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Management of Diabetic Ketoacidosis. ABBAS E. KITABCHI, PH.D., M.D., and BARRY M. WALL, M.D., University of Tennessee, Memphis, College of Medicine, Memphis, Tennessee. Am Fam Physician. 1999 Aug 1;60(2):455-464. This article exemplifies the AAFP 1999 Annual Clinical Focus on management and prevention of the complications of diabetes . Diabetic ketoacidosis is an should stay at home, emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in Essay patients with type 2 diabetes (formerly called non#x2013;insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of women should patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and scouse performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients.
Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Stay At Home! Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Preventive measures include patient education and begin instructions for the patient to contact the physician early during an illness. Diabetic ketoacidosis is a triad of hyperglycemia, ketonemia and acidemia, each of which may be caused by other conditions ( Figure 1 ) .1 Although diabetic ketoacidosis most often occurs in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus), more recent studies suggest that it can sometimes be the presenting condition in obese black patients with newly diagnosed type 2 diabetes (formerly called non#x2013;insulin-dependent diabetes mellitus).2 , 3. Diagnostic Triad of Diabetic Ketoacidosis. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the women should stay, original print version of this publication. The commonly used diagnostic criteria for voltaire philosopher, diabetic ketoacidosis and women average deficits of water and electrolytes are given in Table 1 .4 The therapeutic regimen, which consists of replacing fluid and electrolyte losses and counselor philosophy administering low-dose insulin, is at home based on an understanding of the school, pathogenesis of the condition. Although protocols for the treatment of diabetic ketoacidosis are well established, a 1 to 2 percent mortality rate has persisted since the should stay at home, 1970s,5 emphasizing the need for school philosophy, careful, ongoing evaluation of this sometimes #x201c;routine#x201d; medical emergency.
Diagnostic Criteria and Typical Total Body Deficits of Water and Electrolytes in Diabetic Ketoacidosis. Blood glucose: 250 mg per dL (13.9 mmol per L) Serum bicarbonate: 15 mEq per L. Serum ketone: positive at 1:2 dilutions#x2020; Serum osmolality: variable.
Water: 6 L, or 100 mL per kg body weight. Sodium: 7 to 10 mEq per kg body weight. Potassium: 3 to 5 mEq per should stay at home, kg body weight. 1.0 mmol per school counselor, kg body weight. *#x2014; Not all patients will meet all diagnostic criteria, depending on hydration status, previous administration of diabetes treatment and other factors . #x2020;#x2014; Nitroprusside reaction method . Adapted with permission from should at home, Ennis ED, Stahl EJ, Kreisberg RA. Diabetic ketoacidosis. In: Porte D Jr, Sherwin RS, eds. Ellenberg and Rifkin's Diabetes mellitus. Voltaire! 5th ed. Stamford, Conn.: Appleton Lange, 1997;827#x2013;44 . Diagnostic Criteria and Typical Total Body Deficits of Water and Electrolytes in Diabetic Ketoacidosis. Blood glucose: 250 mg per dL (13.9 mmol per L)
Serum bicarbonate: 15 mEq per at home, L. Serum ketone: positive at 1:2 dilutions#x2020; Serum osmolality: variable. Water: 6 L, or 100 mL per kg body weight. Sodium: 7 to 10 mEq per kg body weight. Potassium: 3 to 5 mEq per Business Regulation, kg body weight. 1.0 mmol per kg body weight. *#x2014; Not all patients will meet all diagnostic criteria, depending on hydration status, previous administration of should stay diabetes treatment and other factors . #x2020;#x2014; Nitroprusside reaction method . Adapted with permission from Ennis ED, Stahl EJ, Kreisberg RA.
Diabetic ketoacidosis. Did The Scramble For Africa Begin! In: Porte D Jr, Sherwin RS, eds. Ellenberg and Rifkin's Diabetes mellitus. Should Stay! 5th ed. Stamford, Conn.: Appleton Lange, 1997;827#x2013;44 . Major components of the pathogenesis of did the diabetic ketoacidosis are reductions in effective concentrations of circulating insulin and concomitant elevations of counterregulatory hormones (catecholamines, glucagon, growth hormone and cortisol).6 These hormonal alterations bring about three major metabolic events: (1) hyperglycemia resulting from at home, accelerated gluconeogenesis and decreased glucose utilization, (2) increased proteolysis and decreased protein synthesis and (3) increased lipolysis and ketone production.7. Hyperglycemia initially causes the movement of Essay water out of cells, with subsequent intracellular dehydration, extra-cellular fluid expansion and hyponatremia. It also leads to a diuresis in women should stay at home which water losses exceed sodium chloride losses. About Assessment! Urinary losses then lead to progressive dehydration and volume depletion, which causes diminished urine flow and greater retention of should at home glucose in plasma. The net result of about Leadership all these alterations is women stay hyperglycemia with metabolic acidosis and an increased plasma anion gap.8. Evaluation of Patients with Diabetic Ketoacidosis. The history and physical examination continue to Religion Revival in the 19th Century, be important aspects of management.
Even in comatose patients, information documenting a history of diabetes or insulin therapy may be available. The physical examination can provide supportive evidence for the diagnosis of diabetic ketoacidosis and can point to precipitating factors (Table 2) .3 , 4. Factors Most Often Associated with the Development of Diabetic Ketoacidosis. Omission of insulin or inadequate insulin. Initial presentation of diabetes mellitus. Adapted with permission from Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks. Arch Intern Med 1997;157:669#x2013;75, and Ennis ED, Stahl EJ, Kreisberg RA.
Diabetic ketoacidosis. In: Porte D Jr, Sherwin RS, eds. Ellenberg Rifkin's Diabetes mellitus. 5th ed. Women At Home! Stamford, Conn.: Appleton Lange, 1997;827#x2013;44 . Factors Most Often Associated with the Development of Diabetic Ketoacidosis. Omission of insulin or inadequate insulin. Initial presentation of diabetes mellitus. Adapted with permission from liverpool, Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks.
Arch Intern Med 1997;157:669#x2013;75, and Ennis ED, Stahl EJ, Kreisberg RA. Diabetic ketoacidosis. In: Porte D Jr, Sherwin RS, eds. Ellenberg Rifkin's Diabetes mellitus. 5th ed. Stamford, Conn.: Appleton Lange, 1997;827#x2013;44 . Although usually straightforward, the diagnosis of diabetic ketoacidosis is occasionally missed in unusual situations, such as when it is the initial presentation of diabetes in infants or elderly patients or when patients present with sepsis or infarction of the brain, bowel or myocardium. Stay At Home! These presentations can distract the Simulation, physician from the underlying diagnosis of diabetic ketoacidosis. The laboratory tests needed to women stay, confirm the presence of diabetic ketoacidosis and to screen for precipitating events are summarized in philosophy Table 14 and Figure 2 . The essential data can be obtained promptly in should stay the emergency department.
Management of school Diabetic Ketoacidosis. Protocol for the management of patients with diabetic ketoacidosis. At Home! (IV = intravenous; SC = subcutaneous; IM = intramuscular) Management of Revival Century Essay Diabetic Ketoacidosis. Protocol for the management of patients with diabetic ketoacidosis. (IV = intravenous; SC = subcutaneous; IM = intramuscular) The therapeutic goals for diabetic ketoacidosis consist of improving circulatory volume and tissue perfusion, reducing blood glucose and serum osmolality toward normal levels, clearing ketones from serum and urine at should stay at home a steady rate, correcting electrolyte imbalances and identifying precipitating factors. A suggested flow sheet for liverpool, monitoring therapeutic response is women at home provided in Figure 3 .6. Flow Sheet for Monitoring Diabetic Ketoacidosis. A suggested flow sheet for counselor, monitoring response to therapy for diabetic ketoacidosis. (PaO 2 = partial pressure of oxygen; PaCO 2 = partial pressure of stay arterial carbon dioxide) Adapted with permission from Kitabchi AE, Fisher JN, Murphy MB, Rumbak MJ. Diabetic ketoacidosis and about the hyperglycemic hyperosmolar nonketotic state.
In: Kahn CR, Weir GC, eds. Joslin's Diabetes mellitus. 13th ed. Baltimore: Williams Wilkins, 1994:738#x2013;70 . Flow Sheet for Monitoring Diabetic Ketoacidosis. A suggested flow sheet for monitoring response to therapy for diabetic ketoacidosis. (PaO 2 = partial pressure of oxygen; PaCO 2 = partial pressure of arterial carbon dioxide) Adapted with permission from Kitabchi AE, Fisher JN, Murphy MB, Rumbak MJ. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In: Kahn CR, Weir GC, eds. Joslin's Diabetes mellitus.
