Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and progno...Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and prognostic characteristics of DKA in pregnant women in Dakar hospitals and to study the predictive factors of its occurrence. Methods: This retrospective study was conducted from January 2013 to January 2021 in the Internal Medicine/ Endocrinology-Diabetology-Nutrition and Gynaecology-Obstetrics departments of the National University Hospital Centre in Pikine, Senegal. Medical files of all pregnant women hospitalised for DKA during this period were collected. Results: A total of 10 patients were included in the study. Average age was 30.9 years. Two patients with unplanned pregnancies had pre-gestational diabetes mellitus (pre-GDM) and did not have regular diabetic follow-up. Among the 8 patients with GDM, risk factors for GDM were found in 7 women, and three had a history of GDM. Blood glucose levels were >1.02 and >11 g/L for these two groups, respectively. None of the women had been systematically screened for GDM between 24 and 28 gestational weeks. Signs of ketosis were present: 6 patients had Kussmaul dyspnea and one patient had a Glasgow Coma Score of 10/15. The precipitating factor was infection in three patients. Two patients had pre-eclampsia. The evolution of DKA was favourable in all patients. For pregnancy outcomes: 4 cases of intrauterine foetal death were recorded, 2 women carried their pregnancy to term, a woman gives birth prematurely and 3 patients were lost to follow-up. Conclusion: DKA during pregnancy is rare in Dakar hospitals but health risk increases with the lack of screening for GDM in pregnant women, follow-up in a specialised environment, and pregnancy planning in diabetic patients. The obstetrical prognosis is poor for GDM patients, with a high rate of foetal death in utero.展开更多
Introduction: Diabetic ketoacidosis (DKA) is the most common metabolic complication of diabetes. Although historically reported in children, it is increasingly observed in adults. Short-term outcomes and prognosis var...Introduction: Diabetic ketoacidosis (DKA) is the most common metabolic complication of diabetes. Although historically reported in children, it is increasingly observed in adults. Short-term outcomes and prognosis vary widely across healthcare settings. Therefore, we aimed to determine the prevalence, diagnostic characteristics, and outcomes of newly diagnosed diabetic ketoacidosis in a hospital setting in Dakar. Methodology: We conducted a descriptive and analytical cross-sectional study from January 1, 2020, to January 31, 2021, in the Endocrinology-Metabolism Department of the Pikine National Hospital Center. All diabetic patients hospitalized for newly diagnosed diabetic ketoacidosis during this period were included. Results: A total of 54 patients were enrolled in the study. The prevalence of newly diagnosed DKA in the facility was 17.1%. The mean age was 38.54 years, with a male predominance and a sex ratio of 1.16. Thirty-five patients had a family history of diabetes. Upon admission, 14.9% of patients had altered consciousness, and 92.4% exhibited cardinal symptoms, with an average duration of 14.2 days. Kussmaul breathing and gastrointestinal symptoms were observed in 13% and 33% of cases, respectively. The mean capillary blood glucose level at admission was 3.43 g/L. Infection was identified as the precipitating factor in half of the cases, while no triggering factor was found in the remaining cases. The mean BMI was 25.27 kg/m², and the average glycated hemoglobin (HbA1c) level was 12.2%. We recorded the diabetes classification for all patients. Nine had type 1 diabetes, twelve had type 1b diabetes, thirty-one had type 2 diabetes, and two had diabetes secondary to corticosteroid therapy. All patients received continuous intravenous insulin therapy via a syringe pump. The mean time to ketosis resolution was 34.6 hours. The average total dose of regular insulin administered was 442.3 IU. The mean duration of hospitalization was 7.6 days. One patient died, and fifty-one were discharged while continuing insulin therapy, with an average dose of 53 IU. Conclusion: The prevalence of newly diagnosed DKA remains high. With proper management, the prognosis is generally favorable. Diabetes classification is crucial, as it determines subsequent treatment strategies.展开更多
Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associate...Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related autoantibodies.Diabetic ketoacidosis with normal blood glucose levels has been reported during sodiumglucose co-transporter 2(SGLT2)inhibitor therapy.CASE SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise,thirst,and vomiting.Blood analysis showed high blood glucose levels(428 mg/dL),a mild increase of hemoglobin A1c(6.6%),and increased ketone bodies in urine.The patient was diagnosed with type 2 diabetes mellitus.The patient was initially treated with insulin,which was subsequently changed to an oral SGLT2 inhibitor.Antibodies to glutamic acid decarboxylase were negative.Four days after receiving oral SGLT2 inhibitor,she consulted at Mie University Hospital,complaining of fatigue and vomiting.Laboratory analysis revealed diabetic ketoacidosis with almost normal blood glucose levels.The endogenous insulin secretion was markedly low,and the serum levels of islet-related autoantibodies were undetectable.We made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis.The patient's general condition improved after therapy with intravenous insulin and withdrawal of oral medication.She was discharged on day 14 with an indication of multiple daily insulin therapy.CONCLUSION This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose levels.This case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.展开更多
Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-...Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-therapy.Case Presentation:We describe a patient with a known history of urothelial carcinoma who presented with dia-betic ketoacidosis 6 weeks following his second cycle of atezolizumab.His serum lactate level was slightly elevated(2 mM)and hisβ-hydroxybutyrate level was elevated(3.9 mM).High anion gap metabolic acidosis secondary to dia-betic ketoacidosis was diagnosed.Subsequent testing demonstrated hemoglobin A 1c level of 9.9%,positivity for anti-glutamic acid decarboxylase antibody(0.03 nM,reference range<0.02 nM),and suppressed C-peptide level(0.1μg/L,reference range 0.9-7.1μg/L)in the absence of detectable anti-islet antigen 2(IA-2)or anti-insulin antibodies.His initial management included cessation of atezolizumab treatment,intravenous sodium chloride administration,and insulin pump infusion,after which metabolic acidosis gradually resolved.The insulin pump was subsequently switched to Protaphane at 18 units before breakfast and 8 units before dinner,together with metformin at 1000 mg twice daily.Four weeks later his medication was changed to human isophane insulin plus neutral insulin(70%/30%;Mixtard 30 HM;26 units/4 units).Linagliptin at 5 mg was added 1 month later.His hemoglobin A 1c level declined to 8.1%1 year later.Conclusions:PD-L1 inhibitors can induce type 1 diabetes,and patients can present with diabetic ketoacidosis.Blood glucose levels should be regularly monitored in patients who are prescribed these medications.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis(DKA).However,the relationship between COVID-19 infection and progression to typ...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis(DKA).However,the relationship between COVID-19 infection and progression to type 1 diabetes(T1D)in children has not been well defined.AIM To evaluate the influence of COVID-19 infection and inactivated vaccine adminis-tration on the progression of T1D among Chinese children.METHODS A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Hehai University between September 2020 and December 2023.The patients were divided into three groups based on their history of COVID-19 infection and vaccination:the infection group,the vacci-nation-only group,and the non-infection/non-vaccination group.Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.RESULTS The incidence of DKA was significantly higher in the COVID-19 infection group(70.2%)compared to the non-infection/non-vaccination group(62.5%)and vac-scination-only group(45.6%;P=0.015).Prior COVID-19 infection was correlated with increased DKA risk(OR:1.981,95%CI:1.026-3.825,P=0.042),while vacci-nation was associated with a reduced risk(OR:0.558,95%CI:0.312-0.998,P=0.049).COVID-19 infection mildly altered immune profiles,with modest dif-ferences in autoantibody positivity,lymphocyte distribution,and immunoglobulin levels.Notably,HLA-DR3 po-sitive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection(both P<0.05).CONCLUSION COVID-19 infection predisposes children to severe T1D,characterized by enhanced DKA risk.Inactivated vaccination significantly lowers DKA incidence at T1D onset.These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.展开更多
Objective: This study aims to analyze the causes of postoperative transition from euglycemic diabetic ketoacidosis (EDKA) to diabetic ketoacidosis (DKA), summarize clinical nursing experiences, enhance the recognition...Objective: This study aims to analyze the causes of postoperative transition from euglycemic diabetic ketoacidosis (EDKA) to diabetic ketoacidosis (DKA), summarize clinical nursing experiences, enhance the recognition and management of such complications, and improve patient prognosis. Methods: A detailed case analysis was conducted on a patient who developed EDKA early after breast cancer surgery, which subsequently transitioned to DKA. A multidisciplinary team (MDT) consultation was employed to formulate a personalized nursing plan. Specific methods included comprehensive clinical data collection, monitoring of blood glucose, urine ketones, and blood ketone levels;implementing dynamic insulin adjustment strategies;providing dietary education and psychological support;and guiding dietary adjustments through nutritional consultations. Results: Through personalized observation, blood glucose management, dietary management, psychological care, and wound care, the patient’s blood and urine ketone levels returned to normal, the flap healed well, and blood glucose was maintained within the normal range. The patient is currently undergoing postoperative adjuvant chemotherapy. Conclusion: For postoperative patients with unexplained nausea, vomiting, and dehydration, regardless of diabetes history, timely testing of blood glucose, blood ketones, blood urea nitrogen, creatinine, electrolytes, and blood gas analysis can facilitate early detection of EDKA. Additionally, personalized management of blood glucose, diet, psychological care, and wound care is crucial for the prevention and treatment of EDKA.展开更多
Background: Diabetic ketoacidosis (DKA) is a severe complication of diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. It can lead to complications such as hypertriglyceridemia-induced pancreati...Background: Diabetic ketoacidosis (DKA) is a severe complication of diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. It can lead to complications such as hypertriglyceridemia-induced pancreatitis due to increased lipolysis and triglyceride formation. Case Presentations: A 28-year-old female presented with symptoms consistent with diabetic ketoacidosis (DKA), including polyuria, polydipsia, polyphagia, and unintentional weight loss. Laboratory results revealed severe hyperglycemia (glucose 22.9 mmol/L, HbA1c 14.5%), metabolic acidosis (pH 7.15), and elevated beta-hydroxybutyrate (6.75 mmol/L). Further evaluation showed markedly elevated triglycerides (45 mmol/L) and lipase (2928 IU/L), indicating mild pancreatitis. Upon reviewing her clinical presentation and lab findings, poorly controlled diabetes was determined to be the primary cause, leading to DKA and secondary hypertriglyceridemia. The patient was managed in the ICU with insulin therapy, fluid resuscitation, and Fenofibrate to address hypertriglyceridemia. Identifying the primary precipitant through this comprehensive assessment is crucial for directing management toward aggressive control of hyperglycemia, ketosis, and triglyceride levels. Conclusions: This case underscores the complex interplay between DKA, hypertriglyceridemia, and pancreatitis. Accurate clinical evaluation is essential to tailor management strategies focusing on aggressive control of hyperglycemia and triglyceride levels to prevent complications and optimize patient outcomes.展开更多
