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https://www.readbyqxmd.com/read/28099783/ketosis-and-diabetic-ketoacidosis-in-response-to-sglt2-inhibitors-basic-mechanisms-and-therapeutic-perspectives
#1
REVIEW
Hongyu Qiu, Aleksandra Novikov, Volker Vallon
Inhibitors of the sodium-glucose cotransporter SGLT2 are a new class of anti-hyperglycemic drugs that have been approved for the treatment of type 2 diabetes mellitus (T2DM). These drugs inhibit glucose reabsorption in the proximal tubules of the kidney thereby enhancing glucosuria and lowering blood glucose levels. Additional consequences and benefits include a reduction in body weight, uric acid levels, and blood pressure. Moreover, SGLT2 inhibition can have protective effects on the kidney and cardiovascular system in patients with T2DM and high cardiovascular risk...
January 18, 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/28098426/dapagliflozin-in-patients-with-type-1-diabetes-a-post-hoc-analysis-of-the-effect-of-insulin-dose-adjustments-on-24-hour-continuously-monitored-mean-glucose-and-fasting-beta-hydroxybutyrate-levels-from-a-phase-iia-pilot-study
#2
Robert R Henry, Paresh Dandona, Jeremy Pettus, Sunder Mudaliar, John Xu, Lars Hansen
AIMS: To investigate the effects of total daily insulin dose (TDD) reductions on 24-hour continuously monitored mean glucose and fasting beta-hydroxybutyrate (a marker for diabetic ketosis/ketoacidosis [DKA]) using patient-level data from a 14-day, pilot study of dapagliflozin in type 1 diabetes. MATERIALS AND METHODS: Exploratory correlation analysis was performed post-hoc to determine the relationship between change in TDD and a) 24-hour mean glucose (by continuous glucose monitoring) and b) fasting beta-hydroxybutyrate, in 70 patients with type 1 diabetes receiving insulin and dapagliflozin (1-, 2...
January 18, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28090049/thyroid-storm-precipitated-by-diabetic-ketoacidosis-and-influenza-a-a-case-report-and-literature-review
#3
Toshiyuki Ikeoka, Hiroaki Otsuka, Naruhiro Fujita, Yukiko Masuda, Shigeto Maeda, Ichiro Horie, Takao Ando, Norio Abiru, Atsushi Kawakami
A 46-year-old woman with a history of Graves' disease presented with the chief complaints of appetite loss, weight loss, fatigue, nausea, and sweating. She was diagnosed with diabetic ketoacidosis (DKA), thyroid storm, and influenza A. She was treated with an intravenous insulin drip, intravenous fluid therapy, intravenous hydrocortisone, oral potassium iodine, and oral methimazole. As methimazole-induced neutropenia was suspected, the patient underwent thyroidectomy. It is important to maintain awareness that thyroid storm and DKA can coexist...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28077344/detection-of-h-fabp-heart-type-fatty-acid-binding-protein-levels-in-diabetic-ketoacidosis-and-identification-of-early-cardiac-effects-of-ketoacidosis
#4
Fatma Hilal Yılmaz, Sevil Arı Yuca, Hüsamettin Vatansev, Emine Ayça Cimbek, Yaşar Şen, İsa Yılmaz, Fikret Akyürek, Derya Arslan, Derya Çimen, Alaadin Yorulmaz
OBJECTIVE: This is study aims to measure the level of serum heart-type fatty acid binding protein (h-FABP) in patients presenting with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) and to determine its role in identifying early period cardiac ischemia. METHODS: This prospective study included 35 patients diagnosed with DKA, 20 patients diagnosed with DK, and 20 control subjects.The h-FABP, creatine kinase-MB (CK-MB), and troponin-I levels were studied in patients with DKA and DK as well as in the control group at the time of presentation...