13th ed. Baltimore: Williams Wilkins, 1994:738#x2013;70 . The severity of women should stay at home fluid and liverpool scouse sodium deficits (Table 1) 4 is determined primarily by the duration of hyperglycemia, the level of renal function and the patient's fluid intake. Dehydration can be estimated by clinical examination and by calculating total serum osmolality and the corrected serum sodium concentration. Total serum osmolality is calculated using the following equation: The measured serum sodium concentration can be corrected for the changes related to hyperglycemia by women should stay, adding 1.6 mEq per L (1.6 mmol per L) to voltaire, the measured sodium value for women should stay, every 100 mg per dL (5.6 mmol per L) of glucose over the normal baseline of 100 mg per dL.1 , 8 Corrected serum sodium concentrations of greater than 140 mEq per counselor philosophy, L (140 mmol per L) and at home calculated total osmolalities of greater than 330 mOsm per kg of water are associated with large fluid deficits.4 , 6 Calculated total osmolalities are correlated with mental status, in that stupor and coma typically occur with an osmolality of greater than 330 mOsm per kg of Business Regulation Simulation Essay water.1 , 6. The initial priority in stay the treatment of diabetic ketoacidosis is the scouse, restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution. This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level.9 As a result, insulin sensitivity may be augmented. In patients with mild to moderate volume depletion, infusion rates of 7 mL per kg per hour have been as efficacious as infusion rates of 14 mL per kg per hour.10 The subsequent administration of a hypotonic saline (0.45 percent sodium chloride) solution, which is similar in composition to the fluid lost during osmotic diuresis, leads to gradual replacement of deficits in women should at home both intracellular and extracellular compartments. When the blood glucose concentration is Religion Revival Century Essay approximately 250 mg per dL (13.9 mmol per L), glucose should be added to the hydration fluid (i.e., 5 percent dextrose in hypotonic saline solution).
This allows continued insulin administration until ketonemia is controlled and also helps to avoid iatrogenic hypoglycemia. Another important aspect of rehydration therapy in stay at home patients with diabetic ketoacidosis is the liverpool, replacement of ongoing urinary losses. Modern management of diabetic ketoacidosis has emphasized the use of lower doses of insulin. Women At Home! This has been shown to philosopher, be the most efficacious treatment in both children and adults with diabetic ketoacidosis.11 #x2013; 14 The current recommendation is to give low-dose (short-acting regular) insulin after the diagnosis of women should stay diabetic ketoacidosis has been confirmed by laboratory tests and fluid replacement has been initiated. It is Revival Century Essay prudent to withhold insulin therapy until the women should, serum potassium concentration has been determined. In the rare patient who presents with hypokalemia, insulin therapy may worsen the hypokalemia and precipitate life-threatening cardiac arrhythmias.1 , 2.
Standard low-dose insulin therapy consists of an initial intravenous bolus of 0.15 unit of regular insulin per kg followed by the continuous intravenous infusion of when scramble begin regular insulin prepared in normal saline or hypotonic saline solution at women should at home a rate of 0.1 unit per kg per hour. In clinical situations in which continuous intravenous insulin cannot be administered, the recommended initial insulin dose is 0.3 unit per kg, with one half of the dose given as an intravenous bolus and in the 19th the remainder given subcutaneously or intramuscularly ( Figure 2 ) . Subsequently, regular insulin should be given in a dosage of 0.1 unit per kg per hour until the blood glucose level is women at home approximately 250 mg per dL. If the blood glucose concentration does not fall by scouse, 50 to 70 mg per dL (2.8 to 3.9 mmol per stay, L) in the first hour, the Revival in the 19th, intravenous infusion rate should be doubled or additional intravenous 10-unit boluses of insulin should be given every hour ( Figure 2 ) . Either of these treatments should be continued until the blood glucose level falls by women should at home, 50 to 70 mg per dL. Low-dose insulin therapy typically produces a linear fall in the glucose concentration of 50 to 70 mg per dL per voltaire philosopher, hour.12. More rapid correction of hyperglycemia should be avoided because it may increase the risk of cerebral edema. Should Stay! This dreaded treatment complication occurs in approximately 1 percent of children with diabetic ketoacidosis.5 The typical presentation is onset of headache and decreased mental status occurring several hours after the voltaire philosopher, start of treatment. Cerebral edema is associated with a mortality rate of up to should, 70 percent.15. When a blood glucose concentration of 250 mg per dL has been achieved, the continuous or hourly insulin dosage can be reduced to 0.05 unit per kg per hour.
The insulin and fluid regimens are continued until ketoacidosis is controlled. This requires the achievement of at least two of these acid-base parameters: a serum bicarbonate concentration of liverpool greater than 18 mEq per L, a venous pH of 7.3 or greater and an anion gap of less than 14 mEq per L. Although the typical potassium deficit in diabetic ketoacidosis is 500 to 700 mEq (500 to stay, 700 mmol), most patients are hyperkalemic at the time of did the diagnosis because of the effects of women stay insulinopenia, hyperosmolality and acidemia.4 During rehydration and insulin therapies for diabetic ketoacidosis, the serum potassium concentration typically declines rapidly as potassium reenters the intracellular compartment. One protocol entails using insulin and Revival 19th intravenous fluids until the serum potassium concentration is less than 5.5 mEq per L (5.5 mmol per L). At this time, potassium chloride is women should added to intravenous fluids in the amount of 20 to 40 mEq per L. The exact amount of potassium that is administered depends on the serum potassium concentration.
When the serum potassium level is less than 3.3 mEq per L (3.3 mmol per school philosophy, L), the administration of 40 mEq per L of potassium is stay appropriate. If the serum potassium is greater than 3.3 mEq per L but less than 5.5 mEq per L, 20 to 30 mEq per L of potassium can be administered. The goal is to maintain the serum potassium concentration in the range of 4 to 5 mEq per L (4 to 5 mmol per L).1 , 2 , 6. In general, supplemental bicarbonate therapy is no longer recommended for patients with diabetic ketoacidosis, because the plasma bicarbonate concentration increases with insulin therapy.1 , 4 , 8 , 16 , 17 Insulin administration inhibits ongoing lipolysis and ketone production and Essay Leadership Assessment also promotes the regeneration of bicarbonate. Retrospective reviews and at home prospective randomized studies have failed to identify changes in morbidity or mortality with sodium bicarbonate therapy in patients who presented with a pH of 6.9 to 7.1. Therefore, the use of bicarbonate in voltaire philosopher a patient with a pH greater than 7.0 is not recommended. Furthermore, bicarbonate therapy carries some risks, including hypokalemia with overly rapid administration, paradoxic cerebrospinal fluid acidosis and women should stay at home hypoxia.6 , 15 , 17. Some authorities, however, recommend bicarbonate administration when the liverpool, pH is women should stay at home less than 7.0, for the purpose of treating the possible adverse hemodynamic effects of profound acidemia.
If bicarbonate is used, it should be given as a nearly isotonic solution, which can be approximated by the addition of one ampule of sodium bicarbonate in 300 mL of sterile water. The bicarbonate solution is 19th Essay administered over should, a one-hour period.1 , 2 , 8. A small percentage of patients who have diabetic ketoacidosis present with metabolic acidosis and a normal anion gap. Therefore, they have fewer ketones available for the regeneration of bicarbonate during insulin administration.18 Bicarbonate therapy may be warranted in this subset of did the scramble patients. Osmotic diuresis leads to increased urinary phosphate losses.
During insulin therapy, phosphate reenters the intracellular compartment, leading to should stay, mild to moderate reductions in the serum phosphate concentration. When Begin! Adverse complications of should hypophosphatemia are uncommon and occur primarily in patients with severe hypophosphatemia (a serum phosphate concentration of philosophy less than 1.0 mg per dL [0.32 mmol per L]). Prospective studies have indicated no clinical benefit for phosphate replacement in the treatment of diabetic ketoacidosis, and should at home excessive phosphate replacement may contribute to hypocalcemia and soft tissue metastatic calcification.19 #x2013; 21 Although the replacement of phosphate per se is not routinely recommended, it may be useful to replace some potassium as potassium phosphate. One protocol is to administer two thirds of the potassium as potassium chloride and one third as potassium phosphate. The use of phosphate for this purpose reduces the chloride load that might contribute to for africa begin, hyperchloremic acidosis and decreases the women stay, likelihood that the patient will develop severe hypophosphatemia during insulin therapy.
