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Acid base ketoacidosis

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https://www.readbyqxmd.com/read/29766633/empagliflozin-as-adjunct-to-insulin-in-japanese-participants-with-type-1-diabetes-results-of-a-4-week-double-blind-randomized-placebo-controlled-phase-2-trial
#1
Akira Shimada, Toshiaki Hanafusa, Atsutaka Yasui, Ganghyuck Lee, Yusuke Taneda, Akiko Sarashina, Kosuke Shiki, Jyothis George, Nima Soleymanlou, Jan Marquard
AIMS: This phase 2, double-blind, randomized, placebo-controlled trial (ClinicalTrials.gov NCT02702011) with 4 sites in Japan investigated the pharmacodynamics (PD), pharmacokinetics (PK) and safety profile of empagliflozin in Japanese participants with type 1 diabetes mellitus (T1DM) as adjunctive therapy to insulin. MATERIALS AND METHODS: Participants using multiple daily injections of insulin for ≥12 months, with HbA1c of 7.5%-10.0%, entered a 2-week, open-label, placebo run-in period, followed by a 4-week, double-blind period during which participants were randomized 1:1:1:1 to receive empagliflozin 2...
May 15, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29742696/acute-starvation-ketoacidosis-in-pregnancy-with-severe-hypertriglyceridemia-a-case-report
#2
Li Hui, Li Shuying
RATIONALE: Pregnant women are more prone to ketosis due to the relative insulin resistance, accelerated lipolysis and increased free fatty acids. PATIENT CONCERNS: We report a pregnant woman with hyperlipidemia, who experienced severe metabolic acidosis after a short period of starvation. DIAGNOSES: Based on her clinical symptoms, exclusion diagnosis and therapeutic diagnosis, her condition was diagnosed as starvation ketoacidosis. INTERVENTIONS: An emergency caesarean section under general anesthesia was implemented 2 hours after her admission...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29673582/in-silico-prediction-of-the-pathogenic-effect-of-a-novel-variant-of-bckdha-leading-to-classical-maple-syrup-urine-disease-identified-using-clinical-exome-sequencing
#3
Cynthia Fernández-Lainez, Carmen Aláez-Verson, Isabel Ibarra-González, Sergio Enríquez-Flores, Karol Carrillo-Sanchez, Leonardo Flores-Lagunes, Sara Guillén-López, Leticia Belmont-Martínez, Marcela Vela-Amieva
Maple syrup urine disease (MSUD) is a metabolic disorder caused by mutations in three of the branched-chain α-keto acid dehydrogenase complex (BCKDC) genes. Classical MSUD symptom can be observed immediately after birth and include ketoacidosis, irritability, lethargy, and coma, which can lead to death or irreversible neurodevelopmental delay in survivors. The molecular diagnosis of MSUD can be time-consuming and difficult to establish using conventional Sanger sequencing because it could be due to pathogenic variants of any of the BCKDC genes...
August 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/29500057/nondiabetic-ketoacidosis-in-a-pregnant-woman-due-to-acute-starvation-with-concomitant-influenza-a-h1n1-and-respiratory-failure
#4
G Skalley, S Rodríguez-Villar
Threatening refractory metabolic acidosis due to short-term starvation nondiabetic ketoacidosis is rarely reported. Severe ketoacidosis due to starvation itself is a rare occurrence, and more so in pregnancy with a concomitant stressful clinical situation. This case report presents a nondiabetic woman admitted in intensive care for respiratory failure type 1 during the third trimester of pregnancy with a severe metabolic acidosis refractory to medical treatment. We diagnosed the patient with acute starvation ketoacidosis based on her history and the absence of other causes of high anion gap metabolic acidosis after doing a rigorous analysis of her acid-base disorder...
February 27, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29111277/resolution-of-ketoacidosis-in-children-with-new-onset-diabetes-evaluation-of-various-definitions
#5
Julia E von Oettingen, Erinn T Rhodes, Joseph I Wolfsdorf
AIMS: Data are sparse concerning use of serum electrolyte parameters as compared to venous blood gas (VBG) measurements to monitor acid-base status during treatment of diabetic ketoacidosis (DKA). We explored the utility of various parameters to define DKA resolution by investigating the relationship of venous pH (vpH), anion gap (AG), serum bicarbonate (HCO3 ), and glucose concentration during management of DKA in children with new onset diabetes mellitus (NODM). METHODS: We included all patients with NODM presenting with DKA to Boston Children's Hospital from 10/1/07-7/1/13...
