Treatments for Metabolic disorders
Hospital statistics for Metabolic disorders:
These medical statistics relate to hospitals, hospitalization and Metabolic disorders:
- 105,364 admissions to private hospitals because of endocrine, nutritional, metabolic in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 34% of hospitalisations for endocrine, nutritional, metabolic disorders in public hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 366,389 patient days spent in public hospitals for endocrine, nutritional, metabolic disorders in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 618,249 patient days spent in private hospitals for endocrine, nutritional, metabolic in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- more hospital information...»
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Metabolic Acidosis:
Treatment
(In A Page: Pediatric Signs and Symptoms)
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If primary respiratory process identified, then treat the cause and the acidosis will resolve over time
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Dehydration: Oral or IV fluid replacement; even with normalization of fluid status, improvement in serum bicarbonate may not occur for 2–3 days
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For primary metabolic process
–Estimate deficit =20
– [HCO3] ×Weight (kg) ×0.5
–Replace over 24–48 hours with oral bicarbonate (e.g. bicitra solution 1 cc =1 meq) or IV bicarbonate added to IV fluids; IV sodium bicarbonate “boluses” should be avoided unless acidosis is severe or symptomatic
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Increased AG acidosis: Identify and treat cause
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Distal or proximal RTA: Usually requires bicarbonate supplementation
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Hyperkalemic RTA: Correct serum bicarbonate, increase fluids to improve sodium delivery to distal tubule to enhance potassium secretion
>
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Source: In A Page: Pediatric Signs and Symptoms, 2007
Metabolic acidosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In metabolic acidosis, treatment consists of administration of sodium bicarbonate I.V. for severe cases, evaluation and correction of electrolyte imbalances and, ultimately, correction of the underlying cause. For example, in diabetic ketoacidosis, a low-dose continuous I.V. infusion of insulin is recommended.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Metabolic alkalosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment aims to correct the underlying cause of metabolic alkalosis. Therapy for severe alkalosis may include cautious administration of ammonium chloride I.V. or hydrochloric acid to release hydrogen chloride and restore concentration of extracellular fluid and chloride levels. Potassium chloride and normal saline solution (except in the presence of heart failure) are usually sufficient to replace losses from gastric drainage. Electrolyte replacement with potassium chloride and discontinuing diuretics correct metabolic alkalosis resulting from potent diuretic therapy.
Oral or I.V. acetazolamide, which enhances renal bicarbonate excretion, may be prescribed to correct metabolic alkalosis without rapid volume expansion. Because acetazolamide also enhances potassium excretion, potassium may have to be administered before giving this drug.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Metabolic syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Lifestyle modification, focusing on weight reduction and exercise, is an important part of the treatment regimen. Modest weight reduction through diet and exercise considerably improves hemoglobin A1c levels, reduces insulin resistance, improves blood lipid levels, and decreases blood pressure — all elements of metabolic syndrome. Recent studies have shown that in patients with impaired glucose tolerance, losing an average of 7% of body weight reduced the risk of developing Type 2 diabetes by 58%.
To improve cardiovascular health, a diet rich in vegetables, fruits, whole grains, fish, and low-fat dairy products combined with regular exercise is recommended. Moreover, nutrient-dense, low-energy foodsshould replace low-nutrient, high-calorie foods. Meal replacements and shakes may also reduce risk factors for metabolic syndrome and improve weight loss. (SeeTherapeutic lifestyle change diet, page 908.)
A regular exercise program of moderate physical activity, in addition to dietary modifications, promotes weight loss, improves insulin sensitivity, and reduces blood glucose levels. According to the Surgeon General’s Report on Physical Activity and Health, a person should exercise moderately for a minimum of 30 minutes on most (if not all) days of the week. The selected exercise program should improve cardiovascular conditioning, increase strength through resistance training, and improve flexibility.
Medications may be used in the treatment of metabolic syndrome for patients who have a body mass index (BMI) of 27 kg/m2 or greater in the presence of other risk factors (such as diabetes, hypertension, and hyperlipidemia) or for patients with a BMI of 30 kg/m2 or greater without other risk factors. Weight loss medications may also be added to lifestyle changes if the patient hasn’t achieved significant weight loss after 12 weeks.
Pharmacologic treatment may also be indicated. Phentermine is used for short-term treatment of obesity in conjunction with diet and exercise. The only two medications that have been approved for long-term weight loss are orlistat and sibutramine. Orlistat works by decreasing the absorption of dietary fat by inhibiting pancreatic lipase, which is needed for fat breakdown and absorption. However, because absorption of fat-soluble vitamins is reduced, the patient may require vitamin supplementation. Studies show that when obese patients take orlistat in conjunction with dieting, they achieve greater weight loss and serum glucose control than by dieting alone. Sibutramine promotes weight loss by inhibiting the reuptake of serotonin, norepinephrine, and dopamine and increases the satiety-producing effects of serotonin. Further, it reduces the drop in metabolic rate that commonly occurs with weight loss.
Surgical treatment of obesity, such as through gastric bypass procedures, produces a greater degree and duration of weight loss than other therapies and improves or resolves most of the factors of metabolic syndrome. Candidates for surgical intervention include patients with a BMI greater than 40 kg/m2 or those with a BMI greater than 35 kg/m2 with obesity-related medical conditions. Gastric bypass procedures produce permanent weight loss in the majority of patients.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
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