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Acid base 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
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...
October 17, 2016: Paediatric Anaesthesia
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...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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...
2016: Scientific Reports
Florian K Zeugswetter, Maximilian Pagitz, Mona Sarah Friedrich
OBJECTIVE: To describe the prevalence and possible causes of hypochloremia in the local hospital cat population. MATERIAL AND METHODS: Retrospective study consisting of two parts. Data were collected from the local electronic medical records database using the search terms "chloride" and "cats" (part A), and "blood gas analysis" and "cats" (part B). The medical records of the hypochloremic cats were then reviewed to determine prior treatment or infusions and to identify major underlying disease processes...
August 17, 2016: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Keigo Yasuda, Makoto Hayashi, Masanori Murayama, Noriyoshi Yamakita
CONTEXT AND OBJECTIVE: Diabetic ketoacidosis (DKA) is associated with a metabolic alkalosis, which is thought to be due to vomiting. However, alkalosis can occur in DKA without vomiting. We retrospectively reviewed the acid-base disturbances in DKA admissions without vomiting. PARTICIPANTS AND METHODS: We included admissions of the patients with blood glucose and beta-hydroxybutyrate (βOHB) levels > 250 mg/dL and > 1.0 mmol/L, respectively. Admissions without vomiting were classified into a group with a βOHB > 3...
June 2016: Journal of Clinical Endocrinology and Metabolism
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
Lars W Andersen, Katherine M Berg, Sophia Montissol, Christopher Sulmonte, Julia Balkema, Michael N Cocchi, Richard E Wolfe, Ashok Balasubramanyam, Xiaowen Liu, Michael W Donnino
OBJECTIVES: The pyruvate dehydrogenase complex (PDH) is an essential enzyme in aerobic metabolism. Ketones are known to inhibit PDH activity, but the extent of this inhibition is unknown in patients with diabetic ketoacidosis (DKA). METHODS: We enrolled adult patients presenting to the emergency department in hyperglycemic crisis. Patients were classified as DKA or hyperglycemia without ketoacidosis based on laboratory criteria. Healthy controls were also enrolled...
June 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ronillo Legaspi, Philipp Narciso
Euglycemic Diabetic Ketoacidosis is an uncommon occurrence. It is caused by an interaction of existing and worsening acidosis due to nausea and vomiting by a precipitating illness. In this case, a Type I Diabetic patient initially presented with Diabetic Ketoacidosis (DKA) that eventually evolved into Euglycemic Ketoacidosis brought about by continuous nausea and vomiting. The case presented the complexity involved with Type I Diabetes in regards to glucose and energy metabolism and highlights the need for vigilance in monitoring acid/base balance in all diabetic patients who are ill and present with normal blood glucose level...
September 2015: Journal of the Arkansas Medical Society
Nils Dennhardt, Christiane Beck, Dirk Huber, Katja Nickel, Björn Sander, Lars-Henrik Witt, Dietmar Boethig, Robert Sümpelmann
BACKGROUND: In contrast to preoperative fasting guidelines in paediatric anaesthesia, actual fasting times are often too long. OBJECTIVE: The objective of this study was to evaluate the effect of preoperative fasting on glucose concentration, ketone bodies and acid-base balance in children. DESIGN: A prospective, noninterventional, clinical observational study. SETTING: A single-centre trial, study period from June 2014 to November 2014...
December 2015: European Journal of Anaesthesiology
Diego E Gomez, Shikha Kuthiala, Hai L Liu, Daniel L Durosier, Mingju Cao, Patrick Burns, André Desrochers, Gilles Fecteau, Martin G Frasch
Ketoacidosis during pregnancy carries significant risk of intrauterine fetal demise, but little is known about the impact of ketoacids on the ovine fetus. We report a case series of maternal ketoacidosis in ewes. Maternal ketoacidosis may result in biochemical and acid-base fetal abnormalities associated with changes in feto-placental unit perfusion.
August 2015: Canadian Veterinary Journal. la Revue Vétérinaire Canadienne
Savvidou Savvoula, Pasoglou Vasiliki, Karatzidou Kyparisia, Antoniou Christina, Mallias Ioannis, Kalampakas Athanasios
A 19-year-old female with a 3-day history of high temperature, productive cough and dyspnoea was admitted due to diabetic ketoacidosis and pneumonia of the right lower lobe. Antibiotics (amoxicillin-clavulanic acid), insulin, fluids and electrolytes were administered, as appropriate. The patient was doing well (normal temperature, normal glucose levels, normal acid-base balance) until the sixth day of hospitalization, when she reported bouts of cough when swallowing liquids. Barium oesophagography revealed the presence of a broncho-oesophageal fistula (BOF)...