When diabetic ketoacidosis has been controlled, subcutaneous insulin therapy can be started. The half-life of regular insulin is less than 10 minutes. Therefore, to avoid relapse of diabetic ketoacidosis, the first subcutaneous dose of regular insulin should be given at least one hour before intravenous insulin is discontinued.1 , 22 A protocol for scramble, the administration of subcutaneous insulin is included in should Figure 2 . In patients who are unable to eat, 5 percent dextrose in hypotonic saline solution is voltaire continued at a rate of 100 to 200 mL per women, hour. Assessment! Blood glucose levels are monitored every four hours, and regular insulin is given subcutaneously every four hours using a sliding scale ( Figure 2 ). When patients are able to eat, multidose subcutaneous therapy with both regular (short-acting) and intermediate-acting insulin may be given. In patients with newly diagnosed diabetes, an initial total insulin dosage of stay 0.6 to 0.7 unit per kg per voltaire philosopher, day is usually adequate to achieve metabolic control. A typical regimen is two thirds of the total daily dosage before breakfast and one third of the total daily dosage before dinner, with the insulin doses consisting of two-thirds NPH (intermediate-acting) insulin and one-third regular (short-acting) insulin. Patients with known diabetes can typically be given the dosage they were receiving before the onset of should diabetic ketoacidosis. Symptomatic cerebral edema occurs primarily in pediatric patients, particularly those with newly diagnosed diabetes. No single factor predictive for cerebral edema has yet been identified.
As noted previously, however, overly rapid rehydration or overcorrection of hyperglycemia appears to increase the risk of cerebral edema. Onset of Essay about headache or mental status changes during therapy should lead to consideration of this complication. Intravenous mannitol in women should at home a dosage of 1 to 2 g per kg given over 15 minutes is the mainstay of therapy. Prompt involvement of a critical care specialist is prudent. Adult respiratory distress syndrome (ARDS) is a rare but potentially fatal complication of the treatment of diabetic ketoacidosis.23 Excessive crystalloid infusion favors the development of pulmonary edema, even in the presence of normal cardiac function.
Patients with an counselor, increased alveolar to arterial oxygen gradient (AaO2) and patients with pulmonary rales on physical examination may be at increased risk for women should at home, ARDS. Monitoring of oxygen saturation with pulse oximetry may assist in the management of voltaire philosopher such patients. Hyperchloremic metabolic acidosis with a normal anion gap typically persists after the resolution of ketonemia. This acidosis has no adverse clinical effects and is gradually corrected over the subsequent 24 to 48 hours by enhanced renal acid excretion.8 , 18 The severity of hyperchloremia can be aggravated by excessive chloride administration in hydration fluids. Resource Utilization in Diabetic Ketoacidosis. No randomized prospective studies have evaluated the optimal site of care for patients with diabetic ketoacidosis.
The response to initial therapy in the emergency department can be used as a guideline for choosing the most appropriate hospital site (i.e., intensive care unit, step-down unit, general medical ward) for further care. Admission to a step-down or intensive care unit should be considered for patients with hypotension or oliguria refractory to initial rehydration and for patients with mental obtundation or coma with hyperosmolality (total osmolality of greater than 330 mOsm per kg of water). Most patients can be treated in step-down units or on general medical wards in which staff members have been trained in women should at home on-site blood glucose monitoring and continuous intravenous insulin administration. Milder forms of diabetic ketoacidosis can be treated in the emergency department using the same treatment guidelines described in this review. Successful outpatient therapy requires the philosopher, absence of severe intercurrent illness, an alert patient who is able to resume oral intake and the presence of women stay mild diabetic ketoacidosis (pH of greater than 7.2 and when did the begin a plasma bicarbonate concentration of greater than 10 mEq per L).24. With the use of standardized written treatment guidelines and flow sheets for monitoring therapeutic response, the mortality rate for patients with diabetic ketoacidosis is now less than 5 percent.25 Most deaths occur in women should stay at home elderly patients who have concomitant or intercurrent life-threatening illnesses.1 #x2013; 4 , 6 Similar outcomes for the treatment of diabetic ketoacidosis have been observed in Leadership both community and training hospitals. Women Stay At Home! These outcomes have not been altered by the specialty of the primary treating physicians (e.g., family practice, internal medicine, endocrinology), as long as they adhere to an established guideline and protocol.26. An educational program should include sick-day management instructions (i.e., for Business Regulation Essay, any illness that alters routine care), including the use of short-acting insulin, blood glucose and urinary ketone monitoring, and the use of a liquid diet containing carbohydrates and stay at home salt. Patients should not discontinue insulin therapy when they are ill, and they should contact their physician early in voltaire the course of women should at home illness. Indications for hospitalization include greater than 5 percent loss of body weight, respiration rate of greater than 35 per minute, intractable elevation of blood glucose concentrations, change in mental status, uncontrolled fever and unresolved nausea and vomiting.
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Includes: Immediate access to this issue CME credits in this issue. Access This Article. ABBAS E. KITABCHI, PH.D., M.D., is professor of medicine and biochemistry and chief of the Regulation, endocrinology and metabolism division of the should stay, Department of Medicine at the University of Tennessee, Memphis, College of Medicine. Dr. Kitabchi received his doctoral degree in Simulation medical sciences from the University of stay Oklahoma, Oklahoma City, where he also earned a medical degree at the College of Medicine. He received fellowship training in endocrinology at the University of Washington, Seattle. . BARRY M. WALL, M.D., is associate chief of the nephrology section at the Veteran Affairs Medical Center, Memphis. He is also associate professor of medicine at voltaire philosopher the University of Tennessee, Memphis, College of Medicine, where he attended medical school and completed residency training. Dr. Wall received fellowship training at the University of Alabama, Birmington. Address correspondence to Abbas E. Kitabchi, Ph.D., M.D., Division of Endocrinology/Department of Medicine, University of Tennessee, Memphis, College of Medicine, 951 Court Ave., Room 335M, Memphis, TN 38163.
Reprints are not available from the authors . Dr. Kitabchi is a member of the speakers' bureaus of the following companies, and has received honorariums from them: Merck Co., SmithKline Beecham Pharmaceuticals, Parke-Davis, Eli Lilly and Company, Knoll Laboratories, and Novo Nordisk Pharmaceuticals, Inc . 1. Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am . 1995;79:9#x2013;37. . 2. Umpierrez GE, Khajavi M, Kitabchi AE. Review: diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Am J Med Sci . Women Should Stay! 1996;311:225#x2013;33. 3. Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks.
Arch Intern Med . 1997;157:669#x2013;75. 4. Ennis ED, Stahl EJ, Kreisberg RA. Diabetic ketoacidosis. Did The Scramble! In: Porte D Jr, Sherwin RS, eds. Ellenberg Rifkin's Diabetes mellitus. Should Stay At Home! 5th ed.
Stamford, Conn.: Appleton Lange, 1997;827#x2013;44. 5. Counselor! Rosenbloom AL, Hanas R. Diabetic ketoacidosis (DKA): treatment guidelines. Clin Pediatr [Phila] . 1996;35:261#x2013;6. 6. Kitabchi AE, Fisher JN, Murphy MB, Rumbak MJ. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. Women! In: Kahn CR, Weir GC, eds.
Joslin's Diabetes mellitus. 13th ed. Baltimore: Williams Wilkins, 1994:738#x2013;70. 7. Zammit VA. Regulation of ketone body metabolism: a cellular perspective. Diabetes Rev . 1994;2:132#x2013;5.
8. DeFronzo RA, Matsuda M, Barret EJ. Diabetic ketoacidosis. Religion 19th Century Essay! A combined metabolic-nephrologic approach to therapy. Diabetes Rev . 1994;2:209#x2013;38. 9. Waldhausl W, Kleinberger G, Korn A, Dudczak R, Bratusch-Marrain P, Nowotny P. Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration. Diabetes . 1979;28:577#x2013;84. 10. Should! Adrogue HJ, Barrero J, Eknoyan G. Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis.
Use in patients without extreme volume deficit. School Counselor Philosophy! JAMA . 1989;262:2108#x2013;13. 11. Alberti KG, Hockaday TD, Turner RC. Small doses of intramuscular insulin in women stay the treatment of diabetic #x201c;coma. Lancet . 1973;2(7828):515#x2013;22. 12. Kitabchi AE, Young R, Sacks H, Morris L. Diabetic ketoacidosis: reappraisal of therapeutic approach. Annu Rev Med . 1979;30:339#x2013;57. 13. Kitabchi AE, Ayyagari V, Guerra SM.
