Background: Hypoglycemia is a commonly encountered metabolic state in the patient population. It can be medically defined as a blood sugar <70mg/dL in a diabetic patient or <50mg/dL in a non-diabetic patient. It is less frequently seen in non-diabetics due to the body’s ability to autoregulate insulin administration. Common symptoms are sweating, tremors, palpitations, dizziness, drowsiness, and confusion. If left untreated, these symptoms can progress to seizures, arrythmias, or other complications that ultimately lead to death. Objective: To highlight the possible causes of hypoglycemia and the appropriate work-up for normally euglycemic patients. Case Description: We herein report a case of hypoglycemia in a 36-year-old female with Lupus related end-stage renal disease on hemodialysis via Ash-catheter who presented with peritonitis due to a defunct peritoneal dialysis catheter. The patient was found to be bacteremic; therefore both catheters were removed and antibiotics were started. Repeat blood cultures showed no growth for 48 hours, so the patient was held fasting at midnight for placement of a new catheter. On the day of surgery, she registered multiple blood sugar readings as low as 15mg/dL. Her symptoms were limited to drowsiness and shortness of breath. She was given four D50 boluses, glucagon IV, and a D5 drip that was adjusted to a D15 drip to stabilize her blood sugar. It was discovered that at an admission two months ago, the patient had a few readings in the 30s. She denied any recollection of this and claimed to have been asymptomatic. She also denied a history of low blood sugars and a diagnosis of diabetes. In surgery that day, the patient went into cardiac arrest on the operating table after being sedated. She was resuscitated after one round of chest compressions, and her catheter was placed. During the episodes of low blood sugar, specific labs were drawn for the work-up of hypoglycemia (glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, insulin antibodies, and sulfonylurea/meglitinide screen), but results yielded inconclusive values that prevented a diagnosis. The patient’s blood sugars became steady once her diet was restarted, and she was discharged in stable condition to a rehab facility after cautionary counseling was given. Discussion: This case highlights an optimal way to work-up a patient with new onset hypoglycemia, focusing on patient history and drawing the appropriate labs during hypoglycemic episodes. The specific labs listed above can be used to differentiate between various causes of hypoglycemia (exogenous insulin administration, an insulin secreting tumor [insulinoma], insulin antibodies, insufficient cortisol or glucagon levels, or improper sulfonylurea/meglitinide use) by comparing them to standards. If labs are unable to be obtained, a 72-Hour Fast can be conducted to create a controlled environment, and a Glucagon Tolerance Test can further explore if the cause of hypoglycemia is insulin related. The goal of all of this testing is to be able to identify and treat the underlying cause of the hypoglycemia and prevent future episodes and the complications that accompany it.

This thesis presents some new techniques that were developedfor continuous chemical analysis of a paper furnish. First, ageneral background is presented, covering topics from theorigins of papermaking to present day. A short introduction topapermaking chemistry and a variety of presently availableon-line chemical analysers and measurement strategies are alsodiscussed. A method is described for the continuous fractionation of apaper furnish containing coarse fibres (&gt;10µm) in orderto obtain a sample for analytical purposes (Paper I). Aconsistent sample, containing a representative fraction of thedissolved and colloidal substances (DCS) present in the bulkfurnish, was achieved by preventing cake formation on a filtersurface. A combination of turbulent flow above a membranefilter, while continuously withdrawing a relatively low samplevolume, were key factors in the prevention of filterfouling. For the continuous flow-extraction of DCS, a technique isdescribed whereby the extracting solvent was injected at a highvelocity into a continuous flow of analyte (Paper II).Comparison with conventional flow extraction showed anextraction enhancement of up to 9 times for colloidaltriglycerides. To achieve a continuous determination of chemicalsubstances, a real-time fully automated colorimetric titrationapparatus was developed (Paper III&amp;IV). This was achievedby using a series of micro-machined mixing channels for thecontinuous flow of analyte, with a sequence of detection unitsand titrant addition points along the flowpath (Paper III). Afuzzy logiccontroller was implemented to continuously adaptfor changes in the sample concentration, providing thepossibility of titrating over two orders of magnitude in sampleconcentration with minimal loss of accuracy (Paper IV). Also, a system is presented whereby the filtration apparatus(Paper I) is combined with the titration device (Paper III&amp;IV) in order to continuously determine total charge (orcolloidal charge) of a paper furnish in real-time (Paper V).This was achieved by utilising a back-titration approach andselected examples are presented showing the dynamicinteractions between wood fibres and polyelectrolyte adsorptionat various conditions of pH and polyelectrolyte molecularweight. Finally, some suggestions for a more comprehensive wet-endchemical monitoring platform are discussed and the role of thepresent work in evaluated in this context. <b>Keywords:</b>Chemical monitoring, continuous flowextraction, cross-flow filtration, dissolved and colloidalcomponents, fuzzy-logic control, on-line system, pitchanalysis, polyelectrolyte titration, process control, samplework-up, titrimetric analysis.

<p>This thesis presents some new techniques that were developedfor continuous chemical analysis of a paper furnish. First, ageneral background is presented, covering topics from theorigins of papermaking to present day. A short introduction topapermaking chemistry and a variety of presently availableon-line chemical analysers and measurement strategies are alsodiscussed.</p><p>A method is described for the continuous fractionation of apaper furnish containing coarse fibres (>10µm) in orderto obtain a sample for analytical purposes (Paper I). Aconsistent sample, containing a representative fraction of thedissolved and colloidal substances (DCS) present in the bulkfurnish, was achieved by preventing cake formation on a filtersurface. A combination of turbulent flow above a membranefilter, while continuously withdrawing a relatively low samplevolume, were key factors in the prevention of filterfouling.</p><p>For the continuous flow-extraction of DCS, a technique isdescribed whereby the extracting solvent was injected at a highvelocity into a continuous flow of analyte (Paper II).Comparison with conventional flow extraction showed anextraction enhancement of up to 9 times for colloidaltriglycerides.</p><p>To achieve a continuous determination of chemicalsubstances, a real-time fully automated colorimetric titrationapparatus was developed (Paper III&IV). This was achievedby using a series of micro-machined mixing channels for thecontinuous flow of analyte, with a sequence of detection unitsand titrant addition points along the flowpath (Paper III). Afuzzy logiccontroller was implemented to continuously adaptfor changes in the sample concentration, providing thepossibility of titrating over two orders of magnitude in sampleconcentration with minimal loss of accuracy (Paper IV).</p><p>Also, a system is presented whereby the filtration apparatus(Paper I) is combined with the titration device (Paper III&IV) in order to continuously determine total charge (orcolloidal charge) of a paper furnish in real-time (Paper V).This was achieved by utilising a back-titration approach andselected examples are presented showing the dynamicinteractions between wood fibres and polyelectrolyte adsorptionat various conditions of pH and polyelectrolyte molecularweight.</p><p>Finally, some suggestions for a more comprehensive wet-endchemical monitoring platform are discussed and the role of thepresent work in evaluated in this context.</p><p><b>Keywords:</b>Chemical monitoring, continuous flowextraction, cross-flow filtration, dissolved and colloidalcomponents, fuzzy-logic control, on-line system, pitchanalysis, polyelectrolyte titration, process control, samplework-up, titrimetric analysis.</p>