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management ketoacidosis

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https://www.readbyqxmd.com/read/29770221/risperidone-induced-type-2-diabetes-presenting-with-diabetic-ketoacidosis
#1
Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen, Francis M Finucane
A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2 ). Dipstick urinalysis showed ketonuria and glycosuria...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29768296/pediatric-diabetic-ketoacidosis-with-hypotensive-shock-and-rash-an-unusual-presentation
#2
Yehonatan Pasternak, Omer Niv, Yehezkel Hezi Waisman
We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29753318/successful-pregnancy-in-maple-syrup-urine-disease-a-case-report-and-review-of-the-literature
#3
Sarah Catharina Grünert, Stefanie Rosenbaum-Fabian, Anke Schumann, Karl Otfried Schwab, Nadja Mingirulli, Ute Spiekerkoetter
BACKGROUND: Maple syrup urine disease (MSUD) is an autosomal recessive disorder of branched-chain amino acid metabolism. Patients with MSUD are at risk of life-threatening metabolic decompensations with ketoacidosis and encephalopathy. These episodes are often triggered by physiological stress. Only few cases of pregnancies in MSUD mothers have been reported so far. CASE PRESENTATION: We present the favorable outcome of a pregnancy in a woman with classical MSUD...
May 12, 2018: Nutrition Journal
https://www.readbyqxmd.com/read/29735574/management-of-type-1-diabetes-with-a-very-low-carbohydrate-diet
#4
Belinda S Lennerz, Anna Barton, Richard K Bernstein, R David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T Rhodes, Cara B Ebbeling, Eric C Westman, William S Yancy, David S Ludwig
OBJECTIVES: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events...
May 7, 2018: Pediatrics
https://www.readbyqxmd.com/read/29716801/eruptive-xanthoma-in-the-setting-of-hypertriglyceridemia-and-pancreatitis
#5
Matthew Stark, Jonathan Stuart
BACKGROUND: Undifferentiated dermatologic complaints are often encountered in the emergency department. While a patient's exposures, risk factors, and comorbidities may help guide emergency department evaluation, the accurate diagnosis of dermatologic findings is critical to allowing rapid identification and treatment of disease. CASE: In this vignette we discuss a case of eruptive xanthoma in a 33-year-old male with diabetic ketoacidosis and pancreatitis. DISCUSSION: Dermatologic complaints pose a unique challenge to the emergency physician...
April 25, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29713649/treatment-discontinuation-and-clinical-events-in-type-2-diabetes-patients-treated-with-dipeptidyl-peptidase-4-inhibitors-or-nph-insulin-as-third-line-therapy
#6
Cristiano S Moura, Zale B Rosenberg, Michal Abrahamowicz, Sasha Bernatsky, Hassan Behlouli, Louise Pilote
Objective: To compare dipeptidyl peptidase-4 (DPP-4) inhibitors with neutral protamine Hagedorn (NPH) insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2) not controlled on metformin and sulfonylureas. Methods: A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations...
2018: Journal of Diabetes Research
https://www.readbyqxmd.com/read/29698339/disparities-in-adherence-to-pediatric-diabetic-ketoacidosis-management-guidelines-across-a-spectrum-of-emergency-departments-in-the-state-of-indiana-an-observational-in-situ-simulation-based-study
#7
Kamal Abulebda, Samer Abu-Sultaneh, Erin E White, Michele L Kirby, Brian C Phillips, Courtney T Frye, Lee D Murphy, Riad Lutfi
BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported. OBJECTIVES: We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29692258/early-occurrence-cases-of-diabetes-mellitus-clinical-picture-in-two-major-tertiary-care-hospitals-in-india
#8
Nitin Joseph, Shreya Sharma, Vinisha Modi, Sanath Majunatha, Saad Arshad Siddiqui, Mihika Sinha
INTRODUCTION: Type 1 diabetes mellitus (T1D) is one of the most common endocrine disease in childhood. However, very limited information is available on this disease. OBJECTIVES: This study was done to assess risk factors, clinical features and management practices in T1D patients. METHODS: A review of records of 39 T1D cases admitted over the past five years in two hospitals was done. RESULTS: The mean age at diagnosis among males was 19...
