Drug- Induced Hepatitis Diabetic Autonomic Neuropathy

 most common cause of acute liver  Neuropathy of the autonomic nervous

failure system.
 Associated with: poor glucose control,
Symptoms: chills, fever, rash, pruritus,
obesity, smoking, hypertension,
arthralgia, anorexia, and nausea. jaundice, dark
hypertriglyceridemia
urine, and an enlarged and tender liver.
3 manifestations:
 If fever, rash, or pruritus occurs from
any medication, its use should be  Cardiac
stopped immediately. o Tachycardia at rest
o Orthostatic hypotension-
Leading cause: acetaminophen; >4000
carotid sinus communicates to
mg/24hrs (lesser in alcoholics or with chronic
autonomic nervous system
liver disease)
through glossopharyngeal
Other: anesthetic agents, medications used to nerve. Normal condition:
treat rheumatic and musculoskeletal disease, sympathetic outflow to
antidepressants, psychotropic medications, preserve or restore blood
anticonvulsants, and antituberculosis agents pressure
- ANS is knocked
Treatment:
out in case of
 short course of high-dose Diabetic
corticosteroids- severe hypersensitivity Neuropathy
reactions because of
 Liver transplantation Diabetes
Mellitus

Treatment:

o diet high in sodium

o use of
sympathomimetic and
other agents (e.g.,
caffeine) that stimulate
an autonomic response
o mineralocorticoid
therapy, and the use of
lower-body elastic
garments that
maximize venous return
and prevent pooling of
blood in the extremities
o Silent myocardial infarction-
pain is not occurring. Troponin I
is high. May feel fatigue.
  In pt. with Coronary
artery disease and
Diabetes at the same
time (Artherosclerosis-
Stable- unstable angina)

 Gastrointestinal

-parasympathetic nervous system is responsible

for proper movement. In case of autonomic
neuropathy, there is no proper vagal stimuli

o Delayed gastric emptying

o Gastroparesis- no proper
propulsion. treatment: small,
frequent meals and prokinetic
agents
o Diabetic diarrhea
 Renal
o Bladder dysfunction
o Erectile Dysfunction
o Retrograde ejaculation
 Excessive sweating
o Sudomotor Neuropathy-
increase sweating in upper
body; absence of sweating of
the extremities.

 Hypoglycemic Unawareness- absent

adrenergic symptoms of hypoglycemia.
o Atypical symptoms: numbness
around mouth and inability to
concentrate.