Background: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor is used as a monotherapy or in combination for lowering the elevated blood glucose level in patients with type 2 diabetes mellitus (T2DM)....Background: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor is used as a monotherapy or in combination for lowering the elevated blood glucose level in patients with type 2 diabetes mellitus (T2DM). It is often associated with certain adverse reactions (urinary tract infection (UTI), diabetes ketoacidosis (DKA), and genital infections). Thus, the Saudi Food and Drug Administration requested a post-authorisation safety study to monitor the safety of empagliflozin during the defined observation period. Methodology: The local, comparator, non-interventional, regulatory post-marketing study using “new user” design was conducted in patients with T2DM, treated with empagliflozin (10 or 25 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors (NCT03764631). Study was conducted from 2018 to 2020, wherein each patient was followed up for 12 months after the index period. Incidence and occurrence of DKA, severe UTIs, volume depletion and dehydration were observed along with metformin, insulin and treatment complexity status and adverse events in the index and Ramadan period. All data collected were analysed using descriptive statistics. Results: Among the 1502 patients enrolled (empagliflozin [n = 751] and DPP-4 inhibitors [n = 751]), 0.1% patients (n = 1) in each group and Conclusion: Empagliflozin was well tolerated over a period of 12 months, with no safety concerns and a favourable benefit/risk ratio.展开更多
Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum f...Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse outcomes.Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus.With the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has increased.The other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage disease.The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio.Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones.The diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic acidosis.Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin replacement.The dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia.展开更多
BACKGROUND Diabetic ketoacidosis(DKA)is a serious complication of type 1 diabetes mellitus(T1DM).Very rarely does DKA lead to cerebral edema,and it is even rarer for it to result in cerebral infarction.Bilateral inter...BACKGROUND Diabetic ketoacidosis(DKA)is a serious complication of type 1 diabetes mellitus(T1DM).Very rarely does DKA lead to cerebral edema,and it is even rarer for it to result in cerebral infarction.Bilateral internal carotid artery occlusion(BICAO)is also rare and can cause fatal stroke.Moreover,case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce.In this study,we present a patient with BICAO,T1DM,hypertension,and hyperlipidemia,who had a catastrophic bilateral cerebral infarction after a DKA episode.We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction.CASE SUMMARY A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata,bilateral frontal lobe,and parietal lobe with right hemiplegia and Broca’s aphasia.She had a history of hypertension for 5 years,hyperlipidemia for 4 years,hyperthyroidism for 3 years,and T1DM for 31 years.The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion.She was admitted to our ward for rehabilitation due to prior stroke sequalae.DKA took place on hospital day 2.On hospital day 6,she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory.After weeks of aggressive treatment,she remained in a coma and on mechanical ventilation due to respiratory failure.After discussion with her family,compassionate extubation was performed on hospital day 29 and she died.CONCLUSION DKA can lead to cerebral infarction due to several mechanisms.In people with existing BICAO and several stroke risk factors such as hypertension, T1DM,hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.展开更多
Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This ...Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit(ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.展开更多
Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uni...Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle.It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution.Worldwide,there is a lack of large-scale studies that help define how hyperglycemic crises should be managed.This article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.展开更多
BACKGROUND Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are commonly prescribed to manage patients with diabetes mellitus.These agents may rarely lead to the development of euglycemic diabetic ketoacidosis(EDKA),w...BACKGROUND Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are commonly prescribed to manage patients with diabetes mellitus.These agents may rarely lead to the development of euglycemic diabetic ketoacidosis(EDKA),which may complicate the disease course of these patients.AIM To analyze the demographic profile,predisposing factors,symptomology,clinical interventions and outcomes of patients presenting with EDKA secondary to SGLT2i use by reviewing the published case reports and series.METHODS We performed a systematic search of PubMed,Science Direct,Google Scholar and Reference Citation Analysis databases using the terms“canagliflozin”OR“empagliflozin”OR“dapagliflozin”OR“SGLT2 inhibitors”OR“Sodium-glucose cotransporter-2”AND“euglycemia”OR“euglycemic diabetic ketoacidosis”OR“metabolic acidosis”.The inclusion criteria were:(1)Case reports or case series with individual patient details;and(2)Reported EDKA secondary to SGLT2i.Furthermore,the data were filtered from the literature published in the English language and on adults(>18 years).We excluded:(1)Conference abstracts;and(2)Case reports or series which did not have individual biochemical data.All the case reports and case series were evaluated.The data extracted included patient demographics,clinical symptomatology,clinical interventions,intensive care unit course,need for organ support