January 12, 2017: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28070957/controlled-trial-of-hartmann-s-solution-versus-0-9-saline-for-diabetic-ketoacidosis
#5
Michael Yung, Georgia Letton, Steve Keeley
AIM: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS). METHODS: We conducted a double-blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA. Patients were stratified by severity (pH < 7.1) and known or new diabetes...
January 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28062431/disseminated-histoplasmosis-presenting-as-diabetic-keto-acidosis-in-an-immunocompetent-patient
#6
Negin Niknam, Prashant Malhotra, Angela Kim, Seth Koenig
Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole...
January 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28049242/factors-associated-with-the-presence-and-severity-of-diabetic-ketoacidosis-at-diagnosis-of-type-1-diabetes-in-korean-children-and-adolescents
#7
Hye Jin Lee, Hyeoh Won Yu, Hae Woon Jung, Young Ah Lee, Jae Hyun Kim, Hye Rim Chung, Jaeho Yoo, Eunyoung Kim, Jeesuk Yu, Choong Ho Shin, Sei Won Yang, Seong Yong Lee
The aim of this study was to identify the risk factors for presence and severity of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in Korean children and adolescents. A retrospective chart review of children and adolescents newly diagnosed with T1DM was conducted in seven secondary and tertiary centers in Korea. Eligible subjects were < 20 years of age and had records on the presence or absence of DKA at the time of T1DM diagnosis. DKA severity was categorized as mild, moderate, or severe...
February 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28044993/higher-than-conventional-subcutaneous-regular-insulin-doses-following-diabetic-ketoacidosis-are-associated-with-better-short-term-glycemic-control-in-children-and-adolescents
#8
Özlem Bağ, Selma Tunç, Özlem Nalbantoğlu, Çiğdem Ecevit, Aysel Öztürk, Behzat Özkan, Korcan Demir
OBJECTIVE: While some guidelines recommend 0.5-1.0 units/kg/d of subcutaneous insulin following resolution of diabetic ketoacidosis (DKA), up to 2 units/kg/d of insulin is used in various centers. The aim of this study is to evaluate the effect of initial insulin dosage on glycemic control in first 48 hours of subcutaneous regular insulin therapy after DKA. METHODS: Hospital records of patients with DKA in the last 3 years [n=76, median (25th - 75th percentile) age=10...
December 30, 2016: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28034690/impact-of-diabetic-ketoacidosis-on-thyroid-function-tests-in-type-1-diabetes-mellitus-patients
#9
Homeira Rashidi, Seyed Bahman Ghaderian, Seyed Mahmoud Latifi, Forogh Hoseini
The aim of current study was to evaluate the function of thyroid during diabetic acidosis, just after the treatment and two weeks after the treatment. This was the analytic study. The study subjects included 20 patients, aged 18-36 years old, with type1 diabetes and diabetic ketoacidosis. All subjects were evaluated for thyroid function tests such as triiodothyronine (T3), thyroxine (T4), T3 resin uptake (T3RU), free T3 (FT3), free T4 (FT4) and thyroid stimulating hormone (TSH), before treatment. After completing DKA treatment and two weeks after discharge, the thyroid function tests were repeated on the subjects and the results were analyzed using paired T-test, ANOVA or repeated measure and Pearson correlation tests...
