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ketoacidosis treatment

Carrie Vargo, Beth-Ann Olliviere-Baptiste, Jay M Brenner, Derek R Cooney, Elliot Rodriguez
Fungal rhino-orbital cerebritis is a devastating opportunistic invasive disease. Survival requires urgent diagnosis. Thus, all patients at risk who present with rhinosinusitis-type symptoms and have co-morbid conditions that decrease their immunocompetence should trigger the clinician's consideration of this disease. Treatment includes antifungals and emergent surgical debridement.
November 2018: Clinical practice and cases in emergency medicine
Miriam Hinaa Ahmad, Ismat Shafiq
We report a case of a 21-year-old African American female with history of pre-diabetes, and a diagnosis of a rare leukemia, blastic-plasmacytoid dendritic neoplasm (BPDCN), who developed diabetic ketoacidosis (DKA) after the third dose of PEG-asparaginase infusion. She was successfully treated with insulin. Asparaginase is a vital part of treatment protocols for acute lymphoblastic leukemia (ALL) in combination with other chemotherapeutic drugs. Asparaginase therapy has been reported to cause hyperglycemia especially when used in conjunction with glucocorticoids for the treatment of ALL in the pediatric population...
October 31, 2018: Endocrinology, Diabetes & Metabolism Case Reports
Nicole Glaser, Nathan Kuppermann
The optimal fluid treatment protocol for children with diabetic ketoacidosis (DKA) has long been a subject of controversy. Until recently, there was no high-quality evidence from randomized clinical trials to support an optimal guideline, and recommendations were mainly based on theoretical considerations. As a consequence, fluid treatment protocols for children with DKA vary between institutions (and countries). In June 2018, the results from the Fluid Therapies Under Investigation in DKA (FLUID) Trial conducted in the Pediatric Emergency Care Applied Research Network (PECARN) were published...
November 11, 2018: Pediatric Diabetes
Stephen D Wiviott, Itamar Raz, Marc P Bonaca, Ofri Mosenzon, Eri T Kato, Avivit Cahn, Michael G Silverman, Thomas A Zelniker, Julia F Kuder, Sabina A Murphy, Deepak L Bhatt, Lawrence A Leiter, Darren K McGuire, John P H Wilding, Christian T Ruff, Ingrid A M Gause-Nilsson, Martin Fredriksson, Peter A Johansson, Anna-Maria Langkilde, Marc S Sabatine
BACKGROUND: The cardiovascular safety profile of dapagliflozin, a selective inhibitor of sodium-glucose cotransporter 2 that promotes glucosuria in patients with type 2 diabetes, is undefined. METHODS: We randomly assigned patients with type 2 diabetes who had or were at risk for atherosclerotic cardiovascular disease to receive either dapagliflozin or placebo. The primary safety outcome was a composite of major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, or ischemic stroke...
November 10, 2018: New England Journal of Medicine
Sicheng Li, Yi Zhang, Zhichun Sun, Ji Hu, Chen Fang
RATIONALE: Programmed cell death-1 protein (PD-1) antibody is an immune-checkpoint inhibitor that triggers anti-tumor response by enhancing immune response. Although PD-1 antibody has been reported effective in some malignant tumor, it can also induce significant immune-related adverse events (irAEs) such as autoimmune diabetes. PATIENT CONCERNS: A 67-year-old male patient with non-small cell lung cancer (NSCLS) presented with polydipsia, polyuria, weakness, and weight loss after use of anti-programmed cell death-1 antibody therapy...
November 2018: Medicine (Baltimore)
Victoria L Zhou, Frances S Shofer, Nikita G Desai, Ilona S Lorincz, Nikhil K Mull, David H Adler, John C Greenwood
BACKGROUND: The resuscitation and critical care unit is a novel emergency department-intensive care unit designed to provide early critical care to emergency department patients for ≤24 h. OBJECTIVES: This study sought to identify clinical variables associated with short intensive care unit (ICU) stays in patients with diabetic ketoacidosis (DKA), who commonly require ICU-level care. METHODS: We conducted a retrospective, single-center, cross-sectional study of DKA patients ≥18 years of age who presented to an academic, urban hospital emergency department over 16 months...
