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ketoacidosis treatment

T E Doris, A Bowron, A Armstrong, B Messer
The longer survival in Duchenne dystrophy can be associated with previously unrecognised medical issues, in particular cardiac and nutritional problems, which provide new challenges in the management of these patients. We describe a series of patients who have DMD presenting with severe acid base abnormalities due to ketoacidosis. The cases described all developed the abnormalities in the context of decreased dietary intake. In all cases, the acid-base derangement resolved with intravenous glucose infusion...
June 18, 2018: Neuromuscular Disorders: NMD
Han Saem Choi, Ahreum Kwon, Hyun Wook Chae, Junghwan Suh, Duk Hee Kim, Ho-Seong Kim
Phosphate is essential in regulating human metabolic processes, and severe hypophosphatemia can induce neurologic and hematological complications and result in respiratory failure and cardiac dysfunction. Therefore, correction of severe hypophosphatemia can be pivotal in the management of diabetic ketoacidosis (DKA). We report the case of a 14-year-old female who was diagnosed with type 1 diabetes and referred to our institute for treatment of DKA. Although the patient received fluid and continuous insulin administration according to the current DKA treatment protocol, generalized tonic seizures and cardiac arrest developed...
June 2018: Annals of Pediatric Endocrinology & Metabolism
Pragya Mangla, Khalid Hussain, Sian Ellard, Sarah E Flanagan, Vijayalakshmi Bhatia
BACKGROUND: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI), also known as congenital hyperinsulinism, has been known to go into spontaneous remission, with patients developing diabetes in later life. A temporary phase of hyperglycemia is, however, rarely reported. CASE PRESENTATION: We describe a 16-month-old child, a known case of diazoxide responsive PHHI, presenting with mixed hyperglycemic hyperosmolar coma and ketoacidosis with rhabdomyolysis while on diazoxide treatment...
June 29, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
Katrien Clotman, Katleen Janssens, Pol Specenier, Ilse Weets, Christophe E M De Block
Context: Pembrolizumab (Keytruda) is a humanized IgG4 monoclonal antibody used in cancer immunotherapy. It targets the programmed cell death-1 (PD-1) receptor which is important in maintaining self-tolerance. However, immune checkpoint blockade is associated with a risk for immune-related adverse events (irAE) potentially affecting the endocrine organs. Type 1 diabetes mellitus is a rare irAE of PD-1 inhibitors, occurring in 0.2% of cases. Evidence Acquisition: Systematic search of 4 databases (Medline, Embase, Web of Science and Cochrane Library) using the search terms "diabetes" or "ketoacidosis" and "pembrolizumab", "nivolumab", "PD-1 inhibitor" or "immunotherapy...
June 27, 2018: Journal of Clinical Endocrinology and Metabolism
Nese Colak Oray, Basak Bayram, Emel Altintas, Semra Sivrikaya, Yusuf Savran
Diabetic ketoacidosis (DKA) is an acute and major life-threatening complication of diabetes mellitus. Fluid resuscitation, insulin therapy, and electrolyte replacement are essential for DKA treatment. Rarely, life threatening allergic reactions might develop in a patient treated with insulin. If anaphylaxis develops after insulin, the DKA treatment options are restricted. A limited number of case reports have been reported in patients with severe anaphylactic reactions to human insulin who were then treated with synthetic insulin analogues...
March 2018: Turkish Journal of Emergency Medicine
Andrew Ziegler, Timothy Williams, Nicole Yarid, Daniel L Schultz, Elizabeth A Bundock
Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA)...
June 25, 2018: Journal of Forensic Sciences
Thomas Danne, Bertrand Cariou, Phillip Banks, Michael Brandle, Helmut Brath, Edward Franek, Jake A Kushner, Pablo Lapuerta, Darren K McGuire, Anne L Peters, Sangeeta Sawhney, Paul Strumph
OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the dual SGLT1 and SGLT2 inhibitor sotagliflozin compared with placebo when combined with optimized insulin in adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: In a double-blind, 52-week, international phase 3 trial, adults with T1D were randomized to placebo ( n = 258) or once-daily oral sotagliflozin 200 mg ( n = 261) or 400 mg ( n = 263) after 6 weeks of insulin optimization...