December 14, 2016: Diabetes & Metabolic Syndrome
https://www.readbyqxmd.com/read/28018682/bent-metal-in-a-bone-a-rare-complication-of-an-emergent-procedure-or-a-deficiency-in-skill-set
#10
Mridula Krishnan, Katherine Lester, Amber Johnson, Kaye Bardeloza, Peter Edemekong, Ilya Berim
Intraosseous (IO) access is an important consideration in patients with difficult intravenous (IV) access in emergent situations. IO access in adults has become more popular due to the ease of placement and high success rates. The most common sites of access include the proximal tibia and the humeral head. The complications associated are rare but can be catastrophic: subsequent amputation of a limb has been described in the literature. We report a 25-year-old female presenting with diabetic ketoacidosis (DKA) in whom emergent IO access was complicated by needle bending inside the humerus...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28018153/a-pediatric-diabetic-ketoacidosis-management-protocol-incorporating-a-two-bag-intravenous-fluid-system-decreases-duration-of-intravenous-insulin-therapy
#11
Megan Veverka, Kourtney Marsh, Susan Norman, Michael Alan Brock, Monica Peng, Jennifer Shenk, Jerome Gene Chen
OBJECTIVES: Diabetic ketoacidosis (DKA) is a leading cause of morbidity and mortality in children with type 1 diabetes. We implemented a standardized DKA management protocol by using a 2-bag intravenous (IV) fluid system. The purpose of the study was to examine if the protocol improved clinical outcomes and process efficiency. METHODS: This was a retrospective study of patients who did and did not undergo the protocol. Patients were included if they were 18 years of age or younger, were diagnosed with DKA, admitted to an intensive care unit or stepdown unit, and received continuous IV insulin...
November 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28013254/stroke-in-pediatric-diabetic-ketoacidosis-case-series
#12
Chandrika Azad, Ravinder Kaur, Dharmendra Kumar Singh, Adhi Arya
Diabetic ketoacidosis (DKA) can present with various neurological complications, but stroke is rare. Here, we present three children with recent-onset diabetes with DKA, two of them had deep coma not responding to standard DKA regimen and the third one had seventh nerve palsy noted after recovering from coma. Computed tomography scan of head showed hemorrhage in the area of midbrain in one patient and infarcts in two patients. In any child of DKA with severe neurological impairment, possibility of stroke should be entertained...
December 24, 2016: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28003053/sglt2-inhibitor-associated-diabetic-ketoacidosis-clinical-review-and-recommendations-for-prevention-and-diagnosis
#13
REVIEW
Ronald M Goldenberg, Lori D Berard, Alice Y Y Cheng, Jeremy D Gilbert, Subodh Verma, Vincent C Woo, Jean-François Yale
PURPOSE: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest class of antihyperglycemic agents available on the market. Regulator warnings and concerns regarding the risk of developing diabetic ketoacidosis (DKA), however, have dampened enthusiasm for the class despite the combined glycemic, blood pressure, and occasional weight benefits of SGLT2 inhibitors. With the goal of improving patient safety, a cross-Canada expert panel and writing group were convened to review the evidence to-date on reported SGLT2 inhibitor-related DKA incidents and to offer recommendations for preventing and recognizing patients with SGLT2 inhibitor-associated DKA...
December 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27991500/high-frequency-of-diabetic-ketoacidosis-at-diagnosis-of-type-1-diabetes-in-italian-children-a-nationwide-longitudinal-study-2004-2013
#14
Valentino Cherubini, Edlira Skrami, Lucia Ferrito, Stefano Zucchini, Andrea Scaramuzza, Riccardo Bonfanti, Pietro Buono, Francesca Cardella, Vittoria Cauvin, Giovanni Chiari, Giuseppe D Annunzio, Anna Paola Frongia, Dario Iafusco, Ippolita Patrizia Patera, Sonia Toni, Stefano Tumini, Ivana Rabbone, Fortunato Lombardo, Flavia Carle, Rosaria Gesuita
This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004-2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis...
December 19, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27951453/screening-and-functional-identification-of-lncrnas-under-%C3%AE-diketone-antibiotic-exposure-to-zebrafish-danio-rerio-using-high-throughput-sequencing
#15
Xuedong Wang, Jiebo Lin, Fanghui Li, Cao Zhang, Jieyi Li, Caihong Wang, Randy A Dahlgren, Hongqin Zhang, Huili Wang
Long non-coding RNAs (lncRNAs) have attracted considerable research interest, but so far no data are available on the roles of lncRNAs and their target genes under chronic β-diketone antibiotic (DKAs) exposure to zebrafish (Danio rerio). Herein, we identified 1.66, 3.07 and 3.36×10(4) unique lncRNAs from the 0, 6.25 and 12.5mg/L DKA treatment groups, respectively. In comparison with the control group, the 6.25 and 12.5mg/L treatments led to up-regulation of 2064 and 2479 lncRNAs, and down-regulation of 778 and 954 lncRNAs, respectively...
