management of diabetic and epileptic patient in dentistry

7/28/2019 Management of Diabetic and Epileptic Patient in Dentistry

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MANAGEMENT OFDIABETIC AND EPILEP

PATIENT IN DENTISTR

PRE

S


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DIABETESMELLITUS


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DEFINITION Diabetes is the most common endocrine disease .It is a group of diseas

by high levels of blood glucose resulting from defects in insulin produc

CLASSIFICATION1.TYPE 1- Insulin dependent or juvenile onset. Immune mediated

Idiopathic

2. TYPE 2-Non Insulin dependent or adult onset. Genetic defects of beta cell function

Genetic defects of insulin action Disease of exocrine pancrease Drug chemical induce Infections

3.GESTATIONAL DIBETES MELLITUS

4.IMPAIRED GLUCOSE TOLERENCE

5.IMPAIRED FASTING GLUCOSE


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TYPE 1 DM

It can occur at any age but is more common among children and young

The peak age onset is 10 to 14 yrs.

It is characterized by insulin deficiency.

In DM circulating insulin is essentially absent.

TYPE 2 DM

Non-ketotic form of diabetes that is not linked to humans lymphocyte markers on the 6th chromosomes.

High incidence of obesity.

GESTATIONAL DM

It is characterized by abnormal result on the oral glucose tolerance testduring pregnancy.

Risk of prenatal illness and death in all levels of disease severity.

IMPAIRED GLUCOSE TOLERANCE/IMPAIRED FASTING GLUCOSE TOLERA

Persons with IGT have plasma glucose level between 140 199 mg/dl aoral glucose tolerance test.

IFGT

The fasting blood sugar level is 100

125mg/dl.


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DM RISK FACTORS

Age above 45 yrs

BMI

Habitual physical activity High risk ethinicity

H/O child weight greater than 9 pounds at birth

H/O gestational diabetes

Hypertension

Triglycerides 250 mg/dl

Cholestrol 35 mg/dl

H/O vascular disease


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COMPLICATIONS

ACUTE COMPLICATIONS

Hypoglycemia

Diabetic ketoacidosis

Hyperglycemia

CHRONIC COMPLICATIONS

Microvasculature

Cardiovascular system- Artherosclerosis,Large vessel disease,Micro

Eyes

Retinopathy,Catract , Glaucoma. Kidney- Diabetic glomerulonephritis.

Nerves- Motor ,sensory , autonomic neuropathy.

Mouth- Gingivitis, Increased dental caries and Periodontal disease

Skin- Pruritis, Mycosis, Diabetic xanthoma.


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HYPERGLYCEMIAETIOLOGY

High blood sugar

Weight gain

Cessation of exercise Pregnancy

Hyperthyroidism

Corticosteroid theraphy

Fever

Acute infection

SIGNS

Hyperglycemia

Acidosis with blood PH- 7.3

Dry warm skin

Fruity, sweet breath odour

Normal to low BP

Rapid weak pulse

Altered level of consciousness


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SYMPTOMS

TYPE 1 DM

Repeated skin infection

Marked irritability Headache

Drowsiness

Malaise

Dry mouth

TYPE 2 DM

Decresed vision

Parasthesia

Loss of sensation

Postural hypotension


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CLINICAL MANIFESTATIONTYPE 1 TY

POLYURIA

+++

POLYDIPSIA ++ +

POLYPHAGIA WITH WT LOSS ++ _

RECURRENT BLURRED VISION + ++

VULVOVAGINITIS OR PRURITIS + ++

LOSS OF STRENGTH ++ +

NOCTURNAL ENURESIS ++ _

ABSENCE OS AYMPTOMS _ ++


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MANGEMENTRECOGNIZE PROBLEM

( Lack of response to sensory stimulation)

DISCONTINUE DENTAL TREATMENT

ACTIVE OFFICE EMERGENCY TEAM

POSITON PATIENT IN SUPINE POSITION WITH FEET ELEVATED

A-B-C ASSESS AND PERFORM BASIC LIFE SUPPORT AS NEEDED

D- PROVIDE DEFINITIVE MANAGEMENT AS NEEDED


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HYPOGLYCEMIAETIOLOGY

Weight loss

Increased physical exercise

Termination of pregnancy Termination of other drug therapies

Recovery from infection and fever

Inadequate food( Carbohydrate intake)

Excessive insulin dose

Sulfonyl urea theraphy

Ethanol intake

SIGNS

Weakness, Dizziness

Pale moist skin

Normal or depressed respiration

Headache

Altered level of consciousness

CLINICAL MANIFESTATION


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CLINICAL MANIFESTATIONEARLY STAGE Mild reaction

Diminished cerebral function

Changes in mood

Decreased spontaneity

Hunger

Nausea

MORE SEVERE STAGE

Sweating

Tachycardia

Increased anxiety

Belligerence

Poor judgement

Uncoporativeness

LATER SEVERE STAGE

Unconsciousness

Seizure activity

Hypotenion

Hypothermia

MANGEMENT


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MANGEMENTRECOGNIZE THE PROBLEM