June 24, 2018: Diabetes Care
John B Buse, Satish K Garg, Julio Rosenstock, Timothy S Bailey, Phillip Banks, Bruce W Bode, Thomas Danne, Jake A Kushner, Wendy S Lane, Pablo Lapuerta, Darren K McGuire, Anne L Peters, John Reed, Sangeeta Sawhney, Paul Strumph
OBJECTIVE: Evaluate the efficacy and safety of the dual sodium-glucose cotransporter 1 (SGLT1) and SGLT2 inhibitor sotagliflozin in combination with optimized insulin in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: The inTandem1 trial, a double-blind, 52-week phase 3 trial, randomized North American adults with T1D to placebo ( n = 268), sotagliflozin 200 mg ( n = 263), or sotagliflozin 400 mg ( n = 262) after 6 weeks of insulin optimization. The primary end point was HbA1c change from baseline at 24 weeks...
June 24, 2018: Diabetes Care
Yu-Mou Chou, Chen-June Seak, Zhong Ning Leonard Goh, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chih-Chuan Lin
RATIONALE: Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Euglycemic diabetic ketoacidosis (eDKA) is however challenging to identify in the emergency department (ED) due to absence of marked hyperglycemia, often leading to delayed diagnosis and treatment. eDKA has been recently found to be associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, one of the newest classes of antidiabetics, though there are very limited reports implicating dapagliflozin as the offending agent in ED patients...
June 2018: Medicine (Baltimore)
Thomas Danne, Torben Biester, Olga Kordonouri
The sodium-glucose cotransporter type 1 (SGLT1) is the primary transporter for absorption of glucose and galactose in the gastrointestinal tract. Inhibition blunts and delays postprandial glucose (PPG) excursion. Sodium-glucose cotransporter type 2 (SGLT2) is expressed in the kidney, where it reabsorbs 90% of filtered glucose. Thus, a dual SGLT1 and SGLT2 inhibition (compared with selective SGLT2 inhibition) could result in lower PPG and robust A1c reduction even in patients with reduced kidney function. Sotagliflozin is an oral potent dual inhibitor of the insulin-independent SGLT1 and SGLT2...
June 2018: Diabetes Technology & Therapeutics
Rafael De León-Borrás, Julio Álvarez-Cardona, Jorge A Vidal, Humberto M Guiot
A 36-year-old man was admitted to the intensive care unit due to diabetic ketoacidosis and pneumonia requiring mechanical ventilation. Three weeks after admission, he developed a refractory bacteremia with Klebsiella pneumoniae carbapenemase-producing bacteria (KPC). He remained febrile and with bacteremia for six weeks despite therapy with polymyxin B, carbapenems, and amikacin. Imaging studies looking for deep-seated infection revealed vertebral L1-L2 diskitis and osteomyelitis with pre-vertebral abscess and bilateral psoas pyomyositis that were not amenable for drainage...
June 2018: Puerto Rico Health Sciences Journal
Gordon Sloan, Tania Kakoudaki, Nishant Ranjan
We report a case of a 63-year-old man who developed diabetic ketoacidosis (DKA) associated with canagliflozin, a sodium glucose co-transporter 2 (SGLT-2) inhibitor. He presented acutely unwell with a silent myocardial infarction, diverticulitis and DKA with a minimally raised blood glucose level. Standard therapy for DKA was initiated. Despite this, ketonaemia persisted for a total of 12 days after discontinuation of canagliflozin. Glucosuria lasting for several days despite discontinuation of the medications is a recognised phenomenon...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Nathan Kuppermann, Simona Ghetti, Jeff E Schunk, Michael J Stoner, Arleta Rewers, Julie K McManemy, Sage R Myers, Lise E Nigrovic, Aris Garro, Kathleen M Brown, Kimberly S Quayle, Jennifer L Trainor, Leah Tzimenatos, Jonathan E Bennett, Andrew D DePiero, Maria Y Kwok, Clinton S Perry, Cody S Olsen, T Charles Casper, J Michael Dean, Nicole S Glaser
BACKGROUND: Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades. METHODS: We conducted a 13-center, randomized, controlled trial that examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis. Children were randomly assigned to one of four treatment groups in a 2-by-2 factorial design (0...