January 2017: Aquatic Toxicology
https://www.readbyqxmd.com/read/27931088/sglt2-inhibitors-a-systematic-review-of-diabetic-ketoacidosis-and-related-risk-factors-in-the-primary-literature
#16
Kelly R Burke, Christine A Schumacher, Spencer E Harpe
STUDY OBJECTIVE: There is currently minimal information regarding risk factors for the development of sodium-glucose cotransporter-2 inhibitor (SGLT2i)-related diabetic ketoacidosis (DKA). We aim to identify individual patient characteristics associated with cases of SGLT2i-related DKA to better describe potential risk factors. DESIGN: Systematic review of primary literature. PATIENTS: 34 case reports of patients with Type 1 and Type 2 Diabetes Mellitus who developed DKA while receiving an SGLT2i...
December 8, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27924173/predictors-of-recurrent-hospital-admission-for-patients-presenting-with-diabetic-ketoacidosis-and-hyperglycemic-hyperosmolar-state
#17
Annabel L Bradford, Courtney Champagne Crider, Xizheng Xu, Syed Hasan Naqvi
BACKGROUND: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission. METHODS: This was a retrospective case-control study of 367 patients presenting during a 5-year period with DKA or HHS at a US tertiary academic medical center...
January 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/27913012/hyperglycemic-high-anion-gap-metabolic-acidosis-in-patients-receiving-sglt-2-inhibitors-for-diabetes-management
#18
Juliette Sandifer Kum-Nji, Aidar R Gosmanov, Helmut Steinberg, Samuel Dagogo-Jack
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a class of antidiabetic medications that improve glycemic control via inhibiting the reabsorption of filtered glucose and are approved for use in type 2 diabetes (T2DM). These drugs have recently been associated with euglycemic diabetic ketoacidosis (DKA). An increasing number of cases of SGLT-2i-associated DKA have occurred in patients with T2DM. Herein, we describe five episodes of hyperglycemic DKA in four type 2 diabetes patients receiving SGLT-2i therapy...
November 9, 2016: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/27896902/substantial-reduction-in-hospital-stay-of-children-and-adolescents-with-diabetic-ketoacidosis-after-implementation-of-clinical-practice-guidelines-in-a-university-hospital-in-saudi-arabia
#19
Abdulrahman Al Nemri, Yasser Sami Amer, Hala Gasim, Mohamed Elfaki Osman, Ayman Aleyadhy, Hessah Al Otaibi, Shaikh Mohammed Iqbal, Nasir Abdullah Aljurayyan, Asaad M Assiri, Amir Babiker, Sarar Mohamed
RATIONALE, AIMS AND OBJECTIVES: We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA). METHODS: This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation. RESULTS: There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG...
November 29, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27881588/glucocorticoids-did-not-reverse-type-1-diabetes-mellitus-secondary-to-pembrolizumab-in-a-patient-with-metastatic-melanoma
#20
Jasna Aleksova, Peter K H Lau, Georgia Soldatos, Grant McArthur
Immune checkpoint inhibitors offer patients with advanced melanoma substantial improvements in survival. Unlike chemotherapy, immune checkpoint inhibitors such as ipilimumab and pembrolizumab cause unique immune-related adverse events (irAEs), including the development of endocrinopathies. We report a case of a man aged 60 years who developed diabetic ketoacidosis (DKA) following the use of pembrolizumab for the treatment of metastatic melanoma. He received four cycles of ipilimumab, before proceeding to pembrolizumab...
November 23, 2016: BMJ Case Reports
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