and outcomes.RESULTS Overall,108 case reports and 17 cases series with 169 unique patients that met all the inclusion criteria were included.The majority of patients were females(54.4%,n=92),and the commonly reported symptoms were gastrointestinal(nausea/vomiting 65.1%,abdominal pain 37.3%)and respiratory(breathlessness 30.8%).One hundred and forty-nine(88.2%)patients had underlying type II diabetes,and the most commonly involved SGLT-2 inhibitor reported was empagliflozin(46.8%).A triggering factor was reported in most patients(78.7%),the commonest being acute severe infection(37.9%),which included patients with sepsis,coronavirus disease 2019,other viral illnesses,and acute pancreatitis.61.5%were reported to require intensive unit care,but only a minority of patients required organ support in the form of invasive mechanical ventilation(13%),vasopressors(6.5%)or renal replacement therapy(5.9%).The overall mortality rate was only 2.4%.CONCLUSION Patients on SGLT2i may rarely develop EDKA,especially in the presence of certain predisposing factors,including severe acute infections and following major surgery.The signs and symptoms of EDKA may be similar to that of DKA but with normal blood sugar levels,which may make the diagnosis challenging.Outcomes of EDKA are good if recognized early and corrective actions are taken.Hence,physicians managing such patients must be aware of this potential complication and must educate their patients accordingly to ensure early diagnosis and management.展开更多
Black esophagus is a very rare disease and its pathogenesis has been unclear.Black esophagus developed concomitantly with candidiasis after diabetic ketoacidosis has not been reported yet.We report a case who develope...Black esophagus is a very rare disease and its pathogenesis has been unclear.Black esophagus developed concomitantly with candidiasis after diabetic ketoacidosis has not been reported yet.We report a case who developed esophageal stricture after the treatment of black esophagus and thus balloon dilatation was performed several times but failed,hence,surgical treatment was performed.展开更多
Diabetes has been classified mainly into types 1 and 2.Some type 2 diabetes patients,when developing ketosis,have been labeled as having atypical diabetes.Lately,syndromes of ketosis-prone diabetes,primarily in patien...Diabetes has been classified mainly into types 1 and 2.Some type 2 diabetes patients,when developing ketosis,have been labeled as having atypical diabetes.Lately,syndromes of ketosis-prone diabetes,primarily in patients who we previously classified as type 2 diabetics,have emerged,and calls are being made to even reclassify diabetes.This mini-review will extensively deal with the historical,molecular,phenotypical,and clinical basis of why ketosis-prone diabetes is different than the traditional principles of type 1 and 2 diabetes and should be classified as such.Clinicians,especially those who are not diabetologists or endocrinologists,as well as hospitalists,intensivists,and primary care providers,will greatly benefit from this review.展开更多
Euglycemic diabetic ketoacidosis(EDKA)is a well-known complication of sodium-glucose co-transporter 2 inhibitors,and many cases with variable onset following the initiation of these agents are reported before,with a m...Euglycemic diabetic ketoacidosis(EDKA)is a well-known complication of sodium-glucose co-transporter 2 inhibitors,and many cases with variable onset following the initiation of these agents are reported before,with a median onset of approximately 2 wk.This letter discusses a 45-year-old lady who initially presented with ischemic stroke but developed EDKA 4 d after starting empagliflozin,a rare occurrence.The patient had severe metabolic acidosis that necessitated admission into the intensive care unit.Prompt discontinuation of empagliflozin and DKA management resulted in clinical recovery.展开更多
BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case...BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case reports with diabetic ketoacidosis(DKA)and is commonly associated with GI bleeding(GIB).CASE SUMMARY We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain.Interestingly,there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset.A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist(GLP-1 RA),though they have not been previously connected to DKA or AEN.The patient was subsequently treated with high dose proton pump inhibitors,GLP-1 RA was discontinued,and an insulin regimen was instituted.The patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.CONCLUSION This report highlights AEN in the absence of overt GIB,emphasizing the importance of early consideration of EGD.展开更多
The coronavirus disease 2019(COVID-19)pandemic has heavily affected health worldwide,with the various forms of diabetes in children experiencing changes at various levels,including epidemiology,diabetic ketoacidosis r...The coronavirus disease 2019(COVID-19)pandemic has heavily affected health worldwide,with the various forms of diabetes in children experiencing changes at various levels,including epidemiology,diabetic ketoacidosis rates and medical care.Type 1 diabetes showed an apparent increase in incidence,possibly owing to a direct damage of the virus to theβ-cell.Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital.Most children with diabetes(both type 1 and type 2)did not show a worsening in metabolic control during the first lockdown,possibly owing to a more controlled diet by their parents.Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic,especially because the downloading of data allowed for the practice of telemedicine.Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice.The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.展开更多
