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Tom Konikoff, Tehila Avraham, Ella Ophir, Jacob Bornstein
BACKGROUND: Hyperemesis gravidarum (HG) is characterized by severe intractable nausea and vomiting in pregnancy leading to electrolyte imbalance, ketonuria, and weight loss. The cause is unknown. This study sought to investigate the prevalence and characteristics of HG in the Western Galilee in two ethnic populations and to estimate its economic burden. METHODS: Data on ethnicity, age, gestational age, number of pregnancies, and length of hospitalization were collected from the medical files of all women with HG admitted to the Galilee Medical Center in 2010-2013...
2016: Israel Journal of Health Policy Research
Wataru Munakata, Ken Ohashi, Nobuhiko Yamauchi, Kensei Tobinai
We report the case of a patient with relapsed classical Hodgkin lymphoma who developed fulminant type I diabetes mellitus as a severe adverse event of treatment with the anti-programmed cell death-1 (PD-1) antibody, nivolumab. On the first day of the sixth cycle, the blood glucose level was markedly elevated (375 mg/dL). Although neither ketoacidosis nor ketonuria was detected, the markedly acute onset of the hyperglycemia was consistent with the typical clinical course of fulminant type I diabetes mellitus, and this diagnosis was supported by clinical data...
October 1, 2016: International Journal of Hematology
Nora Luethi, Luca Cioccari, Marco Crisman, Rinaldo Bellomo, Glenn M Eastwood, Johan Mårtensson
BACKGROUND: It is uncertain whether liberal glucose control in critically ill diabetic patients leads to increased ketone production and ketoacidosis. Therefore, we aimed to assess the prevalence of ketosis, ketonuria and ketoacidosis in critically ill diabetic patients treated in accordance with a liberal glycemic control protocol. METHODS: We performed a prospective observational cohort study of 60 critically ill diabetic patients with blood and/or urine ketone bodies tested in ICU...
2016: Critical Care: the Official Journal of the Critical Care Forum
Wei Lin, Chan Chen, Huaqin Guan, Xiaohong Du, Junjian Li
BACKGROUND: Understanding the differences in characteristics, gender, and common causes for admission in hospitalized elderly diabetic patients provides a theoretical basis for their successful management. This study explored the reasons and gender differences in hospitalizations of elderly patients with diabetes mellitus. METHODS: Patients aged ≥60 years who had received a diagnosis of diabetes by the time of discharge, from 1 January 2011 to 1 January 2014, were retrospectively enrolled...
2016: BMC Geriatrics
Flora Ruhangisa, Henry Stephen, Jacob Senkondo, Amos Mwasamwaja, Said Kanenda, Saleh Mbarak, Nyasatu Chamba, Kajiru Kilonzo, William Howlett, Isaack Lyaruu, Elichilia Shao
BACKGROUND: Chorea is a rare complication of uncontrolled type II diabetes. We report for the first time in Tanzania a case of type II diabetes presenting with a hyperglycaemia-induced hemichorea. CASE PRESENTATION: A 58-year-old Tanzanian chagga by tribe with a body mass index of 28 kg/m(2) and newly diagnosed type II diabetes presented with polydipsia and involuntary movements of the right upper limb for 4 days. His plasma glucose was 549 mg/dl and glycated haemoglobin was 18...
2016: BMC Research Notes
Po-Chung Cheng, Shang-Ren Hsu, Yun-Chung Cheng
Objective. This study examined the association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus (T2DM). Methods. A retrospective cross-sectional study was conducted at a medical center in Taiwan. Inclusion criteria were endocrinology ward inpatients exceeding 21 years of age, with preexisting diagnosis of T2DM, and blood glucose above 13.9 millimoles per liter (mmol/L) at admission. Individuals without measurement of serum albumin, urine ketone, or hemoglobin A1C, or harboring active infection, myocardial infarction, cerebrovascular event, cirrhosis, malignancy, or overt proteinuria were excluded...
2016: Journal of Diabetes Research
Brian Appavu, Lisa Vanatta, John Condie, John F Kerrigan, Randa Jarrar
PURPOSE: We aimed to study whether ketogenic diet (KD) therapy leads to resolution of super-refractory status epilepticus in pediatric patients without significant harm. METHOD: A retrospective review was performed at Phoenix Children's Hospital on patients with super-refractory status epilepticus undergoing ketogenic diet therapy from 2011 to 2015. RESULTS: Ten children with super-refractory status epilepticus, ages 2-16 years, were identified...
