NeuroGlycoPenia cramp attack Wean spasm seizure stimulating Glucagon release...HOW ?

"Every Day And In Every Way I Am Getting Better And Better" ...
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NeuroGlycoPenia is a medical term that refers to a shortage of glucose (glycopenia) in the brain, usually due to hypoglycemia. Glycopenia affects the function of neurons, and alters brain function and behavior. Prolonged neuroglycopenia can result in permanent damage to the brain.

Signs and symptoms of neuroglycopenia

• Abnormal mentation, impaired judgement
• Nonspecific dysphoria, anxiety, moodiness, depression, crying, fear of dying, suicidal thoughts
• Negativism, irritability, belligerence, combativeness, rage
• Personality change, emotional lability
• Fatigue, weakness, apathy, lethargy, daydreaming, sleep
• Confusion, amnesia, dizziness, delirium
• Staring, "glassy" look, blurred vision, double vision
• Automatic behavior
• Difficulty speaking, slurred speech
• Ataxia, incoordination, sometimes mistaken for "drunkenness"
• Focal or general motor deficit, paralysis, hemiparesis
• Paresthesia, headache
• Stupor, coma, abnormal breathing
• Generalized or focal seizures

Not all of the above manifestations occur in every case of hypoglycemia. There is no consistent order to the appearance of the symptoms. Specific manifestations vary by age and by the severity of the hypoglycemia. In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise. The symptoms of a single person do tend to be similar from episode to episode.

In the large majority of cases, hypoglycemia severe enough to cause seizures or unconsciousness can be reversed without obvious harm to the brain. Cases of death or permanent neurologic damage occurring with a single episode have usually involved prolonged, untreated unconsciousness, interference with breathing, severe concurrent disease, or some other type of vulnerability. Nevertheless, brain damage or death has occasionally resulted from severe hypoglycemia (e.g., Sunny von Bülow).

Compensatory responses to neuroglycopenia

Most neurons have the ability to use other fuels besides glucose (e.g., lactic acid, ketones). Our knowledge of the "switchover" process is incomplete. The most severe neuroglycopenic symptoms occur with hypoglycemia caused by excess insulin because insulin reduces the availability of other fuels by suppressing ketogenesis and gluconeogenesis.

A few types of specialized neurons, especially in the hypothalamus, act as glucose sensors, responding to changing levels of glucose by increasing or decreasing their firing rates. They can elicit a variety of hormonal, autonomic, and behavioral responses to neuroglycopenia. The hormonal and autonomic responses include release of counterregulatory hormones. There is some evidence that the autonomic nervous system can alter liver glucose metabolism independently of the counterregulatory hormones.

Adjustment of efficiency of transfer of glucose from blood across the blood-brain barrier into the central nervous system represents a third form of compensation which occurs more gradually. Levels of glucose within the central nervous system are normally lower than the blood, regulated by an incompletely understood transfer process. Chronic hypoglycemia or hyperglycemia seems to result in an increase or decrease in efficiency of transfer to maintain CNS levels of glucose within an optimal range.

In both young and old patients, the brain may habituate to low glucose levels, with a reduction of noticeable symptoms, sometimes despite neuroglycopenic impairment. In insulin-dependent diabetic patients this phenomenon is termed hypoglycemia unawareness and is a significant clinical problem when improved glycemic control is attempted. Another aspect of this phenomenon occurs in type I glycogenosis, when chronic hypoglycemia before diagnosis may be better tolerated than acute hypoglycemia after treatment is underway.

Neuroglycopenia without hypoglycemia

A rare metabolic disease of the blood-brain glucose transport system has been described in which severe neuroglycopenic effects occurred despite normal blood glucose levels. Low levels of glucose were discovered in the cerebrospinal fluid (CSF), a condition referred to as hypoglycorrhacia.

Perhaps a much more common example of the same phenomenon occurs in the people with poorly controlled type 1 diabetes who develop symptoms of HYPOglycemia at levels of blood glucose which are 'normal' for most People.

Glucagon Deficiency Attacked Again ...HOW ?

"Every Day And In Every Way I Am Getting Better And Better" ...
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http://www.ncbi.nlm.nih.GOV/pubmed/8452077
'... Patients younger than 70 years of age had a success rate of 16.2 percent ... versus 12.4 percent for patients older than 70 years ...'



= Over 70 years of age Patients 'treated' by HealthCare services CPR = approx 87 deaths every 100 times CPR is adopted ... usually without any glucagon or glucose which apparently results in the patient's brain / heart being starved to death by the distress of the CPR procedure.