April 24, 2018: Current Diabetes Reviews
https://www.readbyqxmd.com/read/29666080/eye-for-an-eye-near-fatal-outcome-of-fungal-infection-in-a-young-diabetic-girl
#9
Fedja I Vos, Sietze Reitsma, Gwijde F J P M Adriaensen, Wytske J Fokkens
In this report, we describe the case of a young, diabetic girl with ketoacidosis who suffered sudden loss of vision of the right eye. The loss of vision was caused by an invasive rhino-orbital-cerebral fungal infection (mucormycosis) with extensive periorbital thrombosis. Despite maximal antifungal and surgical treatment (including exenteration of the right orbit), the clinical situation deteriorated. It was only after overcoming the difficulties of managing her hyperglycaemia that the patient's condition stabilised and her life was saved...
April 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29628184/the-two-bag-method-for-treatment-of-diabetic-ketoacidosis-in-adults
#10
Nathan L Haas, Roma Y Gianchandani, Kyle J Gunnerson, Benjamin S Bassin, Arun Ganti, Christopher Hapner, Caryn Boyd, James A Cranford, Sage P Whitmore
BACKGROUND: The "two-bag method" of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant. OBJECTIVE: We aimed to evaluate the feasibility and potential benefits of this strategy in adult emergency department (ED) patients with DKA. METHODS: This is a before-and-after comparison of a protocol using the two-bag method operationalized in our adult ED in 2015...
April 5, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29622578/relationship-between-islet-autoantibody-status-and-the-clinical-characteristics-of-children-and-adults-with-incident-type-1-diabetes-in-a-uk-cohort
#11
Vassiliki Bravis, Akaal Kaur, Helen C Walkey, Ian F Godsland, Shivani Misra, Polly J Bingley, Alistair J K Williams, David B Dunger, Colin M Dayan, Mark Peakman, Nick S Oliver, Desmond G Johnston
OBJECTIVES: To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive. DESIGN: Observational cohort study. SETTING: 146 mainly secondary care centres across England and Wales. PARTICIPANTS: 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network...
April 4, 2018: BMJ Open
https://www.readbyqxmd.com/read/29611621/perception-attitude-and-satisfaction-of-paediatric-physicians-and-nurses-towards-clinical-practice-guidelines-at-a-university-teaching-hospital
#12
Yasser Sami Amer, Abdulrahman Al Nemri, Mohamed Elfaki Osman, Elshazaly Saeed, Asaad Mohamed Assiri, Sarar Mohamed
RATIONALE, AIMS, AND OBJECTIVES: To explore perception, attitude, and satisfaction of paediatric clinicians, trainees, and nurses at King Khalid University Hospital towards clinical practice guidelines (CPGs) including the locally adapted diabetic ketoacidosis CPG (DKA-CPG). METHODS: A cross-sectional survey was distributed to 260 doctors and nurses working in the paediatrics department. RESULTS: The response rate was 95.4%. The respondents had a positive perception and attitude towards general CPGs and specifically for the DKA-CPG; 98...
April 3, 2018: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29600506/prediabetes-directly-deteriorates-into-diabetic-ketoacidosis-and-hyperosmolar-hyperglycemic-syndrome-triggered-by-acute-pancreatitis-a-case-report-illustrating-a-chicken-and-egg-paradigm-in-ketosis-prone-diabetes
#13
Runbo Song, Shanjin Cao
INTRODUCTION: Diabetic crises occur most often in patients with type 1 diabetes and occasionally in type 2 diabetes, especially under stressful conditions. However, a diabetic crisis occurring directly from prediabetes is an unusual phenomenon. CASE REPORT: A 45-year-old woman presented with postprandial left upper quadrant abdominal pain, nausea, and vomiting. She had a past medical history of prediabetes with impaired fasting glucose and HbA1c 6.4%. On admission, routine laboratory tests showed high anion gap metabolic acidosis (pH 6...
March 29, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29582531/metabolic-control-of-type-1-diabetes-in-youth-with-autism-spectrum-disorder-a-multicenter-diabetes-patienten-verlaufsdokumentation-analysis-based-on-61-749-patients-up-to-20-years-of-age
#14
J-F Lemay, S Lanzinger, D Pacaud, P L Plener, A Fürst-Burger, T Biester, D Hilgard, E Lilienthal, A Galler, G Berger, R W Holl
BACKGROUND: A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). OBJECTIVE: To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD). METHODS: Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017...
