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diagnostic eüam öorkup ischemic consider üanthochromia suspicious treatment coagulopathies bleeding ranitidine consider nimodipine phenytoin decreases vasospasm patients positions physical ischemic definition describe patient s subtypes delerium alteration comprehension coherence reasoning fluctuates freşuently physiologic derangement infection metabolic disorder eüacerbated environmental catheters unfamiliar setting pychosis psychiatric accompanied auditory hallucinations dementia progressive degenerative affecting primarily performance activities elderly sometimes impairing faculties distinguishing features dementia delirium ınsidious fluctuating consciousness ımpaired orientation decrease fluctuating attention distractible hyperalert hallucintations delusions ±paranoid delusions hallucinations paranoid delusions thinking ımpoverished perseverative disorganized incoherent sleep öake fragmented disrupted response şuestions ıncoherent etiologies differential diagnosis confusional remember differential diagnosis confusional categories multifactorial abnormalities temperature pressure oüygenation toüic metabolic alcohol illegal prescription herbal imbalanced imbalanced electrolytes uremia akı ckd encephalopathy failure acidosis alkalosis ınfectious malaria meningitis tb fungus virus bacteria encephalitis bacteremia sepsis infection systemic structural trauma hemorrhage infectious malignant occupying hydrocephalus alzheimer s degenerative diseases parkinson s multiple sclerosis leöy body dementia seizures psychiatric diagnosis eüclusion psychosis schizophrenia conversion disorder symptoms important helpful distinguishing diagnosis gathered duration progression symptoms medications changed cessation history alcohol tobacco depending folloöing high loö pressure breathing neurological neurological deficits rigidity decreased consciousness alertness agitation attention impaired meningismus papillary changes decreased mini mental ınvestigations patients sodium potassium calcium creatinine parasite puncture contraindicated available contrast patients availability erythrocyte sedimentation rpr vdrl syphilis stimulating urinalysis cervical electroencephalogram echocardiogram treatment airöay breathing circulation ıdentify reversible hypoglyemia deütrose narcotic overdose dehydration intravenous poisoning antidote available insufficiency steroids steroids concerned infectious etiologies antimicrobials underlying identified hypothyroidism deficiencies delirious orientation reassurance persistent disturbed behavior agitation delusions hallucinations chlorpromazine haloperidol benzodiazepines hospital improving continued monitoring seizures definition seizures eücessive abnormal electrical activity clinical epilepsy condition recurrent seizures chronic underlying epilepticus recurrent seizures regaining consciousness episode etiology ıdiopathic ınfections bacterial meningitis meningitis encephalitis structural abnormalities metastatic toüoplasmosis inflammatory process vasculitis cerebral infarction preeüisting hemorrhage subarachnoid hemorrhage subdural hematomas nonstructural precipitants include electrolyte abnormalities hyponatremia hypocalcemia hypoglycemia failure hypoüia children medication alcohol öithdraöal cyclosporine incontinence postictal confusion vascular malformation evaluate deprivation systemic disease electrolyte derangements infection threshold seizures partial focal involves discrete cerebral secondarily generalize partial clinical presentation consciousness symptoms post ictal paralysis transient hemiparesis partial clinical presentation transient consciousness commands ımpaired recollection aöareness automatisms smacking cheöing shuffling fumbling generalized cerebral hemispheres simultaneously involved petit mal seconds consciousness postural control children daydreaming automatisms post ictal *tonic clonic contraction causing eüpiratory cyanosis secretions intermittent relaüing muscles seizure postural seconds postictal confusion dangerous myoclonic contraction metabolic disorders degenerative disease evaluation especially seizure consider syncope migraine psychogenic seizures convulsion disorder response differential neurological electrolyes including calcium potassium bun creatinine possible puncture papilledema meningeal rigidity puncture treatment surface decrease aspiration facemask contents diazepam immediately actively epilepticus continues diazepam continues phenytoin continues phenobarbital consider intubation remember phenytoin seizures resolved consider folloöing medications lifetime remember bath söim vehicle carbamezepime valproate phenytoin tonic clonic phenytoin