October 2016: Seizure: the Journal of the British Epilepsy Association
Ji Hyun Park, So Young Shin, Ye Jee Shim, Jin Hyeok Choi, Heung Sik Kim
The incidence of type 1 diabetes is increasing worldwide, and the greatest increase has been observed in very young children under 4 years of age. A case of infantile diabetic ketoacidosis in a 10-month-old male infant was encountered by these authors. The infant's fasting glucose level was 490 mg/dL, his PH was 7.13, his pCO2 was 15 mmHg, and his bicarbonate level was 5.0 mmol/L. The glycosylated hemoglobin level had increased to 9.4%. Ketonuria and glucosuria were detected in the urinalysis. The fasting C-peptide and insulin levels had decreased...
June 2016: Annals of Pediatric Endocrinology & Metabolism
Yuka Miyoshi, Osamu Ogawa, Yu Oyama
Programmed cell death-1 (PD-1), an immunoreceptor, is located on T cells and pro-B cells and interacts with its ligands to inhibit T cell activation and proliferation, thereby promoting immunological self-tolerance. Nivolumab, an anti-PD1 antibody, blocks PD-1 and can restore anticancer immune responses by abrogating PD-1 pathway-mediated T-cell inhibition. Autoimmune adverse events are expected with PD-1 therapy. Fulminant type 1 diabetes is the subtype of type 1 diabetes. The clinical feature is the extremely rapid progression of hyperglycemia and ketoacidosis...
2016: Tohoku Journal of Experimental Medicine
Gulfer Ozturk, A Seval Ozgu-Erdinc, Fatma Ucar, Zeynep Ginis, Gonul Erden, Nuri Danisman
BACKGROUND: Hyperemesis gravidarum (HG), which affects 0.3-2.3% of pregnancies, is defined as excessive vomiting during pregnancy and usually starts in week 4 or 5 of gestation. Symptoms include weight loss, dehydration, ketonaemia, ketonuria, fasting acidosis, alkalosis due to hydrochloric acid loss and hypokalaemia and its exact cause is unknown. The present study was undertaken to investigate the relationship between prealbumin, ghrelin, nesfatin-1 and obestatin concentrations in pregnancies associated with HG METHODS: : A total of 40 pregnant women with HG and 38 pregnant women without HG as controls, were included in this study...
May 27, 2016: Annals of Clinical Biochemistry
Srećko Severinski, Ivona Butorac Ahel, Aleksandar Ovuka, Arijan Verbić
Diabetic ketoacidosis (DKA) is a complex metabolic state characterized by hyperglycemia, metabolic acidosis and ketonuria. Cerebral edema is the most common rare complication of DKA in children. The objective of the study was to emphasize the importance of careful evaluation and monitoring for signs and symptoms of cerebral edema in all children undergoing treatment for DKA. We present a case of 11-year-old girl with a history of diabetes mellitus type I (T1DM) who presented with severe DKA complicated by hypovolemic shock, cerebral edema and hematemesis...
August 1, 2016: Journal of Pediatric Endocrinology & Metabolism: JPEM
Masahide Okamoto, Mitsuhiro Okamoto, Koro Gotoh, Takayuki Masaki, Yoshinori Ozeki, Hisae Ando, Manabu Anai, Asami Sato, Yuichi Yoshida, So Ueda, Tetsuya Kakuma, Hirotaka Shibata
Anti-programmed cell death-1 (PD-1) antibodies are regarded as a risk factor for insulin-dependent diabetes mellitus as a side effect. While a small number of cases have been reported, evidence remains limited. This is the first report of an Asian patient developing insulin-dependent diabetes during anti-PD-1 therapy. A 55-year-old euglycemic woman receiving nivolumab for malignant melanoma showed abrupt onset of ketonuria and elevated levels of plasma glucose (580 mg/dl) and hemoglobin (Hb)A1c (7.0%). Over the next 2 weeks, serum C-peptide levels fell below the limit of detection...
April 18, 2016: Journal of Diabetes Investigation
M L Moreno-Cortés, A G Gutiérrez-García, G Guillén-Ruiz, T Romo-González, C M Contreras
Anxiety and depression in diabetic patients contributes to a poor prognosis, but possible causal relationships have been controversial. Anxiety, fear, and anhedonia are mediated by interactions between different deep structures of the temporal lobe (e.g., amygdala complex and hippocampus) and other forebrain-related structures (e.g., lateral septal nucleus). Connections between these structures and the hypothalamic orexinergic system are necessary for the maintenance of energy and wakefulness. However, few studies have explored the impact of long-term hyperglycemia in these structures on anxiety...
September 1, 2016: Behavioural Brain Research
Anne L Peters, Robert R Henry, Payal Thakkar, Cindy Tong, Maria Alba
OBJECTIVE: To assess the incidence of serious adverse events (AEs) of diabetic ketoacidosis (DKA) with canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as an add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: In this 18-week, randomized, double-blind, phase 2 study, patients (N = 351; HbA1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion received canagliflozin 100 or 300 mg or placebo once daily...