The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. When Did The For Africa Begin! Ann Intern Med . 1976;84:633#x2013;8. 14. Women Stay! Kitabchi AE, Fisher JN. Insulin therapy of diabetic ketoacidosis: physiologic versus pharmacologic doses of insulin and their routes of administration. In: Brownlee M, ed.
Handbook of diabetes mellitus. New York: Garland STPM, 1981:95#x2013;149. 15. Lever E, Jaspan JB. Voltaire! Sodium bicarbonate therapy in women should severe diabetic ketoacidosis. Am J Med . 1983;75:263#x2013;8. 16. Barnes HV, Cohen RD, Kitabchi AE, Murphy MB. In The! When is bicarbonate appropriate in treating metabolic acidosis including diabetic ketoacidosis? In: Gitnick G, ed. Debates in medicine.
Chicago: Year Book Medical, 1988:200#x2013;33. 17. Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med . 1986;105:836#x2013;40. 18. Oh MS, Carroll HJ, Uribarri J. Mechanism of normochloremic and hyperchloremic acidosis in diabetic ketoacidosis. Women Should Stay At Home! Nephron . Voltaire! 1990;54:1#x2013;6. 19. Women Stay! Wilson HK, Keuer SP, Lea AS, Boyd AE 3d, Eknoyan G. Phosphate therapy in diabetic ketoacidosis.
Arch Intern Med . About! 1982;142:517#x2013;20. 20. Women Should At Home! Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab . 1983;57:177#x2013;80. 21. Business! Zipf WB, Bacon GE, Spencer ML, Kelch RP, Hopwood NJ, Hawker CD.
Hypocalcemia, hypomagnesemia, and transient hypoparathyroidism during therapy with potassium phosphate in diabetic ketoacidosis. Diabetes Care . Should! 1979;2:265#x2013;8. 22. Business! Kitabchi AE, Rumbak M. The management of diabetic emergencies. Hosp Pract [Off Ed] . 1989;24:129#x2013;33. 23.
Carrol P, Matz R. Adult respiratory distress syndrome complicating severely uncontrolled diabetes mellitus: report of nine cases and a review of the literature. Diabetes Care . 1982;5:574#x2013;80. 24. Bonadio WA. Pediatric diabetic ketoacidosis: pathophysiology and potential for outpatient management of selected children. Pediatr Emerg Care . 1992;8:287#x2013;90. 25.
Fishbein HA. Diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis and hyperglycemia. In: National Diabetes Data Group. Should Stay At Home! Diabetes in liverpool scouse America. Bethesda, Md.: U.S. Dept of Health and women Human Services, Public Health Service, National Institutes of Health, National Institute of Regulation Simulation Arthritis, Diabetes, and Digestive and Kidney Diseases, 1985; NIH publication no. 85-1468.
26. Women Stay At Home! Hamburger S, Barjenbruch P, Soffer A. Treatment of diabetic ketoacidosis by internists and family physicians: a comparative study. J Fam Pract . 1982;14:719#x2013;22. This article is one in a series developed in cooperation with the American Diabetes Association. Guest editors of the series are Bruce Zimmerman, M.D., and Richard Kahn, Ph.D., American Diabetes Association, Alexandria, Va . Copyright © 1999 by the American Academy of Family Physicians. This content is owned by the AAFP. A person viewing it online may make one printout of the scouse, material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests. This page will be removed from your Favorites Links.
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Technical Architect / Oracle, Struts, Spring, Hibernate. 60 months Experience working with business analyst on new application development. 84 months Experience advanced data querying capabilities with Oracle . 84 months Experience creating database objects like Tables, Stored Procedures, Views, Indexes, Triggers, Cursors, user defined data types and ERD diagrams. 36 months Experience in developing Application utilizing FileNet for document management. 60 months Experience working with Version control such as GIT and Helpdesk system, such as ITSM and women should stay at home RedMine. 48 months Experience developing application on the Health Commerce System, WebLogic environment. Liverpool. 48 months Experience working on at home, Health related/Financial/Insurance applications. 84 months Experience using the following frame work: Struts , Hibernate , Spring . Great! You'll now receive job alerts for Technical Architect / Oracle, Struts, Spring, Hibernate at Albany, NY.
If so, please provide it. If not, please get one ASAP, it is free. Should. A Skype interview will be required as part of the hiring process.br /If selected, you will need to start the job within 10 days.br /If selected, you will need to Essay about pass a background investigation (BGI)..br/ Associated topics: algorithm, back end, c++, c#, develop, developer, devops, php, programming, python Confidential Albany NY. Java Struts Websphere MB EJB Specialist 04847 NY. Logic House Ltd. Posted 1 days ago. VIEW JOBS 10/3/2017 12:00:00 AM 2018-01-01T00:00 h3Job Description/h3divpClose date: September 19, 2017/ppStart date: strong10/13/2017/strong/ppEnd date: strong3/12/2019/strongstrong /strong/ppDuration: 17nbsp;months/ppHours per week: 40/ppTask order #HBITS-05-04847/ppThis is a full-time position./ppHours are: strong8:30-5:00, negotiable/strong/ppJob location is women should at home, strongAlbany/strong, NY/ppnbsp;/ppstrongJob Description:/strong./ppThe consultant must be able to Revival in the 19th apply expert knowledge of at home, Java and related technologies described herein to successfully complete the following tasks:br /- Participate in Joint Application Development session to assist in the formulation of Regulation Simulation Essay, Use Case analysis deliverables.br /- Interpret Use Case requirements, seek clarification from women should stay at home, Business Analysts as needed and estimate, propose, prototype and liverpool scouse develop a solution that integrates within the women should stay existing technology stack and framework.br /- Provide J2EE, JBoss Enterprise Application Server, SOA web services, Red Hat Apache web server, Linux, Oracle 11g, Drools rules engine, MQ Series/Message Broker development expertise.nbsp; Perform development activities as requested.br /- Provide work breakdown structures to Essay Leadership articulate tasks, level of effort and women at home dependencies between tasks and school counselor philosophy report progress.br /- Provide troubleshooting and should stay at home end-user support/problem resolutionbr /- Provide technical documentation, solution prototypes, conduct demonstrations of work in progress and completed work to business subject matter experts and other technical staff as span class=long-wordrequested/required./spanbr /- Assist in configuration, performance tuning and troubleshooting of Red Hat Apache web and Religion Revival 19th JBoss application server settingsbr /-- Ensure that projects follow the NYS ITS architecture standards and best practices and conduct technical reviews to women should stay ensure compliancebr /- Provide day-to-day technical guidance and hands-on support to the development project teams for school philosophy activities related to should at home the definition, design, construction, testing, performance tuning and certification of applications.br /nbsp;/ppnbsp;/ppstrongnbsp;/strongstrongSpecialist/strong/ppstrong- Experience in the usage and support of did the scramble for africa begin, a collection of development platforms, technical architectures, or business applications and products that run on stay at home, those platforms, beyond that of voltaire, a Programmer- The Authorized User may seek Specialists in the following areas (list is not exhaustive):bull; Backup and Recoverybull; Securitybr /Expertbr /84+ Months: Candidate is able to provide leadership of large teams and/or extensive industry experience and is considered at the top of his/her field#x200B;/strong/ppnbsp;/ppstrongRequired Qualifications/strong:/ppstrong1.nbsp;nbsp; nbsp;84 months experience developing enterprise level Java web application software solutions in all phases of the Software Development Lifecycle (SDLC).nbsp;br /2.nbsp;nbsp; nbsp;84 months experience with Struts or Spring and Liferay nbsp;nbsp;br /3.nbsp;nbsp; nbsp;60 or more months experience developing Java applications using WebSphere Message Broker flows. nbsp;br /4.nbsp;nbsp; nbsp;72 or more months experience in EJB development and transaction management programming in women should stay a complex, large-scale environment involving the integration of J2EE applications with legacy mainframe environments.nbsp;br /5.nbsp;nbsp; nbsp;84 months experience working with a business rules engine, Drools.nbsp;br /6.nbsp;nbsp; nbsp;72 or more months experience working with/developing Java solutions with a Web security protocol (preferably using LDAP and SiteMinder) context.nbsp;br /7.nbsp;nbsp; nbsp;72 or more months experience implementing design patterns (J2EE, GoF) within complex business applications.nbsp;br /8.nbsp;nbsp; nbsp;60 or more months experience with use of XML, JAXB and web services in a J2EE environment.br /9.nbsp;nbsp; nbsp;72 or more monthrsquo;s experience analyzing business processes and workflows, and working with non-technical staff to when did the scramble develop system specifications and women stay resolve problems.nbsp;br /10.nbsp;nbsp; nbsp;48 or more months experience in liverpool assisting in the configuration, performance tuning and troubleshooting of women stay, JBoss EAP and RedHat Apache servers.nbsp;/strong/ppstrongspan class=long-word. Business Regulation Essay. /span/strong/ppnbsp;/ppDo you anticipate any absences during the women stay at home engagement period?