2013: Respiratory Medicine Case Reports
Zhanling Chen, Xiuwei Zhang, Jianrong Huang, Pengqiang Wen, Guobing Wang, Gen Tang, Ying Zu, Xiaowen Chen, Dong Cui, Min Zhang, Zhongxiang Qi, Chengrong Li
OBJECTIVE: To analyze the clinical features and mutation of MUT gene in a Chinese patient with isolated methylmalonic acidemia. METHODS: The clinical characteristics and laboratory tests data were collected. Genomic DNA was extracted from peripheral blood leukocytes. The 13 exons and their flanking sequences of the MUT gene were amplified with polymerase chain reaction and subjected to direct DNA sequencing. RESULTS: The patient has featured failure to thrive, lethargy, seizure, hypotonia, severe ketoacidosis and hyperammonemia...
April 2015: Zhonghua Yi Xue Yi Chuan Xue za Zhi, Zhonghua Yixue Yichuanxue Zazhi, Chinese Journal of Medical Genetics
Omar Nadhem, Essam Nakhla, Roger D Smalligan
A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months...
2015: Case Reports in Medicine
Kamel S Kamel, Mitchell L Halperin
New England Journal of Medicine, Volume 372, Issue 6, Page 546-554, February 2015.
February 5, 2015: New England Journal of Medicine
Tomohiro Hori, Seiji Yamaguchi, Haruo Shinkaku, Reiko Horikawa, Yosuke Shigematsu, Masaki Takayanagi, Toshiyuki Fukao
Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency and mitochondrial acetoacetyl-CoA thiolase (beta-ketothiolase or T2) deficiency are classified as autosomal recessive disorders of ketone body utilization characterized by intermittent ketoacidosis. Patients with mutations retaining no residual activity on analysis of expression of mutant cDNA are designated as severe genotype, and patients with at least one mutation retaining significant residual activity, as mild genotype. Permanent ketosis is a pathognomonic characteristic of SCOT-deficient patients with severe genotype...
2015: Pediatrics International: Official Journal of the Japan Pediatric Society
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
Naoko Tanda, Yoshinori Hinokio, Jumpei Washio, Nobuhiro Takahashi, Takeyoshi Koseki
Ketone bodies including acetone are disease biomarkers for diabetes that sometimes causes severe ketoacidosis. The present study was undertaken to clarify the significance of exhaled acetone and plasma ketone bodies at bedside in a clinical setting. The oral glucose tolerance test (OGTT) was performed in 10 healthy Japanese volunteers (five females and five males). Exhaled breath acetone and volatile sulfide compounds (VSCs) in mouth air were measured simultaneously with blood sampling during the OGTT using a portable gas chromatograph equipped with an In2O3 thick-film type gas sensor and a VSC monitor...
December 2014: Journal of Breath Research
Peter M van Hasselt, Sacha Ferdinandusse, Glen R Monroe, Jos P N Ruiter, Marjolein Turkenburg, Maartje J Geerlings, Karen Duran, Magdalena Harakalova, Bert van der Zwaag, Ardeshir A Monavari, Ilyas Okur, Mark J Sharrard, Maureen Cleary, Nuala O'Connell, Valerie Walker, M Estela Rubio-Gozalbo, Maaike C de Vries, Gepke Visser, Roderick H J Houwen, Jasper J van der Smagt, Nanda M Verhoeven-Duif, Ronald J A Wanders, Gijs van Haaften
Ketoacidosis is a potentially lethal condition caused by the imbalance between hepatic production and extrahepatic utilization of ketone bodies. We performed exome sequencing in a patient with recurrent, severe ketoacidosis and identified a homozygous frameshift mutation in the gene encoding monocarboxylate transporter 1 (SLC16A1, also called MCT1). Genetic analysis in 96 patients suspected of having ketolytic defects yielded seven additional inactivating mutations in MCT1, both homozygous and heterozygous...
November 13, 2014: New England Journal of Medicine
Helena Krakowczyk, Edyta Machura, Malgorzata Rusek-Zychma, Ewelina Chrobak, Katarzyna Ziora
INTRODUCTION: Ketosis in children may result from physiological adaptation to situations like fasting, fat-rich diet, straining physical activity, as well as from serious endocrine or metabolic disorders. The most frequently diagnosed cause of ketoacidosis are states of acetonemia and acetonuria with vomiting, during airways infections. GOAL: Assessment of the natural history and clinical presentation of acetonemic vomiting in children. PATIENTS AND METHODS: 85 children from 18 months to 12 years of age with acetonemic vomiting were incorporated in this study...
2014: Przegla̧d Lekarski
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