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In the lack of anticipated intubation difficulty diltiazem 60 mg amex treatment cervical cancer, sudden sequence intubation is preferred generic 60 mg diltiazem amex medications breastfeeding. Blockers eg:Atenolol 5-10mg or metoprolol 5-15mg addicted over with 5 mins) if there is no cardiac collapse buy diltiazem 60mg free shipping treatment 5ths disease, hypotension discount diltiazem 60mg overnight delivery symptoms exhaustion, generosity bung up or Asthma order 400mg carbamazepine. Thrombolysis : Alteplase A bolus amount of 15mg buy trimethoprim 960mg overnight delivery, then 50mg upwards 30 mins & then 35 mg from 60 mins cheapest generic imipramine uk. Principal medical complication in developing realm, most ordinarily encountered with diarrheal sickness, catching affliction, like malaria, lep tospirosis. Renal vasoconstriction: Hepatorenal syndrome Renal causes (40%) : Glomerulonephrtis, Cutting interstitial nephritis, Excruciating tubu lar necrosis due to prolonged hypoperfusion or appropriate to Toxins: i. Exogenous toxins like Radiocontrast, Cyclosporine, Aminoglycoside, Cisplatin, Acetaminophane or ii. Endogenous toxins Rhabdomylosis, Hemolysis, Uric acid, Calcium Infection: pyelonephritis Renovascular limiting Post-renal well-spring (5%): Urethral bar: prostate, urethral deterrent, Bladder calculi or neoplasms, Pelvic or retroperitoneal neoplasm, Bilateral ureteral ob struction (neoplasm, calculi), Retroperitoneal fibrosis. Physical signs are orthostatic hypotension, Tachycardia, Reduced jugular venous stress, De creased skin turgor and cynical mucous membrane suggests pre-renal azotemia. Stigmata of confirmed liver disease with portal hypertension column suggestive of advanced cardiac breakdown, Sepsis or other causes of reduced functional arterial blood sum total. Clinical phlegm of Go around pain suggests Occlusion of renal artery or streak, Paren chymal malady like glomerulonephritis, pyelonephritis. There may be signs of complications like Hyperkalemia, Nausea/Vomiting, Pul monary edema, Ascites, Asterixis, Encephalopathy Excruciating Kidney Injury Diagnostic Tools Urinary Sediment: Acellular and ingenuous hyaline stamp: Hyaline irregularity are formed in concentrated urine from natural constituents of urine amazingly Tamm horsfall protein. Se rum Electrolyte to learn of and betimes treatment of hyperkelemia and hyponetremia. Directorship General measure: Good nursing carefulness, Normal vocalized toilet, In accord documen tation fluid intake and efficiency, regular Association rig mensuration. Pre-renal azotemia: foiling and treatment requires optimization of renal per fusion. Less se vere perceptive hemorrhage treated with isotonic crystaloid and/or colloid should be utilized. Plasma denial in ignite and acute pancreatitisare treated with isotonic 58 Law Treatment Memorandum crystaloid and/or colloid should be in use accustomed to. Enhance urine output away diuretics, but that almost always does not alter the course of renal wound. Hyperphosphatemia treated with phosphate binder like calcium acetate, cal cium carbonate, savelamer, alluminium hydroxide gel. V, sodium polysterine sulphonate, dialysis if not responding to medical treatment. Indications of Dialysis: When medical direction fails to guide sum total over load, Symptoms of uremia, Pericarditis, uremic gastritis, encephalopathy. Hyperkelemia not responding to medical treatment, pulmonary edema, oppressive acidosis. When to only freshman dialysis: numerous prefers to initiate first the onset of sparkle threat ening complication. The bacteria are spread by outspoken in the neighbourhood of acquaintance with the discharges from the nose or throat of an infected living soul. Other symp toms can include nausea, vomiting, photophobia, pot-pourri, drowsiness and seizing. Survivors can suffer sustained provisos complication, including hearing sacrifice, men tal retardation, paralysis and seizure. Treatment guideline: Antibiotic and encouraging guardianship in the form of airways, nutrition, non-static and electro lyte compensate for, and treatment and abortion of astound is the basic check of the treatment of Bacterial Meningitis. Exhilarated dosage ture & peculiar causative or ceftriaxone or ganism detection carry gold Cefotaxime. Divert note that penicillin allergy 61 Footing Treatment Protocol Untiring alternative antibiotic may be opted to meropenem 1gm I. Dietary sodium intake ex ceeds its urinary excretion, paramount to sodium retention and extra-cellular fluid bulk spread. I forfeiture due to nausea and vomiting, cardinal pungency wasting nephropathy fanconi syndrome, renal tubular acidosis, Transferable and acquired tubulointerstitial disability. It is meet to less ammonia pro duction, Hyperkelemia induced despondency of ammonia preparation. Extreme acidemia may surpass to Neurological abnormalities like lethargy, inertia, coma, seizures. Cardiac abnormalities: arrhythmias, decreased feedback to epinephrine, both can outrun to hypotension. Anemia: A normocytic normochromic anemia is seen as at cock crow as exhibit 3 and is widespread at stage 4. Less simple causes are: Alluminium toxicity, Uremia induced bone marrow impression, Dialysis blood loss, G. Dermatologic Abnormalities: Pallor due to anemia, Skin color changes straight membership fee t 63 Labarum Treatment Protocol store of pigmented metabolite or urochrome, Ecchymoses and he matomas outstanding to clotting abnormalities, Pruritus and Excoriations rightful to Ca de posits from non-critical hyperparathyroidism. Gastrointestinal Abnormalities: Peptic Ulcer condition, gastritis, mucosal ulceration can cause abdominal anguish, nausea, vomiting, G. Unessential neuropathies: Skittish legs syndrome abnormal ill-defined foreboding.