November 3, 2018: Journal of Emergency Medicine
Lauren Elizabeth Palk
Nurses commonly encounter patients with type 1 or type 2 diabetes mellitus in their practice. Management of these conditions requires an in-depth knowledge of blood glucose monitoring. It is essential that nurses are aware of normal blood glucose levels, so that they can respond to complications caused by elevated and reduced blood glucose levels. This article aims to enhance nurses' knowledge of the acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state, to assist in their recognition and management in clinical practice...
November 6, 2018: Nursing Standard
Takashi Sasaki
Until date, diabetes treatment has focused on the prevention of chronic complications due to microangiopathy and cardiovascular events as well as acute complications with diabetic ketoacidosis and diabetic hyperosmolar hyperglycemic coma. Recently, the prevention of sarcopenia, a dysnutrition state accompanying aging or obesity in patients with diabetes, has become a new target of diabetes treatment. This article is protected by copyright. All rights reserved.
October 27, 2018: Journal of Diabetes Investigation
Julian Maamari, Sai-Ching J Yeung, Patrick S Chaftari
Immune checkpoint inhibitors are a new class of anticancer drugs recently approved by the US Food and Drug Administration (FDA) for the treatment of various malignancies. Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death protein-1 (PD-1) receptor and blocks its interaction with programmed cell death ligand-1 (PD-L1) and programmed cell death ligand-2 (PD-L2). Pembrolizumab was first approved by the FDA in 2014 for the treatment of advanced melanoma and is currently approved for use in non-small cell lung cancer and several other neoplasms...
October 21, 2018: American Journal of Emergency Medicine
Stephen Melnick, Priya Rajagopalan, Theresa Lynn, Anthony Donato
Context : Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel treatment approved for type 2 diabetes mellitus to lower hyperglycemia, systolic blood pressure, and promote weight loss. Commonly reported serious adverse events include increased mycotic urogenital infections, orthostatic hypotension, and normoglycemic ketoacidosis. Case report : We present a case of a 47-year old man with a history of type 2 diabetes mellitus initiated on the SGLT-2 inhibitor canagliflozin preoperatively before a penile implant, who presented with late postoperative MRSA bacteremia and scrotal abscess requiring implant extraction...
2018: Journal of Community Hospital Internal Medicine Perspectives
Paresh Dandona, Chantal Mathieu, Moshe Phillip, Lars Hansen, Diethelm Tschöpe, Fredrik Thorén, John Xu, Anna Maria Langkilde
OBJECTIVE: This study evaluated the long-term safety and efficacy of dapagliflozin as an adjunct to adjustable insulin in patients with type 1 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS: DEPICT-1 (Dapagliflozin Evaluation in Patients With Inadequately Controlled Type 1 Diabetes) was a randomized (1:1:1), double-blind, placebo-controlled Phase 3 study of dapagliflozin 5 mg and 10 mg in patients with type 1 diabetes (HbA1c , 7.5-10.5% [58-91 mmol/mol]) (NCT02268214)...
October 23, 2018: Diabetes Care
Vijay Gayam, Amrendra Kumar Mandal, Pavani Garlapati, Mazin Khalid, Arshpal Gill, Khalid Mowyad
Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis...
2018: Case Reports in Gastrointestinal Medicine
Jemma Dowsett, Rebecca Humphreys, Robert Krones
Obesity is a global epidemic. Obesity in those with type I diabetes (T1DM) contributes to poor glycemic control and complications. Bariatric surgery as management for obesity is increasing in those with T1DM. However, there is limited data pertaining to these patients and their potential post-operative complications. These complications include severe hyperglycemia and diabetic ketoacidosis (DKA). This case study describes a 43-year-old woman with T1DM whose post-operative period following her bariatric surgery was complicated by euglycemic DKA...
October 17, 2018: Obesity Surgery
Sebastian Hörber, Sarah Hudak, Martin Kächele, Dietrich Overkamp, Andreas Fritsche, Hans-Ulrich Häring, Andreas Peter, Martin Heni
Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus. It usually occurs in patients with type 1 diabetes where it is typically associated with only moderately increased blood glucose. Here, we report the case of a 52-year-old female patient who was admitted to the emergency unit with severely altered mental status but stable vital signs. Laboratory results on admission revealed very high blood glucose (1687 mg/dL/93.6 mmol/L) and severe acidosis (pH <7) with proof of ketone bodies in serum and urine...