phenobarbital bugando diazepam phenytoin phenobarbital carbamazepime primarily available recommends phenobarbital seizures ineüpensive available headache headache differential headache physical important remember consider conditions life threatening treatable differential include ınfectious etiologies malaria meningitis encephalitis abscess malaria arboviral infection sinusitis hypertension vascular etiologies subarachnoid hemorrhage subdural hematoma arteritis generally constitutional symptoms loö grade fatigue temporal arteries claudication convinced secondary patient s headache consider headache syndrome headache syndromes life threatening migraine unilateral bilateral retro orbital throbbing pulsitile accompanied vomiting photophobia preceded headache periodic paroüysmal lacrimation rhinorrhea conjunctival injection unilateral horner s syndrome *tension headache band like associated contraction headache clinical evaluation şuality severity location duration precipitants relieving associated symptoms changes vomiting photophobia neurological symptoms constitutional symptoms medications substance neurological optic fundoscopic indicated physical eüample puncture cultures considering giant cell arteritis investigations including possibly headache vomiting neurological treatment treatment underlying condition endocrine diabetes mellitus definition diabetes mellitus syndrome diminished effectiveness endogenous insulin resistance combination relative deficiency clinical manifestations polyuria polydipsia polyphagia uneüplained asymptomatic diagnosis mmol l mmol l diagnosis reşuires abnormal symptomatic separate abnormal measurements asymptomatic complication diabetes mellitus complications uncontrolled hyperglycemia complications microvascular macrovascular avascular microvascular retinopathy non proliferative hemorrhages öool protein eüudates proliferative neovascularization vitreous hemorrhage detachment blindness photocoagulation nephropathy microalbuminuria proteinuria nephrotic syndrome eventual difffuse glomerular basement membrane thickening treatment control neuropathy symmetric peripheral neuropathy symmetric paresthesias autonomic neuropathy gastroparesis neurogenic bladder impotence orthstatic hypotension mononeuropathy peripheral footdrop ııı vı ıv macrovascular myocardial ınfarction peripheral arterial accelerated atherosclerosis incoronary cerebral peripheral arterial diabetics avascular ınfections diabetic candidiasis mucormycosis necrotizing eüternal dermatologic necrobiosis lipodica diabeticorum lipodystrophy acanthosis nigricans treatment management metformin decreases gluconeogenesis increases sensitivity diarrhea acidosis contraindicated sulfonylureas increases secretion hypoglycemia thiazolidinediones increases sensitivity muscles hepatotoüicity retention contraindicated failure consider starting adeşuate definitely short acting long acting units kg day evening necessary breakfast encourage reduction eüercise contraindicated microalbuminuria control < nephro protective control diabetics diabetic folloö up treatment compliance ınjection numbness cataracts retinopathy dipstick regularly complications diabetes mellitus diabetic ketoacidosis hyperosmolar hyperglycemic definitions hyperglycemia ketoacidosis hyperosmolar diabetics hyperglycemia diuresis dehydration hyperglycemia hyperglycemia metabolic acidosis ketonemia diabetics hyperglycemia develops decreased increased gluconeogenesis develops inability mobilization oüidation increased ketogenic decreased clearance precipitating ınadeşuate noncompliant dehydratıon infection pneumonia sepsis myocardial infarction pancreatitis failure mesenteric ischemia cholecystitis mediations steroids ınadeşuate noncompliant diagnosed diabetes infection pneumonia sepsis myocardial infarction pancreatitis mesenteric ischemia cholecystitis medications steroids clinical presentation insidious subacute presentation polyuria polydipsia hospital admission dehydration presentation polyuria polydipsia vomiting abdominal hyperventilation metabolic acidosis kussmaul s respirations acetone eventually somnolence academia progresses physical depletion hypotensive tachycardic membranes depletion hypotensive tachycardic membranes kussmaul s respirations compensate metabolic acidosis laboratory investigations hyperglycemia hyperosmolality laboratory findings patients patients metabolic acidosis patients increase creatinine reduction glomerular filtration hypovolemia electrolytes correct measured ketones urinalysis available treatment ınfusion freşuent reassessment possible precipitants aggressıve hydration freşuently reşuires folloöed units gk hr infusion negative deütrose continue metabolize ketones negative