American family physician
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Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 and type 2 diabetes resulting from an absolute or relative insulin deficiency. It can occur in patients of all ages and can be the initial presentation of diabetes, especially in young children. Polyuria and polydipsia are the most common symptoms, followed by nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness. ⋯ Amylase, lipase, hepatic transaminase levels, troponin, creatine kinase, blood and urine cultures, and chest radiography are additional tests to consider. Treatment involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications. Prevention strategies include identifying diabetes before DKA develops, educating patients to manage high-risk situations, and ensuring uninterrupted access to therapies for diabetes.
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Easy bruising and bleeding are commonly seen in primary care. Use of a bleeding assessment tool and a comprehensive history, physical examination, and patient-provided photographs can help identify causes of abnormal bleeding and bruising. Family history can aid diagnosis of a heritable cause. ⋯ Normal PT and aPTT results may indicate a platelet disorder. A normal PT result with a prolonged aPTT result indicates a disorder of the intrinsic coagulation pathway, and a prolonged PT result with a normal aPTT result may indicate a disorder of the extrinsic coagulation pathway. Consultation with a hematologist is recommended when initial evaluation indicates a bleeding disorder or when suspicion remains high despite a normal laboratory workup result.
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Tongue conditions occur in 15.5% of the US population. The most common tongue conditions are geographic tongue, fissured tongue, and black hairy tongue; these conditions do not require treatment. Median rhomboid glossitis can be associated with a candidal infection; symptomatic lesions usually improve with use of antifungals. ⋯ Burning mouth syndrome often involves the tongue, and if it does not resolve spontaneously, studies have shown improvement with gabapentin, topical clonazepam, capsaicin, and cognitive behavior therapy. Oral lichen planus is a chronic inflammatory disorder that can affect the tongue and is best treated with topical or systemic corticosteroids and calcineurin inhibitors. There is a lack of consensus on the definition and treatment of ankyloglossia (tongue-tie); however, some evidence supports that frenotomy can improve breastfeeding and decrease lactation-associated nipple pain.