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alcoholic ketoacidosis

Monique Mostert, Anthony Bonavia
BACKGROUND Besides providing anesthesia for surgery, the anesthesiologist's role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient's perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient's surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient's anesthetic management...
October 18, 2016: American Journal of Case Reports
Ryan S Gerrity, Anthony F Pizon, Andrew M King, Kenneth D Katz, Nathan B Menke
BACKGROUND: Alcoholic ketoacidosis (AKA) is a complex syndrome that results from disrupted metabolism in the setting of excessive alcohol use and poor oral intake. Dehydration, glycogen depletion, high redox state, and release of stress hormones are the primary factors producing the characteristic anion gap metabolic acidosis with an elevated β-hydroxybutyrate (β-OH) and lactate. CASE REPORT: We present the case of a 47-year-old man who presented to the emergency department with metabolic acidosis and profoundly elevated lactate levels who had AKA...
October 2016: Journal of Emergency Medicine
Po-Jen Chien, Ming Ye, Takuma Suzuki, Koji Toma, Takahiro Arakawa, Yasuhiko Iwasaki, Kohji Mitsubayashi
Isopropanol (IPA) is an important solvent used in industrial activity often found in hospitals as antiseptic alcohol rub. Also, IPA may have the potential to be a biomarker of diabetic ketoacidosis. In this study, an optical biosensor using NADH-dependent secondary alcohol dehydrogenase (S-ADH) for IPA measurement was constructed and evaluated. An ultraviolet light emitting diode (UV-LED, λ=340nm) was employed as the excitation light to excite nicotinamide adenine dinucleotide (NADH). A photomultiplier tube (PMT) was connected to a two-way branch optical fiber for measuring the fluorescence emitted from the NADH...
October 1, 2016: Talanta
Nimrah Bader, Lubna Mirza
We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin...
May 2016: Pakistan Journal of Medical Sciences Quarterly
Cristian Palmiere, Camilla Tettamanti, Marc Augsburger, Sandra Burkhardt, Sara Sabatasso, Christelle Lardi, Dominique Werner
Significantly increased blood ketone body levels can be occasionally observed in the forensic setting in situations other than exposure to cold, diabetic or alcoholic ketoacidosis. Though infrequent, these cases do occur and deserve thorough evaluation in order to establish appropriate differential diagnoses and quantify the role that hyperketonemia may play in the death process. Starvation ketoacidosis is a rare cause of metabolic acidosis and is a phenomenon that occurs normally during fasting, as the body switches from carbohydrate to lipid energy sources...
August 2016: Journal of Forensic and Legal Medicine
S L Belsey, R J Flanagan
The results of biochemical analyses in specimens obtained postmortem may aid death investigation when diabetic and alcoholic ketoacidosis is suspected, when death may have been the result of drowning, anaphylaxis, or involved a prolonged stress response such as hypothermia, and in the diagnosis of disease processes such as inflammation, early myocardial infarction, or sepsis. There is often cross-over with different disciplines, in particular with clinical and forensic toxicology, since some endogenous substances such as sodium chloride, potassium chloride, and insulin can be used as poisons...
July 2016: Journal of Forensic and Legal Medicine
Anar Modi, Abhinav Agrawal, Farah Morgan
INTRODUCTION: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterised by the triad of hyperglycemia (blood sugar >250 mg/dl), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L) and ketosis. Rarely these patients can present with blood glucose (BG) levels of less than 200 mg/dl, which is defined as euglycemic DKA. The possible etiology of euglycemic DKA includes the recent use of insulin, decreased caloric intake, heavy alcohol consumption, chronic liver disease and glycogen storage disorders...
April 21, 2016: Current Diabetes Reviews
Yehuda Handelsman, Robert R Henry, Zachary T Bloomgarden, Sam Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Ele Ferrannini, Vivian A Fonseca, Alan J Garber, George Grunberger, Derek LeRoith, Guillermo E Umpierrez, Matthew R Weir
AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology DKA = diabetic ketoacidosis EMA = European Medicines Agency FDA = U.S. Food and Drug Administration SGLT-2 = sodium glucosecotransporter 2 T1D = type 1 diabetes T2D = type 2 diabetes.