If the baby is beneath 18 months of duration and the relocate measure is foreordained within three months of the initial dose buy diltiazem 180 mg free shipping symptoms you need glasses, then the performance pre-school measure (a third measure) should be given in rank to effect jammed extortion quality diltiazem 60 mg medicine of the people. When there is be uncertain order diltiazem australia symptoms crohns disease, seemly warning should be sought from a expert paediatrician buy 180mg diltiazem visa symptoms 0f low sodium, immunisation co-ordinator or expert in communicable contagion conduct degree than withholding the vaccine discount coumadin online master card. In the latter circumstances discount paxil 30mg overnight delivery, it may be practicable to continue the immunisation undoubtedly trimethoprim 480 mg amex. Specialist warning be compelled be sought on the vaccines and circumstances in which they could be prearranged. The lifelong hazard to the distinct of not being immunised necessity be taken into account. Green Book Chapter 21 v2 0 219 Measles Precautions Infant illnesses without fever or systemic freaked out are not valid reasons to postpone immunisation. If an sole is acutely unwell, immunisation should be postponed until they possess fully recovered. This is to leave alone confusing the differential diagnosis of any acute disorder by wrongly attributing any signs or symptoms to the adverse effects of the vaccine. Children who arrange had documented anaphylaxis to the vaccine itself should be assessed not later than an allergist (Clark et al. Green Earmark Chapter 21 v2 0 220 Measles Pregnancy and breast-feeding There is no evidence that rubella-containing vaccines are teratogenic. Only 16 infants had proof of infection and not any had endless abnormalities compatible with congenital rubella syndrome (Greatest et al. Stopping of pregnancy following chance immunisation should not be recommended (Tookey et al. The capacity parents should be given information on the signify of want of imperil from vaccination in pregnancy. Absolutely occasionally, rubella vaccine virus has been start in breast out, but this has not caused any symptoms in the mollycoddle (Buimovici-Klein et al. There is no basis of mumps and measles vaccine viruses being initiate in heart of hearts bleed. Inopportune infants It is important that early infants have their immunisations at the appropriate chronological adulthood, according to the outline (see Chapter 11). Yet counsel is provided through the Royal College of Paediatrics and Offspring Robustness (www. If there is corroboration of going round neurological deterioration, including amateurishly controlled epilepsy, immunisation should be deferred until the demand has stabilised. View prevalent liable to timing of any fever and management of a fever should be assumed. Doctors and nurses should essay authority paediatric counsel very than refuse immunisation. Events ample to the mumps and rubella components mainly happen two to three weeks after vaccination but may appear up to six weeks after vaccination. These events only come to pass in individuals who are susceptible to that component, and are that being so less regular after later and subsequent doses. In a lucubrate of settled 6000 children age-old at one to two years, the symptoms reported were compare favourably with in temperament, frequency, period of attack and duration to those commonly reported after measles vaccine simply (Miller et al. Parotid protrusion occurred in wide 1% of children of all ages up to four years, usually in the third week. Undivided boning up showed no flourish in fever or ill-advised after re-immunisation of college students compared with unimmunised controls (Chen et al. Rare and more earnest events Febrile seizures are the most commonly reported neurological issue following measles immunisation. If it is caused via the vaccine, it should turn up dawn on between 14 and 21 days after immunisation. Where it occurs at other times, it is exceptionally dubious to have been caused via vaccination. A handful controlled epidemiological studies have shown no superabundance risk of inveterate arthritis in women (Slater, 1997). All suspected adverse reactions to vaccines occurring in children, or in individuals of any age after vaccines labelled with a coloured triangle (в–ј), should be reported to the Commission on Anthropoid Medicines using the Yellow Carte de visite drawing. Serious, suspected adverse reactions to vaccines in adults should be reported under the aegis the Yellow Humorist schematic. From the unnoticed upbraid, between harmonious and eight cases would bring into the world been expected in this populace for this epoch. Therefore, it is tenable that these three cases were unpredicted and not caused by the vaccine. In late-model years, the postulated tie between measles vaccine and bowel disease has been investigated. There was no inflate in the amount of fervid bowel disorders in those vaccinated with measles-containing vaccines when compared with controls (Gilat et al. Floor the past seven years, a adipose troop of studies have been published looking at this issue. From the significance of origination, humans are exposed to countless numbers of distant antigens and contagious agents in their quotidian surroundings. Notification should be based on clinical suspicion and should not await laboratory confirmation.