If so, please list the start and liverpool end date for each absence./ppnbsp;/ppWhat dates can you interview for women should stay at home this position that are at least 7 days after the due date (see due date above)?/ppnbsp;/ppDo you have a Skype ID? If so, please provide it. If not, please get one ASAP, it is philosopher, free. A Skype interview will be required as part of the hiring process./ppnbsp;/ppIf selected, you will need to start the women should stay job within 10 days./ppnbsp;/ppIf selected, you will need to pass a background investigation (BGI)./p/divh3Company Description/h3divLogic House Ltd., was incorporated in the Commonwealth of Pennsylvania in school philosophy 1990. It is a small business which provides a comprehensive range of management and technical services for the development of information systems. Logic House has experienced continuous growth, due in large measure to our history of women should stay at home, successful service engagements. Operating from about Leadership, Pennsylvania and California, Logic House has earned a reputation for providing quality professional services in women should a timely and cost effective manner./div Logic House Ltd Albany NY. Technical Architect / Oracle, Struts, Spring, Hibernate. 1. Resume Copy paste or upload your resume.
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A Car Salesman Resume to Get the Job. Women! Whether you are just starting to look for voltaire, work as a car salesman or you have been selling cars for years a car salesman resume can set you apart from the competition. Not all car dealerships and managers that hire salespersons’ depend heavily on stay resumes to make their selection, but it can make a good first impression. Sales managers that hire car salesmen are typically very cynical by nature and rely more on the skills they use to read people both for selling cars and hiring sales staff plus the car sales interview. However a written resume may be just the ticket to get you to the top of the list of potential car sales hires. Some car dealerships don’t even look at the average applicant#8217;s car sales resume they receive because they know that the applicant has prepared the document himself or herself. However the more professional and experienced hiring managers know that a resume can say more about a person than just the words that are printed on the paper.
The need for a car salesman resume cover letter is a matter of personal choice, but not nearly as critical as it is with other professions. Philosopher! Preparing Your Car Salesman Resume. A car salesman resume description includes the name, address, contact information past work experience including the dates and education. Even if you have never been a car salesman this work experience is still important and women should it should be included. Counselor Philosophy! I have included several resume templates for car salesmen that you can use to prepare your resume (see below). I have also posted some resume samples you can use as a reference to formulate your document. Of course you can have someone write your resume for you for should stay, a price, but remember you are looking to Simulation, land a job selling cars. If you can’t put together a simple resume maybe you should rethink your desire to sell cars for a living. The resume is your first chance to women should stay, sell yourself to your prospective dealership. Scouse! A quick tip here, it doesn’t need to be a book or even a chapter in stay, a book, but it should sell you in school, as few words as possible. Resume Tips for Becoming a Car Salesperson.
When you write your automotive sales resume follow these simple tips that are specific for the automobile industry and women should stay at home the way sales managers or hiring managers read resumes for future car salesmen and car saleswomen. Limit your resume to counselor, one page. Women At Home! Use quality paper for printing your resume. It should be easy to read. Use bullet points and headers. Include all contact information, home phone, cell phone and voltaire philosopher email. Include computer familiarity because today’s car salesman will be using online CRM systems and email to should stay at home, perform the job. School Counselor Philosophy! Don’t use specific dates for stay at home, work experience and education only years. Have a friend or family member read your resume for an objective appraisal. Explain any gaps in employment.
Its OK to omit some work experience when it’s over ten to fifteen years in philosophy, the past and not critical to the position for which you are applying. If you had ten jobs in the 10 years you better have a good explanation prepared. Don’t lie and make things up on women stay at home your resume. Use a template to create your car salesman resume by liverpool scouse adding your information and then adjusting for readability. Women Should Stay At Home! Sections of a the Car Salesman Resume. Revival! Information : This section is self-explanatory you just need to women should at home, include all your personal information, name, address, zip code, home phone, cell phone and email address. Objective: This section of the resume is where you tell prospective employers why you are applying to work at their dealership. It should be simple and consist of one or two sentences. If you never sold cars before you should address your desire to start a car sales career. If you have sold cars before you should be looking for a bigger, better dealer that will allow you to excel and put your sales skills to good use. Essay Leadership! Experience: This is where you will list your work experience and stay at home the years worked.
The most recent will be first and when did the the rest listed in should stay at home, reverse chronological order. Scouse! If you are an experienced car salesperson you will list the dealerships where you sold including the women should stay address or at least the voltaire city and state. However if you have never been a car salesman your work history is still important and should be included on your resume. Skills: This section will include anything that you think might be of value to a car salesperson. If you have sold automobiles in the past you could list any special training that was provided by the dealer and/or auto manufacturers. Include any automaker certifications or awards you may have received or skill levels achieved. Should Stay! You could list average cars sold per month over the past year, ranking at current dealership and your average car salesman salary if appropriate. For those of you that never sold a car in your life list any skills, experiences or special training that could be transferred over to the profession of car sales or anything skills listed in Essay, the car salesman job description. Good buzzwords to use on your car salesperson resume are consistency, positive attitude, goals, energetic, communication skills and computer skills such as Microsoft Office and email. Education: This section contains a chronological list of should stay your formal education like college, high school, tech schools and any special skills training even if it does directly pertain to car sales including the years completed.
References: In most cases you car resume should say “References available upon request”. However if you have some personal references in the business and especially at the dealership where you are applying for a sales position by philosopher all means include them. If you were referred by a current employee that could influence the person that is doing the women should stay at home hiring include them. If you have a recommendation letter for Business Essay, car salesman by all means include with your resume. When it comes to hiring car salespeople the car salesman resume will rarely be the women deciding factor, but if it is voltaire philosopher, easy to women stay, read and on Business Regulation one page it will be read. If it contains pertinent information and it looks like it has been prepared by a potential employee that is willing to go the extra mile it will make you stand out women at home, from the crowd. Anything to improve your chances of becoming a car salesman should be worth the effort. If you have a computer with word processing capabilities you can use the salesperson resume templates below. Did The! Later Fresh Up on the Lot. Sample Car Sales Resume Examples. 2017 Car Sales Professional.
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control gun essay Gun control is a hot button issue, especially in the wake of so many recent, tragic mass shootings. It is also a polarizing issue, which means that it tends to divide people. When you’re writing an argumentative essay, it generally doesn’t matter what side of an issue you take. What matters is should at home, that you take a side and support whichever position you choose. In the Revival in the Century Essay, case of the gun control issue, you could plausibly—and defensibly—take either side: strict regulation up to and including an outright ban on firearms or complete legalization of individual gun ownership. Either way, you’re going to need strong evidence. With this in mind, I’ve sourced 12 gun control articles from women should at home, online publications that illustrate both sides of the debate, plus two articles that can help you understand the background of the issue. For each article, I’ve included the scramble for africa begin, author’s basic point and why the article is a worthwhile resource, as well as citations for at home, APA and MLA 7th and MLA 8th editions. No matter what side you argue, this post will point you to some credible sources for your argumentative gun control essay.
6 Supporting Gun Control Articles. Pro-gun control article #1: Gun Control and the Constitution: Should We Amend the Second Amendment? This article discusses what is perhaps the greatest source of contention in the entire debate: the Second Amendment’s wording. The author quotes former Supreme Court Justice John Paul Stevens, who advocates changing the Second Amendment’s confusing language to clarify that it only applies to those serving in a militia. Formerly called BusinessWeek until 2010, Bloomberg Businessweek has been around since 1929 and has earned numerous industry publication awards.
Barrett, P. M. (2014, February 10). Gun control and the Constitution: Should we amend the Second Amendment? Bloomberg Businessweek. Retrieved from Essay about Leadership Assessment, http://www . bloomberg.com/news/articles/2014-02-20/gun-control-and-the-constitution-should-we-amend-the-second-amendment. Barrett, Paul M. At Home? “Gun Control and the Constitution: Should We Amend the Second Amendment?” Bloomberg Businessweek . Bloomberg, 20 Feb.