March 26, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29575401/previously-undiagnosed-attention-deficit-hyperactivity-disorder-associated-with-poor-metabolic-control-in-adolescents-with-type-1-diabetes
#15
C Nylander, K Lindström, N Khalifa, E Fernell
BACKGROUND: Managing modern diabetes treatment requires efficient executive functions. Patients with attention-deficit/hyperactivity disorder (ADHD) and type 1 diabetes have poor metabolic control and present with ketoacidosis more often than patients without ADHD. OBJECTIVE: To assess whether patients with type 1 diabetes and with indications of executive problems met criteria for ADHD, and to investigate whether these patients had difficulties achieving metabolic control...
March 24, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29573523/presenting-predictors-and-temporal-trends-of-treatment-related-outcomes-in-diabetic-ketoacidosis
#16
Christopher M Horvat, Heba M Ismail, Alicia K Au, Luigi Garibaldi, Nalyn Siripong, Sajel Kantawala, Rajesh K Aneja, Diane S Hupp, Patrick M Kochanek, Robert S B Clark
OBJECTIVE: This study examines temporal trends in treatment-related outcomes surrounding a diabetic ketoacidosis (DKA) performance improvement intervention consisting of mandated intensive care unit admission and implementation of a standardized management pathway, and identifies physical and biochemical characteristics associated with outcomes in this population. METHODS: A retrospective cohort of 1,225 children with DKA were identified in the electronic health record by International Classification of Diseases codes and a minimum pH less than 7...
March 24, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29568696/aplastic-anemia-secondary-to-nivolumab-and-ipilimumab-in-a-patient-with-metastatic-melanoma-a-case-report
#17
D E Meyers, W F Hill, A Suo, V Jimenez-Zepeda, T Cheng, N A Nixon
Background: Immune checkpoint blockade (ICB) is becoming an increasingly prevalent strategy in the clinical realm of cancer therapeutics. With more patients being administered ICB for a host of tumor types, the scope of adverse events associated with these drugs will likely grow. Here we report a case of aplastic anemia (AA) in a patient with metastatic melanoma secondary to dual ICB therapy. To our knowledge, this is only the second case of AA secondary to dual ICB in the literature, and the first to have a positive patient outcome...
2018: Experimental Hematology & Oncology
https://www.readbyqxmd.com/read/29563012/diabetes-in-childhood-and-adolescence
#18
Ralph Ziegler, Andreas Neu
BACKGROUND: The incidence of type 1 diabetes mellitus in childhood and adolescence is steadily rising and now stands at 22.9 new cases per year per 100 000 persons up to age 15. METHODS: This review is based on pertinent publications retrieved by a selective literature search, with special attention to the current German S3 guideline on diabetes in childhood and adolescence. RESULTS: Polydipsia, polyuria, and weight loss are the characteristic presenting symptoms of diabetes mellitus...
March 2, 2018: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29559406/working-party-approved-by-the-french-society-of-anaesthesia-and-intensive-care-medicine-sfar-and-the-french-society-for-the-study-of-diabetes-sfd
#19
Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
In diabetic patients undergoing surgery, we recommend assessing glycaemic control preoperatively by assessing glycated haemoglobin (HbA1c) levels and recent capillary blood sugar (glucose) levels, and to adjust any treatments accordingly before surgery, paying particular attention to specific complications of diabetes. Gastroparesis creates a risk of stasis and aspiration of gastric content at induction of anaesthesia requiring the use of a rapid sequence induction technique. Cardiac involvement can be divided into several types...
March 17, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29557753/hyperglycemic-hyperosmolar-state-a-pragmatic-approach-to-properly-manage-sodium-derangements
#20
Marco Baldrighi, Pier Paolo Sainaghi, Mattia Bellan, Ettore Bartoli, Luigi Mario Castello
INTRODUCTION: Although hypovolemia remains the most relevant problem during acute decompensated diabetes in its clinical manifestations (diabetic ketoacidosis, DKA, and hyperglycemic hyperosmolar state, HHS), the electrolyte derangements caused by the global hydroelectrolytic imbalance usually complicate the clinical picture at presentation and may be worsened by treatment itself. AIM: This review article is focused on the management of dysnatremias during hyperglycemic hyperosmolar state with the aim of providing clinicians a useful tool to early indentify the sodium derangement in order to address properly its treatment...
March 19, 2018: Current Diabetes Reviews
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