June 2016: Endocrine Practice
Alexander H Flannery, David A Adkins, Aaron M Cook
OBJECTIVE: Patients with a chronic alcohol use disorder presenting to the ICU may be deficient in important vitamins and electrolytes and are often prescribed a "banana bag" as a reflexive standard of therapy. The difficulty of diagnosing Wernicke's encephalopathy in the critical care setting is reviewed. Furthermore, whether the contents and doses of micronutrients and electrolytes in standard banana bags meet the needs of critically ill patients with an alcohol use disorder is assessed based on available evidence...
August 2016: Critical Care Medicine
Nurulamin M Noor, Krishna Basavaraju, Dan Sharpstone
Alcoholic ketoacidosis (AKA) is a cause of severe metabolic acidosis usually occurring in malnourished patients with a history of recent alcoholic binge, often on a background of alcohol dependency. AKA can be fatal due to associated electrolyte abnormalities and subsequent development of cardiac arrhythmias. This is a diagnosis that is often delayed or missed, in patients who present with a severe lactic and ketoacidosis. Here we report the case of a 64-year-old female who presented with generalized abdominal pain, nausea and shortness of breath...
March 2016: Oxford Medical Case Reports
Ignasi Galtés, María Ángeles Gallego, Raquel Esgueva, Carles Martin-Fumadó
A 54-year-old man was admitted to hospital after being found unconscious in his home. He had a history of alcoholism, multiple drug addictions, and type I diabetes mellitus. At admission, he had hyperglycaemia (550 mg/dL) with glucosuria and ketone bodies in the urine, along with septic shock refractory to bilateral alveolar infiltrates and severe respiratory failure. The patient died 24 hours post admission due to multiple organ failure, with diabetic ketoacidosis decompensated by possible respiratory infection in a patient with polytoxicomania...
March 2016: Revista Española de Enfermedades Digestivas
Sarah Gleeson, Eoin Mulroy, David E Clarke
A 31-year-old woman presented to the hospital with symptoms of nausea, malaise, and emesis. She was breastfeeding her 10-month-old infant. She was found to have severe ketoacidosis. The patient was not in diabetic ketoacidosis or alcoholic ketoacidosis; nor had she ingested any toxins. After she was admitted to the hospital, received intravenous fluids, and stopped breastfeeding, her symptoms resolved. She was found to have lactation ketoacidosis, an uncommon condition in humans. A review of all causes of ketoacidosis is presented with special emphasis on lactation ketocacidosis...
2016: Permanente Journal
H Cooper, A Tekiteki, M Khanolkar, G Braatvedt
AIM: To perform a detailed analysis of patients with recurrent diabetic ketoacidosis admissions in order to establish risk factors for readmission. METHODS: The medical records of all adults and young people (> 15 years) with Type 1 diabetes admitted to Auckland City Hospital over a 15-year period from 1997 to 2011 with a primary diagnosis of ketoacidosis were analysed. Patients readmitted with ketoacidosis within 5 years of their index admission were identified and compared with patients without ketoacidosis readmission who were matched for age, gender, ethnicity and duration of diabetes...
April 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Poorani Goundan, Ana Junqueira, Donna Kelleher-Yassen, Devin Steenkamp
The aim of this paper is to review the relevant literature related to the epidemiology, pathophysiology, natural history, clinical features and treatment of fibrocalculous pancreatic diabetes (FCPD). We review the English-language literature on this topic published between 1956 and 2014. FCPD is a form of diabetes usually associated with chronic calcific pancreatitis. It has been predominantly, though not exclusively, described in lean, young adults living in tropical developing countries. Historically linked to malnutrition, the etiology of this phenotype has not been clearly elucidated, nor has there been a clear consensus on specific diagnostic criteria or clinical features...