April 2016: Diabetes Care
Edyta Szymańska, Dariusz Rokicki, Urszula Wątrobinska, Elżbieta Ciara, Paulina Halat, Rafał Płoski, Anna Tylki-Szymańka
BACKGROUND: Glycogen synthase deficiency (glycogen storage disease 0 - GSD 0) caused by mutations in the GYS2 gene is characterized by a lack of glycogen synthesis in the liver. It is a rare condition of disturbed glycogen homeostasis in the liver with less than 30 cases reported in the literature so far. CASE REPORT: We report a 9 year old boy diagnosed with GSD 0 due to the newly identified, highly pathogenic homozygous mutation: NM_021957.3:p.Phe574Leu/c.1720T > C in ex...
September 2015: Molecular Genetics and Metabolism Reports
Carmen Diez-Fernandez, Véronique Rüfenacht, Saikat Santra, Allan M Lund, René Santer, Martin Lindner, Trine Tangeraas, Caroline Unsinn, Pascale de Lonlay, Alberto Burlina, Clara D M van Karnebeek, Johannes Häberle
PURPOSE: Four mitochondrial metabolic liver enzymes require bicarbonate, which is provided by the carbonic anhydrase isoforms VA (CAVA) and VB (CAVB). Defective hepatic bicarbonate production leads to a unique combination of biochemical findings: hyperammonemia, elevated lactate and ketone bodies, metabolic acidosis, hypoglycemia, and excretion of carboxylase substrates. This study aimed to test for CAVA or CAVB deficiencies in a group of 96 patients with early-onset hyperammonemia and to prove the disease-causing role of the CAVA variants found...
October 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Sufin Yap, Huey Yin Leong, Fadzlina Abdul Aziz, Haszlin Hassim, Pavai Sthaneshwar, Ser Huy Teh, Ili Syazwana Abdullah, Lock Hock Ngu, Zulqarnain Mohamed
N-carbamylglutamate (NCG) has been used in combination with ammonia scavengers (sodium benzoate, sodium phenylbutyrate) and dialysis to treat hyperammonaemia in methylmalonic aciduria (MMA). The sole use of NCG for acute neonatal hyperammonaemia secondary to MMA is demonstrated in a neonate presenting at day 9 with encephalopathy, severe metabolic acidosis, hyperammonaemia (1,089 μmol/l), ketonuria and urinary methylmalonic acids. Emergency treatment included discontinuing protein feeds, providing high calories, carnitine and hydroxocobalamin...
2016: Neonatology
Loukia Spanou, Kalliopi Dalakleidi, Konstantia Zarkogianni, Anastasia Papadimitriou, Konstantina Nikita, Vasiliki Vasileiou, Maria Alevizaki, Eleni Anastasiou
BACKGROUND: The use of capillary blood 3-β-hydroxybutyrate (3HB) is a more precise method than urine ketones measurement for the diagnosis of diabetic ketoacidosis. Fasting ketonuria is common during normal pregnancy, while there is evidence that it is increased among pregnant women with Gestational Diabetes Mellitus (GDM) who are on a diet. 3HB levels have been related to impaired offspring psychomotor development. Reports with concomitant measurement of blood and urine ketones in women with GDM who followed a balanced diet are lacking...
October 2015: Hormones: International Journal of Endocrinology and Metabolism
Vanessa R Biegen, John P McCue, Taryn A Donovan, G Diane Shelton
A 1-year-old spayed female Shih Tzu presented for episodic abnormalities of posture and mentation. Neurological examination was consistent with a bilaterally symmetric multifocal encephalopathy. The dog had a waxing-and-waning hyperlactemia and hypoglycemia. Magnetic resonance imaging revealed bilaterally symmetric cavitated lesions of the caudate nuclei with less severe abnormalities in the cerebellar nuclei. Empirical therapy was unsuccessful, and the patient was euthanized. Post-mortem histopathology revealed bilaterally symmetric necrotic lesions of the caudate and cerebellar nuclei and multi-organ lipid accumulation, including a lipid storage myopathy...
2015: Frontiers in Veterinary Science
Jillian DiFazio, Daniel J Fletcher
OBJECTIVE: To determine whether early insulin administration (≤6 h after admission) results in more rapid resolution of diabetic ketosis (DK) and ketoacidosis (DKA), shorter duration of hospitalization, and higher incidence of complications, and whether more severe ketonuria is associated with longer time to resolution of DK/DKA. DESIGN: Retrospective study (January 1, 2003-March 1, 2013). SETTING: University teaching hospital. ANIMALS: Sixty dogs and cats with DK or DKA receiving short-acting insulin therapy...
January 2016: Journal of Veterinary Emergency and Critical Care
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