BACKGROUND Diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is rising.Due to the complexity of its management and the need for rigorous monitoring,many DKA patients...BACKGROUND Diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is rising.Due to the complexity of its management and the need for rigorous monitoring,many DKA patients are managed in the intensive care unit(ICU).However,studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes.It is,therefore,essential to identify suitable candidates for ICU care in DKA patients.AIM To evaluate factors that predict the requirement for ICU care in DKA patients.METHODS This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation,Doha,Qatar,between January 2015 and March 2021.All adult patients(>14 years)fulfilling the American Diabetes Association criteria for DKA diagnosis were included.RESULTS We included 922 patients with DKA in the final analysis,of which 229(25%)were managed in the ICU.Compared to non-ICU patients,patients admitted to ICU were older[mean(SD)age of 40.4±13.7 years vs 34.5±14.6 years;P<0.001],had a higher body mass index[median(IQR)of 24.6(21.5-28.4)kg/m2 vs 23.7(20.3-27.9)kg/m2;P<0.030],had T2DM(61.6%)and were predominantly males(69%vs 31%;P<0.020).ICU patients had a higher white blood cell count[median(IQR)of 15.1(10.2-21.2)×103/uL vs 11.2(7.9-15.7)×103/uL,P<0.001],urea[median(IQR)of 6.5(4.6-10.3)mmol/L vs 5.6(4.0-8.0)mmol/L;P<0.001],creatinine[median(IQR)of 99(75-144)mmol/L vs 82(63-144)mmol/L;P<0.001],C-reactive protein[median(IQR)of 27(9-83)mg/L vs 14(5-33)mg/L;P<0.001]and anion gap[median(IQR)of 24.0(19.2-29.0)mEq/L vs 22(17-27)mEq/L;P<0.001];while a lower venous pH[mean(SD)of 7.10±0.15 vs 7.20±0.13;P<0.001]and bicarbonate level[mean(SD)of 9.2±4.1 mmol/L vs 11.6±4.3 mmol/L;P<0.001]at admission than those not requiring ICU management of DKA(P<0.001).Patients in the ICU group had a longer LOS[median(IQR)of 4.2(2.7-7.1)d vs 2.0(1.0-3.9)d;P<0.001]and DKA duration[median(IQR)of 24(13-37)h vs 15(19-24)h,P<0.001]than those not requiring ICU admission.In the multivariate logistic regression analysis model,age,Asian ethnicity,concurrent coronavirus disease 2019(COVID-19)infection,DKA severity,DKA trigger,and NSTEMI were the main predicting factors for ICU admission.CONCLUSION In the largest tertiary center in Qatar,25%of all DKA patients required ICU admission.Older age,T2DM,newly onset DM,an infectious trigger of DKA,moderate-severe DKA,concurrent NSTEMI,and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.展开更多
文摘Introduction: Diabetic ketoacidosis (DKA) in pregnancy is rare but associated with maternal and foetal morbidity and mortality. The objectives of this study were to evaluate the epidemiological, diagnostic, and prognostic characteristics of DKA in pregnant women in Dakar hospitals and to study the predictive factors of its occurrence. Methods: This retrospective study was conducted from January 2013 to January 2021 in the Internal Medicine/ Endocrinology-Diabetology-Nutrition and Gynaecology-Obstetrics departments of the National University Hospital Centre in Pikine, Senegal. Medical files of all pregnant women hospitalised for DKA during this period were collected. Results: A total of 10 patients were included in the study. Average age was 30.9 years. Two patients with unplanned pregnancies had pre-gestational diabetes mellitus (pre-GDM) and did not have regular diabetic follow-up. Among the 8 patients with GDM, risk factors for GDM were found in 7 women, and three had a history of GDM. Blood glucose levels were >1.02 and >11 g/L for these two groups, respectively. None of the women had been systematically screened for GDM between 24 and 28 gestational weeks. Signs of ketosis were present: 6 patients had Kussmaul dyspnea and one patient had a Glasgow Coma Score of 10/15. The precipitating factor was infection in three patients. Two patients had pre-eclampsia. The evolution of DKA was favourable in all patients. For pregnancy outcomes: 4 cases of intrauterine foetal death were recorded, 2 women carried their pregnancy to term, a woman gives birth prematurely and 3 patients were lost to follow-up. Conclusion: DKA during pregnancy is rare in Dakar hospitals but health risk increases with the lack of screening for GDM in pregnant women, follow-up in a specialised environment, and pregnancy planning in diabetic patients. The obstetrical prognosis is poor for GDM patients, with a high rate of foetal death in utero.
文摘Introduction: Diabetic ketoacidosis (DKA) is the most common metabolic complication of diabetes. Although historically reported in children, it is increasingly observed in adults. Short-term outcomes and prognosis vary widely across healthcare settings. Therefore, we aimed to determine the prevalence, diagnostic characteristics, and outcomes of newly diagnosed diabetic ketoacidosis in a hospital setting in Dakar. Methodology: We conducted a descriptive and analytical cross-sectional study from January 1, 2020, to January 31, 2021, in the Endocrinology-Metabolism Department of the Pikine National Hospital Center. All diabetic patients hospitalized for newly diagnosed diabetic ketoacidosis during this period were included. Results: A total of 54 patients were enrolled in the study. The prevalence of newly diagnosed DKA in the facility was 17.1%. The mean age was 38.54 years, with a male predominance and a sex ratio of 1.16. Thirty-five patients had a family history of diabetes. Upon admission, 14.9% of patients had altered consciousness, and 92.4% exhibited cardinal symptoms, with an average duration of 14.2 days. Kussmaul breathing and gastrointestinal symptoms were observed in 13% and 33% of cases, respectively. The mean capillary blood glucose level at admission was 3.43 g/L. Infection was identified as the precipitating factor in half of the cases, while no triggering factor was found in the remaining cases. The mean BMI was 25.27 kg/m², and the average glycated hemoglobin (HbA1c) level was 12.2%. We recorded the diabetes classification for all patients. Nine had type 1 diabetes, twelve had type 1b diabetes, thirty-one had type 2 diabetes, and two had diabetes secondary to corticosteroid therapy. All patients received continuous intravenous insulin therapy via a syringe pump. The mean time to ketosis resolution was 34.6 hours. The average total dose of regular insulin administered was 442.3 IU. The mean duration of hospitalization was 7.6 days. One patient died, and fifty-one were discharged while continuing insulin therapy, with an average dose of 53 IU. Conclusion: The prevalence of newly diagnosed DKA remains high. With proper management, the prognosis is generally favorable. Diabetes classification is crucial, as it determines subsequent treatment strategies.