January 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29068248/diabetic-ketoacidosis-in-the-cat-recognition-and-essential-treatment
#6
Elke Rudloff
Practical relevance: Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses...
November 2017: Journal of Feline Medicine and Surgery
https://www.readbyqxmd.com/read/28928980/common-yet-elusive-a-case-of-severe-anion-gap-acidosis
#7
Akanksha Agrawal, Marina Kishlyansky, Sylvia Biso, Soumya Patnaik, Chitra Punjabi
Acid-base disturbances are common occurrence in hospitalized patients with life threatening complications. 5-oxoproline has been increasingly recognized as cause of high anion gap metabolic acidosis (AGMA) in association with chronic acetaminophen use. However, laboratory workup for it are not widely available. We report case of 56-year-old female with severe AGMA not attributable to ketoacidosis, lactic acidosis or toxic ingestion. History was significant for chronic acetaminophen use, and laboratory workup negative for all frequent causes of AGMA...
September 2017: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/28914421/acid-base-safety-during-the-course-of-a-very-low-calorie-ketogenic-diet
#8
Diego Gomez-Arbelaez, Ana B Crujeiras, Ana I Castro, Albert Goday, Antonio Mas-Lorenzo, Ana Bellon, Cristina Tejera, Diego Bellido, Cristobal Galban, Ignacio Sajoux, Patricio Lopez-Jaramillo, Felipe F Casanueva
BACKGROUND AND AIMS: Very low-calorie ketogenic (VLCK) diets have been consistently shown to be an effective obesity treatment, but the current evidence for its acid-base safety is limited. The aim of the current work was to evaluate the acid-base status of obese patients during the course of a VLCK diet. METHOD: Twenty obese participants undertook a VLCK diet for 4 months. Anthropometric and biochemical parameters, and venous blood gases were obtained on four subsequent visits: visit C-1 (baseline); visit C-2, (1-2 months); maximum ketosis; visit C-3 (2-3 months), ketosis declining; and visit C-4 at 4 months, no ketosis...
October 2017: Endocrine
https://www.readbyqxmd.com/read/28761186/blood-lactate-concentration-in-diabetic-dogs
#9
Poliana Claus, André M Gimenes, Jacqueline R Castro, Matheus M Mantovani, Khadine K Kanayama, Denise M N Simões, Denise S Schwartz
Human diabetic patients may have increased lactate levels compared to non-diabetics. Despite the use of lactate levels in critical care assessment, information is lacking for diabetic dogs. Therefore, this prospective cross-sectional clinical study aimed to determine lactate concentrations in 75 diabetic dogs [25 newly diagnosed non-ketotic diabetics, 25 under insulin treatment, and 25 in diabetic ketoacidosis (DKA)], compared to 25 non-diabetic dogs. Lactate levels (mmol/L) were not different among groups ( P = 0...
August 2017: Canadian Veterinary Journal. la Revue Vétérinaire Canadienne
https://www.readbyqxmd.com/read/28748724/acid-base-and-electrolyte-disorders-associated-with-the-use-of-antidiabetic-drugs
#10
REVIEW
Theodosios Filippatos, Eleftheria Tzavella, Christos Rizos, Moses Elisaf, George Liamis
The use of antidiabetic drugs is expected to substantially increase since diabetes mellitus incidence rises. Currently used antidiabetic drugs have a positive safety profile, but they are associated with certain acid-base and electrolyte abnormalities. The aim of the review is to present the current data regarding the antidiabetic drugs-associated acid-base and electrolyte abnormalities. Areas covered: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been linked with the scarce, but serious, complication of euglycemic diabetic ketoacidosis, as well as with an increase in serum potassium, magnesium and phosphorus levels...
October 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/28742636/the-influence-of-chloride-for-the-interpretation-of-plasma-bicarbonate-during-the-treatment-of-diabetic-ketoacidosis
#11
Juan Pablo Ferreira, Magali Hamui, Milagros Torrents, Romina Carrano, Mabel Ferraro, Ismael Toledo
INTRODUCTION: Hyperchloremic metabolic acidosis can occur in diabetic ketoacidosis (DKA) and may affect the acid-base interpretation during treatment. OBJECTIVES: This study aims to describe the prevalence of hyperchloremia during the treatment of DKA and its effect on the interpretation of bicarbonate value. METHODS: A cross-sectional study, including all cases of DKA in patients aged 1 to 18 years old admitted from 2010 to 2015, was performed...