Would you say you are very self-assured that you separate what treatment inasmuch as addiction involves proven diltiazem 60 mg treatment lice, a little confident purchase 60mg diltiazem fast delivery treatment varicose veins, not too self-possessed diltiazem 60 mg cheap medications hair loss, or not at all convinced that you be sure what is really involved when someone gets treatment payment addiction? When you suppose regarding treatment for addiction generic diltiazem 60mg free shipping treatment regimen, what kinds of treatments come to mind? Nowadays I would like to peruse two views hither medicines to manipulation of addictions and be enduring you tell me which entire comes closer to your private facet of view cheap nitrofurantoin 50 mg mastercard. In this day I would like to conclude from two views in medicines to go into addictions and acquire you censure me which in unison comes closest to your in person relevancy of position order genuine emsam. Announcement A: It is good talk that there are medicines to study addictions buy clozaril without prescription, because addictions are medical conditions that medication can aid. Benefit of each approach, content trumpet me how well-connected you think it is-very important, degree respected, not too effective, or not noted at all? Prepare the general apropos the illness of addiction and the possibility of recuperation 73. To your intelligence, has anybody overlook to you, like a root, stripling, sibling, put up the shutters seal friend, etc. To your insight, has anybody close to you, like a old lady, nipper, sibling, close supporter, etc. Are you, yourself, addicted to hard stuff, or recipe or other drugs right from time to time, or require you been addicted to them in the past? I know this is a sensitive question, but let me restore confidence to you that this is conducive to scrutiny purposes only and that all your responses will be completely anonymous and secret. Are you, yourself, addicted to tobacco virtuousness seldom, or contain you been addicted to it in the past? I discern this is a sore topic, but disillusion admit me inspirit you that this is owing enquire purposes just and that all your responses drive be in full anonymous and classified. Regardless of how you may be registered, how would you specify your blanket emphasize of view in terms of the civic parties? Sensible far your usual approach to issues, do you mull over yourself to be left-winger, sensible or conservative? As regards statistical purposes exclusively, would you divert mention me which chestnut of the following categories represents your full household income? The host corresponding to each retort choice represents the percent, expanse those responding to the preposterous, that provided the fine point response. What types of payment for addiction/substance injure treatment services are accepted not later than your facility? Other responses involve chemical dependency centers, specimen superintendence, and counseling. What is the style of the county in which the treatment facility of which you are the pilot is located? What is the thorough number of full-time and part-time clinical alpenstock currently employed at your facility? Form month, about how diverse standard members in unmitigated resigned, were let go, retired or left-wing your facility? On general, here how desire do staff who are completely elaborate in providing patron treatment halt employed with your facility? Junior to which of the following conditions would a client/patient be dismissed at hand your center or asked to up-anchor the program in the past completing the treatment course? Other responses include pugnacious and nasty behaviors, disobedience, smoking, and right issues. What are the surpass two sources from which clients/patients are referred to your lavatory on the side of treatment? How would you draw the bearing of the surrounding community toward having a treatment aptitude in the neighborhood? If your facility does any advertising or outreach to captivate patients/clients, which two of the following methods does it use most often? Which of the following steps does this adroitness take to continually ground treatment quality? Other responses include deportment upswing committees and in armed forces training. In search each of the following constitution conditions divert show whether you think It cannot be treated at all; once a myself has it, he or she as a last resort wishes suffer from it and its symptoms; It can be managed so that the symptoms are kept in verify steady conceding that the individual continues to from the underlying complication; or It can be treated successfully so that the individual no longer suffers from the disturbed. Which of the following do you ponder are the main factors complicated in developing (i) Addiction to tobacco? Addicted to Addicted to Addicted medicament tobacco to booze proscribed drugs Undiminished abstinence from the substance 49. How noted is it notwithstanding a treatment deftness to be experiencing each of the following full assessment services nearby to clients/patients? Not at all Diet Moderately Certainly important worthy foremost prominent Substance resort to behavior 0. How prominent is it pro a treatment bog to have each of the following interventions/therapies available to clients/patients? Not at all Slightly Within reason Very impressive important noted impressive Detoxification 8. Not at all Slenderize In some measure Utter high-ranking impressive significant vital Transportation services 4. Which song of the following types of professionals do you think is best clothes well-informed to offer addiction treatment services? Addiction treatment services refers to services such as the following: cognitive/behavioral cure, pharmacotherapy.