September 25, 2018: Endocrinology, Diabetes & Metabolism Case Reports
Obeid Shafi, Virendra Kumar
INTRODUCTION: The optimal fluid therapy in children with DKA is a matter of debate, especially if we take into account its association with cerebral edema, the most important complication. Hypertonic Saline Solution is used in the treatment of cerebral edema, and also has been used for volume resuscitation in children with shock. AIM OF STUDY: To compare the effects of 3% saline and 0.9% saline solutions on changes in vital parameters, sodium and chloride levels, lactate and pH; time needed for the correction of hyperglycemia; time needed for the control of ketoacidosis and incidence of cerebral edema...
2018: Pediatric Endocrinology, Diabetes, and Metabolism
Julio Rosenstock, Jan Marquard, Lori M Laffel, Dietmar Neubacher, Stefan Kaspers, David Z Cherney, Bernard Zinman, Jay S Skyler, Jyothis George, Nima Soleymanlou, Bruce A Perkins
OBJECTIVE: To evaluate the safety and efficacy of empagliflozin 10- and 25-mg doses plus a unique lower dose (2.5 mg) as adjunct to intensified insulin in patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: The EASE (Empagliflozin as Adjunctive to inSulin thErapy) program ( N = 1,707) included two double-blind, placebo-controlled phase 3 trials: EASE-2 with empagliflozin 10 mg ( n = 243), 25 mg ( n = 244), and placebo ( n = 243), 52-week treatment; and EASE-3 with empagliflozin 2...
October 4, 2018: Diabetes Care
Jong Seo Yoon, Kyu Jung Park, Young Bae Sohn, Hae Sang Lee, Jin Soon Hwang
Permanent neonatal diabetes mellitus is most commonly caused by mutations in the ATP-sensitive potassium channel (KATP) subunits. Prompt initiation of sulfonylurea treatment can improve glycemic control in children with KCNJ11 mutation. In this report, we present a case of permanent neonatal diabetes caused by a mutation in the KCNJ11 gene that was successfully treated via early switching of insulin to sulfonylurea treatment. A 53-day-old female infant presented with diabetic ketoacidosis. Insulin was administered for the ketoacidosis and blood glucose regulation...
September 2018: Annals of Pediatric Endocrinology & Metabolism
Marc Xipell, Ricardo Arturo Losno, Carolina Garcia-Vidal, Montserrat Rovira, Izaskun Alejo-Cancho, Jorge Puig de la Bellacasa, Miriam López, Celia Cardozo, Marta Bodro, Josep Mensa, Alex Soriano
BACKGROUND: The most common presentation of mucormycosis in the past was the nasosinusal involvement in patients with diabetic ketoacidosis. However, in the last few years, new groups of patients with risk of mucormycosis have emerged. AIMS AND METHODS: Retrospective analysis of the characteristics, treatment and evolution of patients with mucormycosis in a tertiary hospital in the years 2012-2016. RESULTS: Of the 12 patients included in the study, 7 had a haematological disease as a predisposing factor, most of them (6 patients) related to transplantation of haematopoietic progenitors...
July 2018: Revista Iberoamericana de Micología
Clement Lo, Tadashi Toyama, Ying Wang, Jin Lin, Yoichiro Hirakawa, Min Jun, Alan Cass, Carmel M Hawley, Helen Pilmore, Sunil V Badve, Vlado Perkovic, Sophia Zoungas
BACKGROUND: Diabetes is the commonest cause of chronic kidney disease (CKD). Both conditions commonly co-exist. Glucometabolic changes and concurrent dialysis in diabetes and CKD make glucose-lowering challenging, increasing the risk of hypoglycaemia. Glucose-lowering agents have been mainly studied in people with near-normal kidney function. It is important to characterise existing knowledge of glucose-lowering agents in CKD to guide treatment. OBJECTIVES: To examine the efficacy and safety of insulin and other pharmacological interventions for lowering glucose levels in people with diabetes and CKD...
September 24, 2018: Cochrane Database of Systematic Reviews
TeriSue Smith-Jackson, Mary V Brown, Matthew Flint, Merilee Larsen
AIMS: This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS: 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS: 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39...
November 2018: Journal of Diabetes and its Complications
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