文摘Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related autoantibodies.Diabetic ketoacidosis with normal blood glucose levels has been reported during sodiumglucose co-transporter 2(SGLT2)inhibitor therapy.CASE SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise,thirst,and vomiting.Blood analysis showed high blood glucose levels(428 mg/dL),a mild increase of hemoglobin A1c(6.6%),and increased ketone bodies in urine.The patient was diagnosed with type 2 diabetes mellitus.The patient was initially treated with insulin,which was subsequently changed to an oral SGLT2 inhibitor.Antibodies to glutamic acid decarboxylase were negative.Four days after receiving oral SGLT2 inhibitor,she consulted at Mie University Hospital,complaining of fatigue and vomiting.Laboratory analysis revealed diabetic ketoacidosis with almost normal blood glucose levels.The endogenous insulin secretion was markedly low,and the serum levels of islet-related autoantibodies were undetectable.We made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis.The patient's general condition improved after therapy with intravenous insulin and withdrawal of oral medication.She was discharged on day 14 with an indication of multiple daily insulin therapy.CONCLUSION This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose levels.This case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.
文摘Background:Atezolizumab,an immune checkpoint inhibitor,is a humanized monoclonal,anti-programmed death ligand 1(PD-L1)antibody used for the treatment of metastatic urothelial carcinoma that has progressed after chemo-therapy.Case Presentation:We describe a patient with a known history of urothelial carcinoma who presented with dia-betic ketoacidosis 6 weeks following his second cycle of atezolizumab.His serum lactate level was slightly elevated(2 mM)and hisβ-hydroxybutyrate level was elevated(3.9 mM).High anion gap metabolic acidosis secondary to dia-betic ketoacidosis was diagnosed.Subsequent testing demonstrated hemoglobin A 1c level of 9.9%,positivity for anti-glutamic acid decarboxylase antibody(0.03 nM,reference range<0.02 nM),and suppressed C-peptide level(0.1μg/L,reference range 0.9-7.1μg/L)in the absence of detectable anti-islet antigen 2(IA-2)or anti-insulin antibodies.His initial management included cessation of atezolizumab treatment,intravenous sodium chloride administration,and insulin pump infusion,after which metabolic acidosis gradually resolved.The insulin pump was subsequently switched to Protaphane at 18 units before breakfast and 8 units before dinner,together with metformin at 1000 mg twice daily.Four weeks later his medication was changed to human isophane insulin plus neutral insulin(70%/30%;Mixtard 30 HM;26 units/4 units).Linagliptin at 5 mg was added 1 month later.His hemoglobin A 1c level declined to 8.1%1 year later.Conclusions:PD-L1 inhibitors can induce type 1 diabetes,and patients can present with diabetic ketoacidosis.Blood glucose levels should be regularly monitored in patients who are prescribed these medications.
基金Supported by National Key Research and Development Program of China,No.2021YFC2701900 and No.2016YFC1305300.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis(DKA).However,the relationship between COVID-19 infection and progression to type 1 diabetes(T1D)in children has not been well defined.AIM To evaluate the influence of COVID-19 infection and inactivated vaccine adminis-tration on the progression of T1D among Chinese children.METHODS A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Hehai University between September 2020 and December 2023.The patients were divided into three groups based on their history of COVID-19 infection and vaccination:the infection group,the vacci-nation-only group,and the non-infection/non-vaccination group.Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.RESULTS The incidence of DKA was significantly higher in the COVID-19 infection group(70.2%)compared to the non-infection/non-vaccination group(62.5%)and vac-scination-only group(45.6%;P=0.015).Prior COVID-19 infection was correlated with increased DKA risk(OR:1.981,95%CI:1.026-3.825,P=0.042),while vacci-nation was associated with a reduced risk(OR:0.558,95%CI:0.312-0.998,P=0.049).COVID-19 infection mildly altered immune profiles,with modest dif-ferences in autoantibody positivity,lymphocyte distribution,and immunoglobulin levels.Notably,HLA-DR3 po-sitive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection(both P<0.05).CONCLUSION COVID-19 infection predisposes children to severe T1D,characterized by enhanced DKA risk.Inactivated vaccination significantly lowers DKA incidence at T1D onset.These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.