= Under 70 years of age Patients 'treated' by HealthCare services CPR = approx 83 deaths every 100 times CPR is adopted ... usually without any glucagon or glucose which apparently results in the patient's brain / heart being starved to death by the distress of the CPR procedure.



http://www.ChestJournal.org/cgi/content/full/130/2/419
'... only 2.7% of Patients understood that the success rate of CPR was less than 10% in sick Patients. A minority of Patients (34%) had discussed CPR with their Physician; 37% did not want to discuss their preferences with their Doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation ... The preferred role in decision making was variable, but most Patients (59.7%) and Family Members (81.6%) preferred some degree of shared decision making that included the Family Member. There were no significant differences between cancer and medical Patients in their preferred decisional role ...'




http://www.InteliHealth.com/IH/ihtIH/E/9273/35323/372221.html?d=dmtHMSContent
'... chest compressions alone may be as effective ...'

Medical Myths

CPR: Less Effective Than You Might Think

March 2001
Last reviewed on January 31, 2008

By Robert H. Shmerling, M.D.
Beth Israel Deaconess Medical Center

Imagine your typical TV drama. A child, playing in the park, hovering too close to the pond, falls in. His parents, distracted for a few moments, soon notice that their child is missing. Frantic, they call her name and look everywhere, and it dawns on them. Perhaps she fell in. When they finally locate their daughter and pull her out, she is no longer breathing and has no signs of a pulse. Instinct would tell the viewer that someone would come to the rescue and use CPR to save the day. The child would sputter, wake up, and be returned, shaken but otherwise unharmed, to her parent's arms.

CPR (cardiopulmonary resuscitation) is a method of trying to restore circulation and breathing for a person who has no pulse or is not breathing. You may have the impression from television shows or movies that CPR is a highly effective emergency treatment for anyone who has collapsed.

It surprises many to learn that the dramatic CPR results they often see are a myth. Unfortunately, CPR is often ineffective, and only in certain circumstances is its success rate anything other than dismal. This is not to say it should be abandoned in dire situations, but in general, the expectations of loved ones or those performing CPR are often higher than the situation warrants.

CPR can and does work, but CPR lacks the magical quality people often associate with it. As I've said in other columns, medical myths often have some truth behind them: A drowning victim [AND/OR PATIENTS SUFFERING MASSIVE BLOOD LOSS] should promptly receive CPR, and good outcomes may follow as depicted in the typical TV drama. However, the success rate of CPR varies widely, based on many factors, including:

• The cause of cardiac or respiratory arrest
• The underlying health of the victim
• The time elapsed between the arrest and CPR
• The technique used by the person performing CPR

For example, when a person has stopped breathing because of low body temperature (such as someone rescued after falling through ice into a cold lake) or another readily reversible condition, the success rate is higher. On the other hand, when an elderly person has stopped breathing because of heart problems or pneumonia, especially when other medical problems are present, CPR has a very low success rate.

There are new developments in CPR, including a study showing that for untrained bystanders receiving directions by emergency dispatchers, chest compressions alone may be as effective as compressions with artificial respiration (breathing into the person's mouth to provide oxygen). New guidelines, released in November 2005, suggest more frequent and more rapid chest compressions for most people requiring CPR. In addition, battery-powered defibrillators (that shock the victim's dangerously abnormal heart rhythm back to a safer, more stable rhythm) are becoming smaller, easier to use and increasingly available. These developments may increase the effectiveness of emergency rescues.

As opposed to many medical myths, researchers have reliable data concerning the success rates of CPR (without the use of automatic defibrillators) in a variety of settings:

• 2% to 30% effectiveness when administered outside of the hospital
• 6% to 15% for hospitalized patients
• Less than 5% for elderly victims with multiple medical problems

In June 1996, the New England Journal of Medicine published a study about the success rates of CPR as shown on the television medical shows "ER," "Chicago Hope" and "Rescue 911." According to the shows, CPR successfully revived the victim 75% of the time, more than double the most conservative real-life estimates. In addition, while most CPR is actually performed on sick, older individuals with cardiac disease, most of these shows' patients were young and victims of trauma or a near-drowning — conditions with the highest success rates.

Finally, the patients on these shows either died or fully recovered. In real life, many of those who are revived by CPR wind up severely debilitated. One reason may be that, as noted by a study published in the January 2005 issue of the Journal of the American Medical Association, CPR is frequently not administered adequately, even when provided by trained ambulance personnel. Improved technique (including more frequent and rapid compressions, as recommended in the new guidelines) and use of automatic defibrillators could dramatically improve success rates.

The low success rate of CPR may be an example of how a medical myth is perpetuated by the media because it is more appealing than the truth. Unfortunately, sugar-coating the concept of CPR leads to unrealistic expectations when a loved one requires CPR or is ill, and heroic measures are under consideration. A better understanding of when CPR may be effective and when it is highly unlikely to help will better serve everyone in the unfortunate event of catastrophic illness or injury. If you learn to administer CPR, you may save someone's life, so learning the proper technique is worth the effort. However, you should not expect the results you see on television.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.