( Altered consciousness)


ACTIVE OFFICE EMERGENCY TEAM

P- POSITION PATIENT COMFORTABLY

A-B-C ASSESS AND PERFORM BASIC LIFE SUPPORT AS NEDDED

D- PROVIDE DEFINITIVE MANAGEMENT

ADMINISTER ORAL CARBOHYDRATES

IF SUCCESSFUL IF UNSUCCESSFUL

Permit PT to recover Activate emergency medical services

Discharge PT Administer parentral carbohydrates

Monitor PTDischarge the PT


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DIABETIC KETOACIDOSIS:

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients withmellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with tyunder certain circumstances. DKA results from a shortage of insulin; in response the body switchefatty acids and producing acidic ketone bodies that cause most of the symptoms and complicatio

Signs and symptoms

Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine producabdominal pain that may be severe.

Coffee ground vomiting (vomiting of altered blood) occurs in a minority of patients; this tenfrom erosion of the esophagus.[3] In severe DKA, there may be confusion, lethargy, stupor or evemarked decrease in the level of consciousness).

MANAGEMENT:

1 Fluid replacement

2 Insulin

3 Potassium

4 Bicarbonate

5 Cerebral edema


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MANAGEMENT BY DRUGS

Metfromin

Rosiglitazone

Glipizide

Acarbose

Repaglinide


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EPILEPSY


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DEFINITIONRECURRENT PAROXYSMAL DISORDER OF CEREBRAL FUNCTION MARKEDSUDDEN , BRIEF ATTACKS OF ALTERED CONSCIOUSNESS MOTOR ACTIVITSENSORY PHENOMENA.

CAUSES

Congenital abnormalities

Perinatal injuries

Metabolic and toxic disorders

Head trauma

Tumors and other space occupying lesions

Vascular disease

Infectious disease


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ABSENCE SEIZURE & PARTIALSEIZUREDIAGNOSTIC CLUES FOR THE PRESENCE OF SEIZURE:

Sudden onset of immobility & blank stare

Simple automatic behaviour

Slow blinking eyelids

Short duration

Rapid recovery


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MANAGEMENT

RECOGNIZE PROBLEM


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RECOGNIZE PROBLEM

( Lack of response to sensory stimulation)

DISCONTINUE THE DENTAL TREATMENT

ACTIVE OFFICE EMERGENCY TEAM AS NEDDED

POSITION THE PT IN SUPINE POSITION WITH FEET ELEVATED

Seizure Ceases reassure Pt Seizure continues( 75

active emergency me

Allow Pt to recover before discharge A-B-C Perform basic l


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TONIC CLONIC SEIZURE( GRANMAL)

DIAGNOSTIC CLUES: Presence of aura prior to loss of consciousness

Tonic- clonic muscle contraction

Clenched teeth, tongue biting

PREMODAL PHASE


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RECOGNIZE AURA


ICTAL PHASE

ACTIVATE OFFICE EMERGENCY TEAM

P-POSITION PATIENT IN SUPINE POSTION WITH FEET ELEVATED

CONSIDER ACTIVATION OF EMERGENCY MEDICAL SERVICES

A-B-C ASSESS & PERFORM BASIC LIFE SUPPORT AS NEEDED

DEFINITE CARE ADMINISTER O2 MONITOR VITAL SIGNS

REASSURE PT AND PERMIT RECOVERY DISCHARGE PT

TO HOPITAL TO HOME TO PHYSICIAN


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TONIC-CLONIC STATUS MANAGEM

PREMODAL PHASE


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RECOGNIZE AURA


ICTAL PHASE

ACTIVATE OFFICE EMERGENCY TEAM

P-POSITION PATIENT IN SUPINE POSTION WITH FEET ELEVATED

CONSIDER ACTIVATION OF EMERGENCY MEDICAL SERVICES

A-B-C ASSESS & PERFORM BASIC LIFE SUPPORT AS NEEDED

DEFINITE CARE

PROTECT PT FROM INJURY

IF SEIZURE PERSISTS FOR MORE THAN 15 MINS

A-B-C PERFORM VENIPUNCTURE &ANTICONVULSANT

DEFINITIVE CARE PROTECT PT ADMINISTER 50% IV DEXTRO

FROM INJURY UNTIL EMERGENCY

ASSISTANCE ARRIVES


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MANAGEMENT OF EPILEPSY BY

DRUGS Carbamazepine 15-25 mg/kg

Phenytoin 3-8 mg/kg

Phenobarbitol 2-4 mg/kg

Primidone 10-20 mg/kg

Ethosuximide 10-30 mg/kg

Clonazepam 0.03-0.3 mg/kg

Valporate 15-60 mg/kg

NEW DRUGS Oxcarbazepine

Felbamate

Tiagabine


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management of diabetic and epileptic patient in dentistry

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