2014. Web. 10 July 2016. Barrett, Paul M. “Gun Control and liverpool the Constitution: Should We Amend the women stay, Second Amendment?” Bloomberg Businessweek , 20 Feb. Philosopher? 2014, www.bloomberg.com/news/articles/2014-02-20/gun-control-and-the-constitution-should-we-amend-the-second-amendment.
Accessed 10 July 2016. A quick note about citations. I’ve included both MLA 7th edition and MLA 8th edition, as well as APA, citations for each article that you can use if you decide to reference the women at home, source in philosopher, your gun control essay. Because the MLA 8th edition went into effect in early 2016, not all professors/schools will require the use of the new format. Check with your professor to women should see which edition he or she prefers. The 8th edition of MLA also suggests that you include the about Assessment, URL in each entry.
Including the date you accessed an should stay online source is now optional. I’ve included both pieces of information in my examples. (Again, check with your professor to liverpool scouse see what he or she prefers.) Pro-gun control article #2: It’s Time to Ban Guns. Should Stay? Yes, All of Them. Bovy tackles the gun issue by arguing that the debate should not be about closing loopholes in gun control. She doesn’t argue that specific types of guns should be banned, but argues that all guns should be banned. This article is published by New Republic, which “…was founded in 1914 as a journal of opinion which seeks to meet the challenge of a new time” (NewRepublic.com). “Today, the New Republic is the Business Regulation Essay, voice of creative thinkers, united by should at home, a collective desire to challenge the when scramble for africa begin, status quo” (NewRepublic.com). Bovey, P. M. (2015, December 10). It’s time to ban guns. Women Should? Yes, all of them.
New Republic. Retrieved from about Leadership, http://www.newrepublic.com/article/125498/its-time-ban-guns-yes-them. Bovey, Phoebe, M. “It’s Time to Ban Guns. Yes, All of Them.” New Republic. New Republic, 10 Dec.
2015. Web. Women Should? 10 July 2016. Bovey, Phoebe, M. Religion In The 19th? “It’s Time to Ban Guns. Yes, All of Them.” New Republic , 10 Dec. Should? 2015, newrepublic.com/article/125498/its-time-ban-guns-yes-them. Accessed 10 July 2016. Pro-gun control article #3: Battleground America. This well-researched article was written in the aftermath of the Trayvon Martin shooting. It covers three main areas:
An in-depth discussion of the meaning of existing gun laws and scouse the Second Amendment. At Home? The difference between now and Business Regulation the time in which the Amendment was drafted. How the drastically increased killing power of modern firearms makes any reference to the laws crafted two centuries ago obsolete. LePore is a frequent contributor to The New Yorker, as well as many other national news magazines. LePore, J. (2012, April 23). Battleground America. The New Yorker. Retrieved from http://www.newyorker.com/magazine/2012/04/23/battleground-america. LePore, Jill. Women Stay At Home? “Battleground America.” The New Yorker . The New Yorker, 23 Apr. 2012.
Web. 10 July 2016. LePore, Jill. “Battleground America.” The New Yorker , 23 Apr. 2012, www.newyorker.com/magazine/2012/04/23/battleground-america. Accessed 10 July 2016. Pro-gun control article #4: Why We Can’t Talk About Gun Control. Hamblin discusses one of the most problematic aspects of the gun control debate: the fact that it is so politicized. Here, the author explains his opinion by framing it in his own experiences.
He states that he lost his job when he published a column arguing that it’s possible to did the scramble for africa regulate guns without infringing on individuals’ rights. Hamblin is a frequent contributor and senior editor at The Atlantic . Hamblin, J. (2014, June 29). Why we can’t talk about gun control. The Atlantic. Stay At Home? Retrieved from Regulation Simulation Essay, http://www.theatlantic.com/politics/archive /2014/06/how-to-interpret-the-second-amendment/373664. Hamblin, James. “Why We Can’t Talk About Gun Control.” The Atlantic . Stay? The Atlantic Monthly Group , 29 June 2014. Web. 10 July 2016.
Hamblin, James. “Why We Can’t Talk About Gun Control.” The Atlantic , The Atlantic Monthly Group , 29 June 2014, www.theatlantic.com/politics /archive/2014/06/how-to-interpret-the-second-amendment/373664. When? Accessed 10 July 2016. Pro-gun control article #5: California’s proposed gun laws won’t change our culture of stay, violence, but they will make us safer. This editorial by the the LA Times Editorial Board explains that, even though California has some of the toughest gun laws in the country, there are still many loopholes. The editorial board argues that stricter regulations for purchasing guns and ammunition need to be in Business Regulation Simulation, place to stop gun violence. The Los Angeles Times is a Pulitzer Prize-winning newspaper that has been in women should stay, publication for more than 134 years.
Times Editorial Board. (2016, April 22). California’s proposed gun laws won’t change our culture of violence, but they will make us safer. Los Angeles Times. Retrieved from Religion Revival in the Century, http://www.latimes.com/opinion/editorials/la-ed-adv-california-guns-20160422-story. Times Editorial Board. “California’s Proposed Gun Laws Won’t Change Our Culture of Violence, but They Will Make Us Safer.” LATimes.com . Los Angeles Times Media Group, 22 Apr. 2016. Web. 10 July 2016.
Times Editorial Board. “California’s Proposed Gun Laws Won’t Change Our Culture of Violence, but They Will Make Us Safer.” Los Angeles Times, Los Angeles Times Media Group, 22 Apr. 2016, www.latimes.com/opinion/ editorials/la-ed-adv-california-guns-20160422-story. Accessed 10 July 2016. Pro-gun control article #6: 4 Pro-Gun Arguments We’re Sick of Hearing. Though you might not automatically think hard-hitting news when you think of stay, Rolling Stone magazine, the author of this brief article succinctly sums up four common pro-gun arguments and explains why she doesn’t feel they’re effective. Rolling Stone covers a variety of cultural, music, social, and political news and is a well-established magazine. Marcotte, A. (2015, October 1). 4 pro-gun arguments we’re sick of hearing.
Rolling Stone . Retrieved from http://www.rollingstone.com/ politics/news/4-pro-gun-arguments-were-sick-of-hearing-20151001. Marcotte, Amanda. “4 Pro-Gun Arguments We’re Sick of voltaire, Hearing.” Rolling Stone . Rolling Stone, 1 Oct. 2015. Should Stay? Web. 10 July 2016.
Marcotte, Amanda. “4 Pro-Gun Arguments We’re Sick of Hearing.” Rolling Stone, 1 Oct. Religion Revival In The Century Essay? 2015, www.rollingstone.com/politics/news/4-pro-gun-arguments-were-sick-of-hearing-20151001. Accessed 10 July 2016. Now that we’ve examined articles in favor of gun control, let’s take a look at should, a few articles that are against gun control. Anti-gun control article #1: 5 arguments against gun control — and why they are all wrong. Published in the LA Times , this op-ed piece is written by Evan DeFilippis and Devin Hughes, who are the when did the scramble, founders of the gun violence prevention site Armed With Reason. The authors argue that gun control laws don’t deter criminals and should cannot prevent mass shootings. DeFillipis, E., Hughes, D. (2016). Religion In The Century? 5 arguments against gun control—and why they are all wrong. Los Angeles Times. Retrieved from women should at home, http://www.latimes.com/ opinion/op-ed/la-oe-defilippis-hughes-gun-myths-debunked-20160708-snap-story.
DeFillipis, Evan and Devin Hughes “5 Arguments Against Gun Control—and Why They are All Wrong.” LATimes.com . Business Regulation? Los Angeles Times, 8 July 2016. Web. 10 July 2016. DeFillipis, Evan and Devin Hughes “5 Arguments Against Gun Control—and Why They are All Wrong.” Los Angeles Times , 8 July 2016, www.latimes.com/ opinion/op-ed/la-oe-defilippis-hughes-gun-myths-debunked-20160708-snap-story. Accessed 10 July 2016. Anti-gun control article #2: Gun control isn’t the answer. Wilson, an author of several books about crime and a teaching fellow at Pepperdine University, asks an interesting question: how could or would we ever get rid of the hundreds of women should, millions of guns that already exist in the United States? He takes the stance that banning firearms is pointless, that “the genie is out of the bottle.” He discounts the debate—driven by the Virginia Tech shootings that occurred just before he wrote the article—as being driven by election politics and, therefore, insincere.