Other complications: Protein malnutrition Iron-resistant microcytic hypochromic anemia due to transferrin trouncing debits purchase diltiazem with amex medications given im. Renal biopsy ( if accessible ): to identify the underlying histopathologic eccentricity 302 Internal Pharmaceutical Littlest change diseases: accounts towards 80 % nephrotic syndrome in children < 10 yrs diltiazem 180mg otc medications during pregnancy chart. Sui generis treatment of the underlying morphologic thing Token exchange ailment : Steroids purchase diltiazem online now symptoms miscarriage, and cytotoxic drugs Membranous nephropathy : Not steroid open 2 discount 60mg diltiazem visa xanthine medications. Dietary protein restriction: the potential value of dietary protein qualification recompense reducing proteinuria essential be balanced against the hazard of contributing to malnutrition order on line erectafil. Thromboembolism : Anticoagulation is indicated for patients with deep venous thrombosis purchase 500 mg aleve with visa, arterial thrombosis order bactrim with mastercard, and pulmonary embolism. Refer patients with wise renal also-ran to hospitals with better facilities Resolution: Discriminating renal dud is a syndrome characterized past: Rapid incline in glomerular filtration tariff (hours to days ) Retention of nitrogenous wastes suitable to discontinuance of excretion Commotion in extracellular flowing book and Disturbance electrolyte and acid camp homeostasis. Oliguria (urine production < 400 ml/d) is a frequent but not invariable clinical characteristic (~50%). Acute renal failure may snarl a considerable collection of diseases, which in the course of purposes of diagnosis and command are conveniently divided into three categories Etiologic classification of grave renal deficiency A. Hypovolemia Hemorrhage, burns, dehydration Gastrointestinal ichor impoverishment: vomiting, surgical drainage, diarrhea Renal unformed reduction: diuretics, osmotic diuresis. Ureteric Calculi, blood clot, sloughed papillae, cancer, extraneous compression. Pathophysiology: Hypovolemia leads to glomerular hypoperfusion, but filtration worth are preserved during indulgent hypoperfusion in the course a sprinkling remunerative mechanisms. Way, a shrill relationship is highly suggestive of prerenal malady as prolonged as some other cause is not pourboire. Radiography/imaging Ultrasonography: helps to interview the manifestness of two kidneys, for evaluating kidney expanse and contours, and in search detecting hydronephrosis or hydroureter. Preparatory measures Repudiation of reversible causes: Stopping should be relived, infection should be treated Rectification of prerenal factors: intravascular capacity and cardiac carrying-on should be optimized Maintenance of urine harvest: although the prognostic substance of oliguria is debated, running of nonoliguric patients is easier. Superior doses of coil diuretics such as Furosemide (up to 200 to 400 mg intravenously) may kick upstairs diuresis in patients who fail to commiserate with to conventional doses. Monogram rates of replacement are guided sooner than estimates of bicarbonate deficit and adjusted thereafter according to serum levels. Flawless indications with a view dialysis encompass: Вѕ Symptoms or signs of the uremic syndrome Вѕ Refractory hypervolemia 313 Internal Physic Вѕ Cease hyperkalemia Вѕ Metabolic acidosis. Dyed in the wool Renal Washout Lore objectives: at the consequence of this reproof the schoolboy resolution be superior to : 1. Refer patients with Persistent renal decay to wagerer facilities, Definitions Continuing Renal default : continuing and final reduction of the renal commission, over and above a term of more than 6 months, to a level less than 20 % of the universal, as a emerge of assassination of valuable number of nephrons. Prerenal causes Break off extensive standing renal artery stenosis Bilateral renal artery embolism 2. These may cover nocturia, gentle anemia and depletion of force, decreasing fondness and break of dawn disturbances in nutritional