selective serotonin reuptake inhibitors (SSRIs) have the strongest evidence of efficacy and the most favorable side-effect…

Gonadorelin Analogues (GnRHa) Plus Progestogen (No Significant Difference in Heavy Bleeding Compared with GnRHa Alone, but Adding Progestogen Reduces Vasomotor Symptoms and Hot Flashes Associated with GnRHa). One small randomized controlled trial (RCT) found no significant…

Case study: RS, a 37-year-old woman, comes to your office with her four children and elderly mother, who lives with them, for their routine check-ups. She says that her husband has to miss his appointment that day because of work. You see RS first.

Treatment of subclinical hypothyroidism with levothyroxine may be of most benefit to patients with symptoms suggestive of hypothyroidism and those patients with thyroid-stimulating hormone (TSH) levels higher than 10 µIU per mL (10 mIU per L) or positive anti-thyroid peroxidase…

A 58-year-old woman presented to establish a primary care relationship. Her chief complaints were chronic pain of the hip and knee and excessive daytime sleepiness. Over the past few years, she felt that her body had been changing. She reported polyuria, excessive perspiration…

The Agency for Healthcare Research and Quality has issued a systematic review of the evidence regarding screening patients for celiac disease. Celiac disease is also referred to as celiac sprue, gluten-sensitive enteropathy, and non-tropical sprue.

AAP Releases Updated Breastfeeding Recommendations

Cesarean and Vaginal Birth After Previous Cesarean Delivery

Two valuable questions are raised by this clinical dilemma in primary care. The first is whether it is appropriate to perform tests at a patient’s request without clear indications. The second is whether billing the insurance carrier for these tests is proper.

Letter

Diabetic ketoacidosis (say: key-toe-acid-OH-sis), or DKA for short, happens when your body has high blood sugar (also called glucose) and a build-up of acid. If it isn’t treated, it can lead to coma and even death. It mainly affects persons with type 1 diabetes. But, it can…