文摘Objective: This study aims to analyze the causes of postoperative transition from euglycemic diabetic ketoacidosis (EDKA) to diabetic ketoacidosis (DKA), summarize clinical nursing experiences, enhance the recognition and management of such complications, and improve patient prognosis. Methods: A detailed case analysis was conducted on a patient who developed EDKA early after breast cancer surgery, which subsequently transitioned to DKA. A multidisciplinary team (MDT) consultation was employed to formulate a personalized nursing plan. Specific methods included comprehensive clinical data collection, monitoring of blood glucose, urine ketones, and blood ketone levels;implementing dynamic insulin adjustment strategies;providing dietary education and psychological support;and guiding dietary adjustments through nutritional consultations. Results: Through personalized observation, blood glucose management, dietary management, psychological care, and wound care, the patient’s blood and urine ketone levels returned to normal, the flap healed well, and blood glucose was maintained within the normal range. The patient is currently undergoing postoperative adjuvant chemotherapy. Conclusion: For postoperative patients with unexplained nausea, vomiting, and dehydration, regardless of diabetes history, timely testing of blood glucose, blood ketones, blood urea nitrogen, creatinine, electrolytes, and blood gas analysis can facilitate early detection of EDKA. Additionally, personalized management of blood glucose, diet, psychological care, and wound care is crucial for the prevention and treatment of EDKA.
文摘Background: Diabetic ketoacidosis (DKA) is a severe complication of diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. It can lead to complications such as hypertriglyceridemia-induced pancreatitis due to increased lipolysis and triglyceride formation. Case Presentations: A 28-year-old female presented with symptoms consistent with diabetic ketoacidosis (DKA), including polyuria, polydipsia, polyphagia, and unintentional weight loss. Laboratory results revealed severe hyperglycemia (glucose 22.9 mmol/L, HbA1c 14.5%), metabolic acidosis (pH 7.15), and elevated beta-hydroxybutyrate (6.75 mmol/L). Further evaluation showed markedly elevated triglycerides (45 mmol/L) and lipase (2928 IU/L), indicating mild pancreatitis. Upon reviewing her clinical presentation and lab findings, poorly controlled diabetes was determined to be the primary cause, leading to DKA and secondary hypertriglyceridemia. The patient was managed in the ICU with insulin therapy, fluid resuscitation, and Fenofibrate to address hypertriglyceridemia. Identifying the primary precipitant through this comprehensive assessment is crucial for directing management toward aggressive control of hyperglycemia, ketosis, and triglyceride levels. Conclusions: This case underscores the complex interplay between DKA, hypertriglyceridemia, and pancreatitis. Accurate clinical evaluation is essential to tailor management strategies focusing on aggressive control of hyperglycemia and triglyceride levels to prevent complications and optimize patient outcomes.
文摘Background: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor is used as a monotherapy or in combination for lowering the elevated blood glucose level in patients with type 2 diabetes mellitus (T2DM). It is often associated with certain adverse reactions (urinary tract infection (UTI), diabetes ketoacidosis (DKA), and genital infections). Thus, the Saudi Food and Drug Administration requested a post-authorisation safety study to monitor the safety of empagliflozin during the defined observation period. Methodology: The local, comparator, non-interventional, regulatory post-marketing study using “new user” design was conducted in patients with T2DM, treated with empagliflozin (10 or 25 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors (NCT03764631). Study was conducted from 2018 to 2020, wherein each patient was followed up for 12 months after the index period. Incidence and occurrence of DKA, severe UTIs, volume depletion and dehydration were observed along with metformin, insulin and treatment complexity status and adverse events in the index and Ramadan period. All data collected were analysed using descriptive statistics. Results: Among the 1502 patients enrolled (empagliflozin [n = 751] and DPP-4 inhibitors [n = 751]), 0.1% patients (n = 1) in each group and Conclusion: Empagliflozin was well tolerated over a period of 12 months, with no safety concerns and a favourable benefit/risk ratio.
文摘Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse outcomes.Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus.With the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has increased.The other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage disease.The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio.Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones.The diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic acidosis.Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin replacement.The dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia.
文摘BACKGROUND Diabetic ketoacidosis(DKA)is a serious complication of type 1 diabetes mellitus(T1DM).Very rarely does DKA lead to cerebral edema,and it is even rarer for it to result in cerebral infarction.Bilateral internal carotid artery occlusion(BICAO)is also rare and can cause fatal stroke.Moreover,case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce.In this study,we present a patient with BICAO,T1DM,hypertension,and hyperlipidemia,who had a catastrophic bilateral cerebral infarction after a DKA episode.We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction.CASE SUMMARY A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata,bilateral frontal lobe,and parietal lobe with right hemiplegia and Broca’s aphasia.She had a history of hypertension for 5 years,hyperlipidemia for 4 years,hyperthyroidism for 3 years,and T1DM for 31 years.The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion.She was admitted to our ward for rehabilitation due to prior stroke sequalae.DKA took place on hospital day 2.On hospital day 6,she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory.After weeks of aggressive treatment,she remained in a coma and on mechanical ventilation due to respiratory failure.After discussion with her family,compassionate extubation was performed on hospital day 29 and she died.CONCLUSION DKA can lead to cerebral infarction due to several mechanisms.In people with existing BICAO and several stroke risk factors such as hypertension, T1DM,hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.