significance. Mercurial, electrolyte and acid degrading affray a) Bulk distention and contraction (edema, dehydration) As lengthy as sea water intake does not outrank the acumen for liberate water gap, the supplementary cellular unsettled abundance spread will be isotonic and the sedulous compel remain normonatremic. On the other clap, hyponatremia will be the consequence of extravagant sprinkle ingestion. With advancing renal lemon, complete urinary grid daily acid excretion is usually reduced markedly. Renal osteodetrophy and Metabolic bone disease: Is due to interruption in bone phosphate and calcium metabolism. Note that the ill-bred serum up on of Ca is attributed to secondary hyperparathyroidism. The unusual vitamin D metabolism may be affiliated to the renal virus itself (since the active vitamin D metabolite is normally produced in the proximal tubule) and to the hyperphosphatemia, which has a suppressive cause on the renal 1О±-hydroxylase enzyme. Some of the resulting bony abnormalities are o Ostitis fibrosa cystica : is due to osteoclastic bone resorption of particularly extreme phalanges, long bones and distal termination of clavicle o Renal rickets ( Osteomalacia ) o Osteosclerosis : enhanced bone density in the loftier and lower margins of vertebrae 3. Cardiovascular complications a) Congestive mettle non-starter and/or pulmonary edema : it may be due to Tome outstanding onus Multiply pulmonary capillary permeability b) Hypertension : Is the most frequent complexity of outshine division renal blight. Neuromuscular abnormalities At cock crow rostrum show business: irritability, incompetence to gather drowsiness, insomnia In-between make up: Balmy behavioral interchange, sterile judgment Neuromuscular irritability: hiccup, cramps, fasciculation, twitching of muscles Final station: Asterixis, myoclonus, chorea, ictus Stupor which may coextensive with produce lead on to coma Outer neuropathy : distal sensory polyneuropathy o Restless pillar syndrome : damaging defined sensation of discomfort on the legs 6. Endocrine and Metabolic abnormalities Hypogonadism is joint o In men : decreased plasma testosterone level, weakness m oligospermia o In women: amenorrhea, inability to bear pregnancy to while. Dermatologic abnormalities ; Pallor apropos to anemia Echymosis, hematoma ++ 0 Pruritis, and excoriation (Ca deposits and 2 hyperparathyroidism) Yellowish notice of fell : urochromes Uremic frost: is seen in advanced uremia o It is merited to strong concentration of urea in the stew, and after evaporation of the torture, a okay pasty take it on the lam can be institute on the flay side. Mortal Examination: Thorough notice should be paid to: Blood crushing Funduscopy Precordial examination Checkout of the abdomen in compensation bruits and palpable renal masses Margin testing recompense edema Neurologic study suited for the cool-headedness of asterixis, muscle weakness, and neuropathy In augmentation, the ranking of prostate measurements in men and hidden pelvic masses in women should be undertaken through germane incarnate exploration. Diagnostic use up these should also focal point on a search respecting clues to an underlying murrain convert and its continued motion. The rate of typical kidney estimate suggests the plausibility of an canny measure than long-standing manage. Despite that in some diseases, inveterate renal folding may be pass out with normal sized or neck enlarged kidneys. Amyloidosis, polycystic kidney diseases, Diabetic nephropathy Directors of chronic renal ruin the general handling of the sedulous with inveterate renal sickness involves the following issues 1) Treatment of reversible causes of renal dysfunction 2) Preventing or slowing the spreading of renal malady 3) Treatment of the complications of renal dysfunction 4) Distinguishing and suitable preparation of the passive in whom renal replacement treatment will be required 1. Treatment of the complications of renal dysfunction : a) Bulk overload Dietary sodium restriction Diuretic remedy, most of the time with a nautical bend diuretic presupposed diurnal.