July 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28458895/case-of-diabetic-ketoacidosis-as-an-initial-presentation-of-cushing-s-syndrome
#12
Runa Acharya, Udaya M Kabadi
SUMMARY: Diabetic ketoacidosis (DKA) is commonly encountered in clinical practice. The current case is a unique and rare presentation of DKA as the initial manifestation of Cushing's disease secondary to ACTH-secreting pituitary adenoma. Appropriate management as elaborated in the article led to total remission of diabetes as well as the Cushing's disease. LEARNING POINTS: DKA is a serious and potentially life-threatening metabolic complication of diabetes mellitus...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28129999/long-term-risk-of-stroke-in-type-2-diabetes-patients-with-diabetic-ketoacidosis-a-population-based-propensity-score-matched-longitudinal-follow-up-study
#13
Y-L Chen, S-F Weng, C-Y Yang, J-J Wang, K-J Tien
AIM: To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA). METHODS: This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities...
June 2017: Diabetes & Metabolism
https://www.readbyqxmd.com/read/28070957/controlled-trial-of-hartmann-s-solution-versus-0-9-saline-for-diabetic-ketoacidosis
#14
RANDOMIZED CONTROLLED TRIAL
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/27913012/hyperglycemic-high-anion-gap-metabolic-acidosis-in-patients-receiving-sglt-2-inhibitors-for-diabetes-management
#15
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...
March 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/27777693/comparison-of-end-tidal-carbon-dioxide-and-arterial-blood-bicarbonate-levels-in-patients-with-metabolic-acidosis-referred-to-emergency-medicine
#16
Ali Taghizadieh, Mahboub Pouraghaei, Payman Moharamzadeh, Alireza Ala, Farzad Rahmani, Karim Basiri Sofiani
Introduction: The routine and gold standard method to diagnose of acid - base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. Methods: In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated...
2016: Journal of Cardiovascular and Thoracic Research
https://www.readbyqxmd.com/read/27752032/starvation-ketoacidosis-as-a-cause-of-unexplained-metabolic-acidosis-in-the-perioperative-period
#17
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
https://www.readbyqxmd.com/read/27747968/perioperative-intravenous-fluid-therapy-in-children-guidelines-from-the-association-of-the-scientific-medical-societies-in-germany
#18
Robert Sümpelmann, Karin Becke, Sebastian Brenner, Christian Breschan, Christoph Eich, Claudia Höhne, Martin Jöhr, Franz-Josef Kretz, Gernot Marx, Lars Pape, Markus Schreiber, Jochen Strauss, Markus Weiss
This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. A physiologically composed balanced isotonic electrolyte solution (BS) with 1-2...
January 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27599629/approach-to-the-treatment-of-diabetic-ketoacidosis
#19
Kamel S Kamel, Martin Schreiber, Ana P C P Carlotti, Mitchell L Halperin
Diabetic ketoacidosis (DKA), a common cause of severe metabolic acidosis, remains a life-threatening condition due to complications of both the disease and its treatment. This Acid-Base and Electrolyte Teaching Case discusses DKA management, emphasizing complications of treatment. Because cerebral edema is the most common cause of mortality and morbidity, especially in children with DKA, we emphasize its pathophysiology and implications for therapy. The risk for cerebral edema may be minimized by avoiding a bolus of insulin, excessive saline resuscitation, and a decrease in effective plasma osmolality early in treatment...
December 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27373929/metformin-inhibits-branched-chain-amino-acid-bcaa-derived-ketoacidosis-and-promotes-metabolic-homeostasis-in-msud
#20
Davis S Sonnet, Monique N O'Leary, Mark A Gutierrez, Steven M Nguyen, Samiha Mateen, Yuehmei Hsu, Kylie P Mitchell, Antonio J Lopez, Jerry Vockley, Brian K Kennedy, Arvind Ramanathan
Maple Syrup Urine Disease (MSUD) is an inherited disorder caused by the dysfunction in the branched chain keto-acid dehydrogenase (BCKDH) enzyme. This leads to buildup of branched-chain keto-acids (BCKA) and branched-chain amino acids (BCAA) in body fluids (e.g. keto-isocaproic acid from the BCAA leucine), leading to numerous clinical features including a less understood skeletal muscle dysfunction in patients. KIC is an inhibitor of mitochondrial function at disease relevant concentrations. A murine model of intermediate MSUD (iMSUD) shows significant skeletal muscle dysfunction as by judged decreased muscle fiber diameter...
July 4, 2016: Scientific Reports
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