March 2016: Minerva Endocrinologica
Jonas Wuopio, Regina Schiborr, Georgios Charalampakis
Ketoacidosis is a life threatening condition usually caused by diabetes mellitus or alcohol. In this case report we present a lactating woman who developed a severe ketoacidosis a few weeks post partum. Her nutritional status was inadequate due to illness and a diet low on carbohydrates. Five case reports regarding ketoacidosis in lactating women have previously been described in the literature. This case report highlights the importance of nutrition during periods of breast feeding.
2015: Läkartidningen
Eugene M Tan, Ejaaz Kalimullah, M Rizwan Sohail, Kannan Ramar
The approach to the patient with acute renal failure and elevated anion and osmolal gap is difficult. Differential diagnoses include toxic alcohol ingestion, diabetic or starvation ketoacidosis, or 5-oxoproline acidosis. We present a 76-year-old female with type 2 diabetes mellitus, who was found at home in a confused state. Laboratory analysis revealed serum pH 6.84, bicarbonate 5.8 mmol/L, pCO2 29 mmHg, anion gap 22.2 mmol/L, osmolal gap 17.4 mOsm/kg, elevated beta-hydroxybutyrate (4.2 mmol/L), random blood sugar 213 mg/dL, creatinine 2...
2015: Case Reports in Critical Care
Lena Håglin
Hypophosphatemia (HP) with or without intracellular depletion of inorganic phosphate (Pi) and adenosine triphosphate has been associated with central and peripheral nervous system complications and can be observed in various diseases and conditions related to respiratory alkalosis, alcoholism (alcohol withdrawal), diabetic ketoacidosis, malnutrition, obesity, and parenteral and enteral nutrition. In addition, HP may explain serious muscular, neurological, and haematological disorders and may cause peripheral neuropathy with paresthesias and metabolic encephalopathy, resulting in confusion and seizures...
June 2016: Nutritional Neuroscience
Ellie Souganidis, Margaret Grala, Jeffrey Chinsky
A previously healthy 6-year-old child presented to our emergency department after a brief seizure associated with hypoglycemia. The differential diagnosis of hypoglycemia can often lead to excessive testing and initiation of unnecessary therapies. It is well-known that alcohol ingestion can lead to hypoglycemia and potentially seizure in children and should be considered in pediatric patients with altered mental status. However, this child's presenting ethanol level was normal. Nonetheless, there were multiple clues that this was the most likely the following diagnosis: hypoglycemia, mild metabolic ketoacidosis with no osmolar gap, and transient lactic acidemia...
March 2016: Pediatric Emergency Care
Tadanobu Matsuzaki, Wataru Shiraishi, Yasutaka Iwanaga, Akifumi Yamamoto
We report a 55 year old Japanese man with a history of alcohol abuse, who was in a near fasting state for the previous few days.He was admitted to our hospital with abrupt disturbance of consciousness. He presented disturbance of consciousness with extreme hypoglycemia and ketoacidosis with high β-hydroxybutyric acid concentration. Taking into account his living history, we diagnosed with alcoholic ketoacidosis (AKA). Symptoms ameliorated with glucose injection and fluid loading. AKA patients show abdominal pain, nausea or vomiting, but they are usually alert and lucid despite the severe acidosis...
March 1, 2015: Journal of UOEH
Veysel Nijat Baş, Salih Uytun, Yasemin Altuner Torun
Real euglycemic diabetic ketoacidosis [DKA; blood glucose <200 mg/dL (11.1 mmol/L)] is rare, and long-lasting starvation conditions due to intervening diseases in type 1 diabetes mellitus patients may also cause it. Euglycemic DKA is also reported in insulin-dependent diabetics with depression, alcoholics, glycogen storage diseases, and chronic liver disease apart from pregnant cases. This case report is presented to emphasize the importance of evaluation of acid-base state, urine glucose, and ketone values at the application in all newly diagnosed type 1 diabetic patients with normal glucose levels by defining euglycemic DKA that resulted from long-lasting starvation during Ramadan fasting in a newly diagnosed 14-year-old male patient...
March 2015: Journal of Pediatric Endocrinology & Metabolism: JPEM
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