June 14, 2018: New England Journal of Medicine
Harmony Thompson, Helen Lunt, Cate Fleckney, Steven Soule
An adolescent with type 1 diabetes and a history of self-harm, which included intentional overdoses and insulin omission, presented with an insulin degludec overdose. She had been commenced on the ultra-long-acting insulin, degludec, with the aim of reducing ketoacidosis episodes in response to intermittent refusal to take insulin. Insulin degludec was administered under supervision as an outpatient. Because it was anticipated that she would attempt a degludec overdose at some stage, the attending clinicians implemented a proactive management plan for this (and related) scenarios...
2018: Endocrinology, Diabetes & Metabolism Case Reports
(no author information available yet)
Elke Rudloff J Feline Med Surg 2017; 19: 1167-1174 Readers should note that the version of the article that appeared in print in November 2017 and online until June 2018 has been amended. The version now appearing online is the correct one. For information, the following amendment has been made to the original published version. In the fifth paragraph of 'Correction of electrolyte imbalances' box on page 1172, the unit for potassium supplementation should be mEq/kg/h and not mEq/h, as stated. The sentence has therefore been amended to 'Potassium supplementation is calculated according to the serum level and, in general, the rate should not exceed 0...
June 1, 2018: Journal of Feline Medicine and Surgery
Christian Abrahim, Satish Maharaj
Case presentation: A 47-year-old Caucasian woman with type 1 diabetes presented with epigastric pain and vomiting. She had not been adherent with her diet and insulin therapy for the past 3 weeks. She never had a personal or family history of arrhythmia-related symptoms, ventricular tachycardia or fibrillation (VT/VF) or premature sudden cardiac death (SCD). Examination revealed dry mucosa, tachycardia and epigastric tenderness to palpation. Her ECG showed ST elevations (V1-V3) with associated T wave inversions (figure 1A)...
2018: Heart Asia
Walid Abboud, Saif Abdulla, Mohammed Al Zaabi, Ramzi Moufarrej
Glycogenic hepatopathy is a rare but potentially reversible condition characterized by hepatomegaly and elevated liver enzymes occurring in poorly controlled type 1 diabetes mellitus patients and often requires a liver biopsy to confirm the diagnosis. We present the case of a young man who was admitted with diabetic ketoacidosis in the setting of poorly controlled diabetes mellitus type 1 and was noted to have significantly elevated transaminases that continued to worsen despite appropriate treatment of the diabetic ketoacidosis...
2018: Case Reports in Hepatology
Sylvie Picard, Hélène Hanaire, Yves Reznik, Pierre-Yves Benhamou, Salha Fendri, Lise Dufaitre, Eric Leutenegger, Bruno Guerci
BACKGROUND: The impact of a 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unclear in patients suboptimally controlled by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence. PATIENTS AND METHODS: This French multicenter longitudinal observational study included T1D patients with HbA1c >7.5% or history of severe hypoglycemia (SH) or recurrent documented hypoglycemia...
June 2018: Diabetes Technology & Therapeutics
Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Fatima Ismail Hassan, Saeideh Momtaz, Mohammad Abdollahi
Diabetes mellitus (DM) is a chronic metabolic disorder in which blood glucose level raises that can result in severe complications. However, the incidence increased mostly by obesity, pregnancy, persistent corpus luteum, and diestrus phase in humans and animals. This review has focused on addressing the possible understanding and pathogenesis of spontaneous DM in canine, feline, and few wild animals. Furthermore, pancreatic associated disorders, diabetic ketoacidosis, hormonal and drug interaction with diabetes, and herbal remedies associated with DM are elucidated...
April 2018: Veterinary World
Zahra Razavi, Saba Maher, Javad Fredmal
PURPOSE: To compare the safety/efficacy of intermittent subcutaneous rapid-acting insulin aspart with the standard low-dose intravenous infusion protocol of regular insulin for treatment of pediatric diabetic-ketoacidosis. METHODS: For a prospective randomized-controlled clinical trial on 50 children/adolescents with mild/moderate diabetic-ketoacidosis, the diagnostic criteria for ketoacidosis included: blood glucose level >250 mg/dl, ketonuria>++, venous pH <7...
May 24, 2018: Endocrine
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