Though this source is a bit older, it still raises a valid question. Wilson, J. Philosopher? Q. Women Stay? (2007, April 20). Gun control isn’t the answer. Los Angeles Times. Retrieved from http://www.latimes.com/la-oe-wilson20apr20-story.html. Wilson, James Q. “Gun Control Isn’t the Answer.” LATimes.com . Los Angeles Times, 20 Apr. 2007.
Web. Essay Leadership? 10 July 2016. Wilson, James Q. “Gun Control Isn’t the at home, Answer.” Los Angeles Times, 20 Apr. Voltaire Philosopher? 2007, www.latimes.com/la-oe-wilson20apr20-story.html. Accessed 10 July 2016.
Anti-gun control article #3: Why Gun Owners are Right to stay Fight Against Gun Control. Hardy argues that sweeping gun control legislation proposed by the anti-gun lobby leaves no room for when did the scramble begin, compromise. He then does a U-turn and women complains about the slippery-slope nature of bans on one kind of weapon, such as assault weapons or sniper rifles, leading slowly but surely to total prohibition. Hardy fears that the gun control lobby is on a crusade to wipe out individual gun ownership altogether. Hardy is an Arizona attorney and a Second Amendment scholar and writer. Hardy, D. T. School Counselor? (2013, July 18).
Why gun owners are right to fight against gun control. Reason.com. Women Stay? Retrieved from http://www.reason.com/archives/ 2013/07/18/why-second-amendment-supporters-are-righ. Hardy, David T. “Why Gun Owners are Right to Fight Against Gun Control.” Reason.com . Reason Foundation, 18 July 2013. Web. 10 July 2016. Hardy, David T. “Why Gun Owners are Right to Fight Against Gun Control.” Reason.com, Reason Foundation, 18 July 2013, reason.com/ archives/2013/07/18/why-second-amendment-supporters-are-righ. Accessed 10 July 2016. Anti-gun control article #4: ‘American Sniper’ widow: Gun control won’t protect us. This opinion piece discusses one woman’s experience with gun violence and why she believes gun control is not the answer.
Taya Kyle, the writer of this article, is also the author of American Wife: A Memoir of Love, War, Faith, and Renewal . Regulation Simulation? The movie American Sniper was based on her late husband, Chris Kyle. Kyle, T. (2013, July 18). ‘American Sniper’ widow: Gun control won’t protect us. CNN. Retrieved from women should, http://www.cnn.com/2016/01/07/opinions/taya-kyle-gun-control. Kyle, Taya. “‘American Sniper’ Widow: Gun Control Won’t Protect Us.” CNN.com. Leadership Assessment? Cable News Network, 18 July 2013. Web. 10 July 2016.
Kyle, Taya. “‘American Sniper’ Widow: Gun Control Won’t Protect Us.” CNN , 18 July 2013, www.cnn.com/2016/01/07/opinions/taya-kyle-gun-control. Accessed 10 July 2016. Anti-gun control article #5: A Criminologist’s Case Against Gun Control. This article includes an interview with James Jacobs, director of the Center for Research in Crime and Justice at New York University School of Law. He is also a professor of at home, constitutional law and the author of Can Gun Control Work? In this article, Jacobs examines misunderstandings about gun control and examines the effectiveness of various gun control strategies. Davidson, J. (2015, December 1).
A criminologist’s case against gun control. Time. Retrieved from http://www.time.com/4100408/a-criminologists-case-against-gun-control. Davidson, Jacob. “‘A Criminologist’s Case Against Gun Control.” Time.com. Time Inc., 1 Dec. 2015. Web.
10 July 2016. Davidson, Jacob. “‘A Criminologist’s Case Against Gun Control.” Time , 1 Dec. 2015, time.com/4100408/a-criminologists-case-against-gun-control. Accessed 10 July 2016. Anti-gun control article #6: How Gun Control Kills. The author gives examples of incidents of gun violence that were stopped by people carrying guns, arguing that had such people not been on the scene, the results would have been worse. Hunter is an aide to conservative senator Rand Paul.
Hunter, J. (2012, December 27). Scouse? How gun control kills. The American Conservative. Retrieved from http://www.theamericanconservative.com/ articles/how-gun-control-kills. Hunter, Jack. Women? “How Gun Control Kills.” The American Conservative . Burr Media Group, 27 Dec. 2012. Web. Century? 10 July 2016. Hunter, Jack. Women Stay At Home? “How Gun Control Kills.” The American Conservative, Burr Media Group, 27 Dec. 2012, www.theamericanconservative.com/articles/how-gun-control-kills. Accessed 10 July 2016.
2 Resources About the Gun Control Debate. If you’re looking for articles with more background on the subject, check out these two resources that provide an overview of gun control and a variety of discussions about the topic. In 2015–2016, the well-respected news source CNN aired a series of programming titled Guns in America . This resource contains both articles and videos about a wide array of when for africa, gun-related topics, including town-hall meetings, an interview with President Obama, gun violence statistics, interviews with the NRA, a discussion of the gun industry, and should at home segments about guns and police. The articles and school philosophy videos are too numerous to cite in this post, but I’ve included one sample to help illustrate how you might cite these resources. Simon, M., Sanchez, R. (2015, December 4). Women Should Stay? U.S. gun violence: The story in charts and graphs. CNN. Essay Leadership? Retrieved from http://www.cnn.com/2015/12/ 04/us/gun-violence-graphics/index.html.
Simon, Mallory and should stay at home Ray Sanchez. School Philosophy? “U.S. Women? Gun Violence: The Story in Charts and Graphs.” CNN.com. Scouse? Cable News Network, 4 Dec. 2015. Web. 10 July 2016. Simon, Mallory and Ray Sanchez. “U.S. Gun Violence: The Story in Charts and Graphs.” CNN , 4 Dec.
2015, cnn.com/2015/12/04/us/gun-violence-graphics/index.html. Accessed 10 July 2016. This article, published by the The New York Times , provides broad definitions of gun control, includes arguments both for and against gun control, and even speculates as to why it’s so difficult to solve the debate. Perez-Pena, R. (2015, October 7). Gun control explained. The New York Times. Retrieved from http://www.nytimes.com/interactive/2015/10/ 07/us/gun-control-explained.html?_r=0. Perez-Pena, Richard. “Gun Control Explained.” NYTimes.com . The New York Times Company, 7 Oct. 2015. Women Stay? Web. 10 July 2016.
Perez-Pena, Richard. “Gun Control Explained.” The New York Times , 7 Oct. 2015, nytimes.com/interactive/2015/10/07/us/gun-control-explained.html?_r=0. Accessed 10 July 2016. You can cite these or any of thousands of other gun control articles to buttress your argument. (Read 5 Best Resources to Help With Writing a Research Paper if you need assistance researching more scholarly sources.) Whichever side of the issue you take, make sure to mention the source, cite it properly (in-text and in your Works Cited or References list), and format direct quotations, summaries, and paraphrases per MLA 7th edition, MLA 8th edition, or APA guidelines. If you copy the APA or MLA citations I created above, be sure to update the accessed date (10 July 2016) to did the for africa begin the date that you accessed the article. Keep in mind that there will be very, very few sources (including the at home, ones I used above) that are totally objective. Most writers—and most websites—will be catering to an audience. For a fuller list of issues on both sides of the debate, check out these Top Pro Con Arguments on gun control.
Your job is to filter out the bias and see what value a given person’s argument really has. Some of the most rabid commentators on about Leadership Assessment, both sides of the issue actually make good points—you just have to women stay get past all the screaming. Once you’re ready to start writing, check out these sample essays on when did the begin, gun control for women, some ideas on how to put your paper together. If you need help with writing your essay, read How to Assessment Write a Research Paper: a Step-by-Step Guide. Need help with overall formatting according to the style guide you’re using? Give these resources a try:
When you’re finished drafting your argument, don’t forget to have an editor proofread your essay for you. Psst. Women Should At Home? 98% of Kibin users report better grades! Get inspiration from over 500,000 example essays. About the Author. Naomi Tepper is a former Kibin editor, the former content manager for the Kibin blog, and forever a word nerd.
You’re welcome! I’m glad you found this to be helpful. 1) “This is a good place to start because the Second Amendment is pretty. much the cornerstone of the whole debate, and the modification that. Stevens suggests highlights the fact that the Second Amendment refers to. an armed citizen militia, not individual gun ownership.” Actually, the philosopher, fact that Stevens wants to change the women, 2nd points to the fact that the 2nd DOES NOT refer to an armed militia, because his change is nonsense. Religion Revival 19th Century? The organized militia is a body of the government and thus, needs no right to be armed. 2) If you use this one, you are arguing for prior restraint against an inalienable right. At Home? 110 million gun owners.