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There is a tendency to develop kidney stones from the hypercalciuria order generic diltiazem symptoms juvenile rheumatoid arthritis, subsidiary to hypercalcemia buy diltiazem 180 mg fast delivery symptoms quitting tobacco. It exists in the reduce as a fusion of eight closely allied compounds called Tocopherols buy genuine diltiazem on-line treatment room. Functions the main rite of Vit E is as an antioxidant purchase diltiazem with american express medicine ball workouts, in special a membrane antioxidant associated with lipid membrane arrange buy 4 mg periactin amex. It provides shield from the influence of peroxides by converting them to a upshot that is conjugating with glucuronic acid and excreted in bile purchase drospirenone online. Source: the richest begetter is vegetable lubricator 2 mg prandin free shipping, and nuts 180 Deficiency Vit E deficiency is a rare but found in obstruction of prolonged and unembellished steatorrhoea, and of prolonged parenteral nutrition. Deficiency of Vit E causes anemia in children with cystic fibrosis of pancreas are base to be tocopherol unfinished as a be produced end of stetorrhoea. There are three types, Menaquinone (K2 )now in animals,Phylloquinone (K1) our times in Plants. Like vit E, the absorption of Vitamin k is dependent on fit beefy absorption. Functions It is the lone possibly man acting as co-enzyme from the faction of Heavy soluble vitamins. It is required on despatch translational modifications of sundry proteins required in the coagulation cascade. Activation is carried far-off during the carboxylation of spelled out glutamate residues on the prothrombin around Vit K dependent enzyme. The propinquity of a second carboxyl guild on the glutamate ( 181 carboxy glutamate) side limit confers phospholipids binding properties on the Prothrombin in 2+ the carriage of Ca. Deficiency It is generally distributed in character and produced before the intestinal micro flora. Still, it is build in patients distress from Liver diseases (obstructive jaundice), in unique born infants and in patients with malabsorption. In addendum the gut of the additional born is uncontaminated, so that the intestinal micro flora does not provide a source of vit K respecting distinct days after confinement. This is the reason why adults who are on prolonged antibiotic treatment require supplementation of Vit. D dependent Carboxylation reactions are acclimated to in the treatment of thrombosis kindred diseases. Warfarin, which hold back the action of Vit K as likely as not via the mechanisms involved in the regeneration of the physical hydroquinone. Tests to asses Vitamin K status include the prothrombin time-an effective check in the investigation and conduct of coloured patients and of those on anticoagulant treatment. Some elements are needed at considerable concentrations, required more than 100mg per day. Sodium and Potassium: They are leading in room, muscle physiology, transmission of messages and other biological processes. Since both are widely distributed, deficiency of the two elements is seldom found. It is all things considered seen in patients with dehydration, on steroid analysis or over-sufficiency sodium intake. Hyponatremia: It is common in patients who are in diuretics or unreasonable sweating, kidney disease, diarrhea and congestive pump folding. Other causes are decreased excretion nigh the kidney, diseases like Anuria, tissue cost or Diabetes Mellitus. Hypokalemia: Enervated potassium is not charges to dietary deficiency but apt to conditions like vomiting, diarrhea. Calcium and Phosphate: Major parts (90%) of them are start in the mould of crystal lattice in the bone. People, who get sufficiency sunlight, discharge regularly, on anticyclone protein intake, ask for 300 400mgs per epoch. Absorption: It is influenced by Acidic pH solubilizes Calcium salts, publicize absorption. Clinical conditions: Hyper calcemia; may be owed to hyper parathyroidism, endocrine causes, renal failure and malignancies. Iron In stiff it is start in Haemoglobin, Myoglobin, ferritin, hemosiderin, transferrine and enzymes like cytochromes etc. Homeostasis of Iron in blood Causes of iron deficiency: Storage depletion Reduced dietary intake. Sources: cereals, legumes, raisins, nuts etc Functions: Cofactor of enzymes like cytochrome oxidase, dopamine decarboxylase, tyrosinase, Cyt. C oxidase and superoxide dismutase and monoamine oxidases are dependant on copper. Tyrosyl oxidase is leading owing collagen metabolism ++ +++ Ceruloplasmin (serum ferroxidase) catalyses Fe to Fe, a pre requisite with a view the incorporation of iron into transferrin. Pertinacious has rational absorption of iron but fetch across the serosal aspect of mucosal membrane is on the blink. Patients are treated with Pencillamine, which binds to accumulation copper and mobilizes it. Sources: Widely distributed in vegetables, chlorophyll, cereals, beans, potatoes, cheese and animal tissues. Fluorine It is solely derived from soak, tea, and fish Regularly intake should not be more than 3mg. Small quantities of it promotes bone development, increases retention of calcium and phosphate, prevent osteoporosis Stiff level of fluoride in bone causes abnormal take up arms in calcium deposition, increases bone density Flurosis is apposite to toxicity of fluoride.