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Preeclampsia: Pregnancy-specific hypertensive disorder defined by new-onset hypertension after 20 weeks of gestation with proteinuria and/or maternal end-organ dysfunction. It can affect the brain, liver, kidneys, lungs, blood system, and placenta/fetus.

🔹 Core diagnostic clue
➟ New-onset hypertension after 20 weeks
➟ Blood pressure is ≥140/90 mmHg on proper measurement
➟ Occurs in a previously normotensive patient
➟ This is the core defining feature.

🔹 Proteinuria clue
➟ Proteinuria is a classic associated finding
➟ Common thresholds include ≥300 mg/24 h or a significant urine protein result
➟ Proteinuria is not required if severe features or end-organ dysfunction are present.

🔹 Common symptoms
➟ Headache
➟ Visual disturbance such as blurred vision or scotomata
➟ These symptoms suggest possible CNS involvement
➟ Some patients may initially have few or no symptoms.

🔹 Abdominal / hepatic clue
➟ Epigastric pain or right upper quadrant pain
➟ Nausea / vomiting may occur
➟ Suggests possible hepatic involvement
➟ Important severe-disease clue.

🔹 Edema and exam findings
➟ Facial or hand edema may be seen
➟ Hyperreflexia may occur
➟ Clonus suggests more severe neuromuscular irritability
➟ These findings can support worsening disease.

🔹 Severe-feature clues
➟ Severe-range blood pressure: systolic ≥160 or diastolic ≥110 mmHg
➟ Thrombocytopenia
➟ Renal impairment
➟ Elevated liver enzymes
➟ Pulmonary edema or other end-organ damage may occur.

🔹 Fetal / placental effects
➟ Reduced placental perfusion
➟ Fetal growth restriction
➟ Oligohydramnios may occur
➟ Increased risk of placental abruption.

🔹 High-Yield Points
➟ Preeclampsia = new-onset HTN after 20 weeks + proteinuria and/or end-organ dysfunction
➟ Think of headache, visual symptoms, RUQ/epigastric pain, hyperreflexia, and severe BP elevation
➟ Severe disease can affect platelets, kidneys, liver, lungs, and fetus/placenta
➟ It is a major obstetric condition that requires urgent assessment and monitoring.

Medical disclaimer: This note is for education only and is not a substitute for professional medical advice, diagnosis, or treatment.

Propranolol: Non-selective beta-blocker that blocks beta-1 and beta-2 receptors. It is used for conditions such as hypertension, angina, tremor, migraine prophylaxis, arrhythmias, and thyrotoxicosis, but its non-selective action explains key adverse effects like bradycardia, hypotension, bronchospasm, cold extremities, CNS effects, and masking of hypoglycemia symptoms.

🔹 Drug class clue
➟ Propranolol = non-selective beta-blocker
➟ Blocks beta-1 and beta-2 receptors
➟ High-yield pharmacology drug
➟ Important because beta-2 blockade increases bronchospasm risk.

🔹 Common side-effects
➟ Fatigue
➟ Dizziness / lightheadedness
➟ Reduced exercise tolerance
➟ These are common and often dose-related, especially when starting treatment.

🔹 Cardiovascular effects
➟ Bradycardia
➟ Hypotension
➟ May worsen AV conduction block
➟ Important hemodynamic toxicity pattern.

🔹 Respiratory risk
➟ Bronchospasm may occur
➟ Wheeze / dyspnea can occur
➟ Avoid or use great caution in asthma; caution is also needed in some COPD patients
➟ This happens because of beta-2 blockade.

🔹 CNS and peripheral effects
➟ Sleep disturbance / vivid dreams / nightmares may occur
➟ Low mood or depressed mood may occur in some patients
➟ Cold hands and feet / cold extremities are classic
➟ Propranolol is relatively lipophilic, which helps explain CNS effects.

🔹 Metabolic / special caution
➟ Can mask hypoglycemia symptoms, especially tachycardia and tremor
➟ Important in patients with diabetes, especially those using insulin or sulfonylureas
➟ May delay recognition of low blood sugar.

🔹 Practical management
➟ Check pulse and blood pressure
➟ Start low and titrate carefully
➟ Do not stop abruptly
➟ Reduce dose or stop and review if there is marked bradycardia, hypotension, wheeze, or symptomatic intolerance.

🔹 Important caution clues
➟ Higher risk in patients with asthma, baseline bradycardia, AV block, or marked hypotension
➟ Abrupt withdrawal can be harmful in some cardiac patients
➟ Consider a more beta-1 selective blocker if bronchospasm or intolerance is an issue.

🔹 High-Yield Points
➟ Propranolol is a non-selective beta-blocker
➟ Common adverse effects: fatigue, dizziness, bradycardia, hypotension
➟ Classic cautions: bronchospasm, cold extremities, sleep disturbance, masked hypoglycemia
➟ Best practical rule: monitor pulse/BP, titrate carefully, and avoid abrupt stopping.

Medical disclaimer: This note is for education only and is not a substitute for professional medical advice, diagnosis, or treatment.

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Diabetic Ketoacidosis (DKA): Acute hyperglycemic emergency caused by insulin deficiency, leading to hyperglycemia, ketone production, and metabolic acidosis. It occurs most often in type 1 diabetes, but can also occur in some patients with type 2 diabetes.

🔹 Core presentation
➟ Polyuria
➟ Polydipsia
➟ Acute metabolic emergency
➟ Often occurs in type 1 diabetes.

🔹 Dehydration clues
➟ Dry mucosa / dry mouth
➟ Tachycardia
➟ Poor skin turgor may occur
➟ Severe volume depletion is common because of osmotic diuresis.

🔹 GI symptoms
➟ Nausea / vomiting
➟ Abdominal pain
➟ May mimic an acute abdomen
➟ Common in moderate to severe DKA.

🔹 Respiratory clue
➟ Kussmaul respirations
➟ Deep, rapid breathing
➟ Compensatory response to metabolic acidosis
➟ Classic exam finding.

🔹 Breath and neurologic clues
➟ Fruity / acetone breath
➟ Lethargy
➟ Confusion may occur
➟ Severe cases may progress to coma.

🔹 High-yield lab clues
➟ Hyperglycemia
➟ Ketosis / ketonemia
➟ High anion gap metabolic acidosis
➟ Serum or urine ketones are positive
➟ The 2024 consensus describes DKA by the triad of hyperglycemia, increased ketones, and metabolic acidosis.

🔹 Precipitating factors clue
➟ Infection
➟ Missed insulin doses
➟ MI, stroke, or major stress may trigger DKA
➟ Important history clue.

🔹 High-Yield Points
➟ DKA = polyuria + polydipsia + dehydration + abdominal pain
➟ Think of Kussmaul breathing and fruity breath as classic clues
➟ Key labs: hyperglycemia, ketones, high anion gap metabolic acidosis
➟ DKA is a medical emergency and needs urgent treatment.

Medical disclaimer: This note is for education only and is not a substitute for professional medical advice, diagnosis, or treatment.