8855 “gun murders.” 99.9996% of all gun owners…. safe. 3) David Hardy is absolutely right. He’s the voltaire philosopher, only one that backs up his arguments with evidence. 4) Yep. Gun control…or the should stay, possibility of gun control is costing some states long held jobs. And some state politicians their jobs, too. 5) Interesting premise…but just an opinion. Here’s a sixth: Investigate the racist roots of gun control. If you want to discuss the 2nd amendment, stay away from emotional arguments. The 2nd amendment protects a pre-existing, individual, inalienable right to keep and Simulation bear arms.
It does not derived from the Constitution. It is protected by women should stay at home, it. When Scramble For Africa? That is the base from women stay, which you should discuss all gun control. Clearly some one PRO gun control based on their wording. The second amendment, the right to bear arms, is currently under heavy fire. Many people believe that firearms are directly linked to crime, and are just too dangerous in general. These people believe that stricter gun laws need to counselor philosophy be in stay, place, or the second amendment is outdated and no longer relative or necessary.
This is untrue. The second amendment and did the scramble the right to bear arms must remain intact. The second amendment is women should, long standing, and crucial to the American citizens, for purposes including worst case scenarios and life or death situations, and not to mention that through multiple studies, statistics and research have shown and discovered that stricter gun laws, or prohibition altogether, would only worsen the situation. Firearms actually prevent more crimes than they are involved in committing. This right gives the when did the for africa, American citizens the ability to defend and women stay fight for themselves, their neighbors, and their family, in Leadership Assessment, the face of any evil, foreign or local.
One must also remember that stricter gun laws will not necessarily stop or hinder crime. Criminals do, after all, break the law on a regular basis. Most firearms used in criminal activities are illegally obtained, whether stolen or bought through an illegal source. Women Stay? Overall, the second amendment, the right to keep and bear arms, is liverpool scouse, still in place for stay at home, a very good reason. This right allows the people to defend themselves at any given time, and therefor live without certain fear. Looks like you have a good start to your own pro-gun essay here. Simulation Essay? (Just be sure to back up your statements with credible sources and research.) This is just skippy except the second amendment gives me the right to be armed to protect me from an women should oppressive government. They colonists had just fought a war to free themselves from an oppressive government, so the second amendment is not there to give me the right to hunt or shoot burglars.
If the government allows the police or the counselor philosophy, military to become excessive, calling them to protect you from them doesn’t make much sense does it? And yes, there were some pretty awesome weapons (multi-shot repeaters) in the 1700’s that the founders were fully aware of. Just some questions from an outsider. Why are Americans afraid of their neighbor and should stay at home so have to carry a weapon? Why do Americans think that the Police are so incompetent that they have to arm themselves to do their job. Why are citizens allowed to open carry their guns to the mall and local store but politicians will not allow them to carry a weapon to the Conservative Party National Convention? Why do Americans give criminals the right to carry weapons? All of these questions would make great material for Assessment, a paper on should, the topic. wow the Revival in the 19th Century Essay, potato is at home, strong with you, the most violent states in Religion Revival in the Essay, the country are california, new york illinois, and DC, all have some of the should, most restrictive laws in liverpool scouse, the country, and are suprisingly full of “tolerant liberals” Sounds like you could definitely write an essay defending this position, Bree — great research. As an Englishman I have been – on and off – following this for years.
Up till fairly recently, under the Truck Acts( passed in the 19th century) stipulated that all persons in gainful employment had to should be paid in philosophy, “current currency of the realm”. In other words, they had to women should stay be paid in voltaire, cash. Thus the employer would send the pay clerk to women should stay at home the bank, after having worked out how many items of each piece of currency was needed to liverpool render the exact amount down to the last smallest value coin. He would go to the same bank, the should stay at home, same local branch, and the same time. Pre-WW2 this was for the most part safe. Religion Revival Century? The reason was quite simple; in at home, the 1930s the moral standards set out in Business Regulation Simulation, the Christian faith were still strongly respected, even by many who were either non-churchgoers or were not exactly noted for their fervency of belief. However, the influence of the Sunday School movement was very strong. WW2 disrupted this, a factor commented on unfavourably in Vol.1 of Sir John Hamerton’s work, The Second Great War. All the evacuations had the effect of stay, depriving many of the Revival in the Century, “means of grace” that inculcated moral standards. The result was a progressive decline in such standards post-WW2.
Then, first one, then another began to notice the pay clerks’ routine. Result? An increasing round of wage-snatching of should, progressively increasing violence. In the wake of these, some started up security firms who would guarantee safe delivery of the cash. Liverpool Scouse? Eventually some security firms’ personnel began carrying handguns. Women Stay At Home? One incident in December, 1961 fairly threw the Essay about Assessment, cat among the pigeons. Stay? A gang attacked a security van, not knowing that its personnel were armed, as well as having a guard dog.
One of the guards opened fire, wounding one of the gang, who fled away empty-handed, leaving a fearsome array of in the Century, weapons. The reaction of the police was to demand the disarming of all bank guards; one senior police officer even bleated that was “better to lose ?100,000” than to risk the criminals carrying guns in response. I suppose he had in mind that Parliament had not long before decided to limit the categories of capital murder to, among other, “murder committed in the furtherance of theft”, but he may have also feared a more widespread rise in armed robberies. As it was, not far from where I am typing this out, and only 18 months later, 26 times the amount he mentioned was stolen in what we still call the Great Train Robbery. Jumping from women stay, there to the Dunblane massacre and the subsequent Acts that banned all civilian ownership of school counselor, handguns(1996, 1997), a number of features emerge. The murderer had already gotten into bad odour with the Scouts, and increasingly with others, and stay this led at least one junior police officer to Leadership suggest that his licences(for FOUR handguns!) be revoked. Women Stay? In the wake of Lord Cullen’s report the cop’s superior resigned. However, the reaction of at counselor philosophy, least one, if not more, of should stay at home, London’s grubbier tabloids was to scream out louder for Regulation, all civilian ownership of handguns to be banned, a sentiment led one Tory MP to stay at home say that he now knew what it was like to have been a Jew in Hitler’s Germany. For the counselor philosophy, Sun, read Der Sturmer; for women should stay, the Sun’s then editor read Julius Streicher, who duly swung at a rope’s end for the crimes he committed in WW2.
As if that hasn’t been enough, it appears that the proceedings of the Cullen Committee will remain under lock and key till 2096. There has been one recent development—albeit a small one. Religion Revival 19th Essay? Two men attempted to women stay at home break into liverpool scouse a house; one of the women should stay, owners had a shotgun, and he fired at them, killing one. When arraigned before a court on a charge of murder, the presiding judge directed the jury to acquit. He cited a noted English jurist, Sir Edward Coke, who lived some 400 years ago, as saying that “an Englishman’s home is Regulation Simulation Essay, his castle”. Yes, one of the women, leaders of the gun control mob(not very large, but unduly influential) expressed “disappointment” at the ruling and verdict. Still, it is a chink of light. What happens in the future is yet to scouse be seen.
Incidentally, during November 2000 I spent a fortnight on holiday in Texas at the invitation of a woman friend. Amazingly, I felt safer in women should stay, downtown San Antonio than I would in many British cities. I put it down to three factors, viz. (I) they still have the death penalty for murder – we pensioned off the hangman in 1965; (ii) after training and certification one can carry a concealed handgun – makes it dangerous for intending burglars or muggers; (iii) in Teas, and in large parts of the US, one enjoys the “means of grace” in the form of scouse, Christian schooling and Christian broadcasting – here in the UK faith schools are allowed, but secular humanists bleat about “indoctrination” of children, while Christian broadcasting is severely restricted, with even one complainer being apparently enough to shut it down. Molon Labe. My question is how do you plan on finding and removing ever gun across the nation? Stop the black market where other cartel and gangs will flood the street with weapons from other countries that produce them?
Leprechauns riding unicorns patrolling the women should stay, candy land streets of voltaire, delusionalville? So the should stay, plan is to remove them from the law abiding citizens (because they are the school counselor, only ones that would turn them in without a fire fight). Criminalize the women, ones that refuse to scramble begin turn them in should, AND fight them with government agencies that have guns. So now with the Religion in the Century Essay, law abiding citizen are disarmed, the ones that refuse to be disarmed are criminals and the gangs and criminals keep their firearms because well…they are criminals…yeap seems like a solid plan to me! Let’s move forward with this and see how well it turns out.
Hitler, Stalin, Pot and Moa would be proud!