文摘Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit(ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.
文摘Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle.It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution.Worldwide,there is a lack of large-scale studies that help define how hyperglycemic crises should be managed.This article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.
文摘BACKGROUND Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are commonly prescribed to manage patients with diabetes mellitus.These agents may rarely lead to the development of euglycemic diabetic ketoacidosis(EDKA),which may complicate the disease course of these patients.AIM To analyze the demographic profile,predisposing factors,symptomology,clinical interventions and outcomes of patients presenting with EDKA secondary to SGLT2i use by reviewing the published case reports and series.METHODS We performed a systematic search of PubMed,Science Direct,Google Scholar and Reference Citation Analysis databases using the terms“canagliflozin”OR“empagliflozin”OR“dapagliflozin”OR“SGLT2 inhibitors”OR“Sodium-glucose cotransporter-2”AND“euglycemia”OR“euglycemic diabetic ketoacidosis”OR“metabolic acidosis”.The inclusion criteria were:(1)Case reports or case series with individual patient details;and(2)Reported EDKA secondary to SGLT2i.Furthermore,the data were filtered from the literature published in the English language and on adults(>18 years).We excluded:(1)Conference abstracts;and(2)Case reports or series which did not have individual biochemical data.All the case reports and case series were evaluated.The data extracted included patient demographics,clinical symptomatology,clinical interventions,intensive care unit course,need for organ support and outcomes.RESULTS Overall,108 case reports and 17 cases series with 169 unique patients that met all the inclusion criteria were included.The majority of patients were females(54.4%,n=92),and the commonly reported symptoms were gastrointestinal(nausea/vomiting 65.1%,abdominal pain 37.3%)and respiratory(breathlessness 30.8%).One hundred and forty-nine(88.2%)patients had underlying type II diabetes,and the most commonly involved SGLT-2 inhibitor reported was empagliflozin(46.8%).A triggering factor was reported in most patients(78.7%),the commonest being acute severe infection(37.9%),which included patients with sepsis,coronavirus disease 2019,other viral illnesses,and acute pancreatitis.61.5%were reported to require intensive unit care,but only a minority of patients required organ support in the form of invasive mechanical ventilation(13%),vasopressors(6.5%)or renal replacement therapy(5.9%).The overall mortality rate was only 2.4%.CONCLUSION Patients on SGLT2i may rarely develop EDKA,especially in the presence of certain predisposing factors,including severe acute infections and following major surgery.The signs and symptoms of EDKA may be similar to that of DKA but with normal blood sugar levels,which may make the diagnosis challenging.Outcomes of EDKA are good if recognized early and corrective actions are taken.Hence,physicians managing such patients must be aware of this potential complication and must educate their patients accordingly to ensure early diagnosis and management.
基金grants from the catholic university of Korea,College of Medicine
文摘Black esophagus is a very rare disease and its pathogenesis has been unclear.Black esophagus developed concomitantly with candidiasis after diabetic ketoacidosis has not been reported yet.We report a case who developed esophageal stricture after the treatment of black esophagus and thus balloon dilatation was performed several times but failed,hence,surgical treatment was performed.
文摘Diabetes has been classified mainly into types 1 and 2.Some type 2 diabetes patients,when developing ketosis,have been labeled as having atypical diabetes.Lately,syndromes of ketosis-prone diabetes,primarily in patients who we previously classified as type 2 diabetics,have emerged,and calls are being made to even reclassify diabetes.This mini-review will extensively deal with the historical,molecular,phenotypical,and clinical basis of why ketosis-prone diabetes is different than the traditional principles of type 1 and 2 diabetes and should be classified as such.Clinicians,especially those who are not diabetologists or endocrinologists,as well as hospitalists,intensivists,and primary care providers,will greatly benefit from this review.
文摘Euglycemic diabetic ketoacidosis(EDKA)is a well-known complication of sodium-glucose co-transporter 2 inhibitors,and many cases with variable onset following the initiation of these agents are reported before,with a median onset of approximately 2 wk.This letter discusses a 45-year-old lady who initially presented with ischemic stroke but developed EDKA 4 d after starting empagliflozin,a rare occurrence.The patient had severe metabolic acidosis that necessitated admission into the intensive care unit.Prompt discontinuation of empagliflozin and DKA management resulted in clinical recovery.
文摘BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI motility.It has been linked in case reports with diabetic ketoacidosis(DKA)and is commonly associated with GI bleeding(GIB).CASE SUMMARY We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain.Interestingly,there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset.A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist(GLP-1 RA),though they have not been previously connected to DKA or AEN.The patient was subsequently treated with high dose proton pump inhibitors,GLP-1 RA was discontinued,and an insulin regimen was instituted.The patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.CONCLUSION This report highlights AEN in the absence of overt GIB,emphasizing the importance of early consideration of EGD.
文摘The coronavirus disease 2019(COVID-19)pandemic has heavily affected health worldwide,with the various forms of diabetes in children experiencing changes at various levels,including epidemiology,diabetic ketoacidosis rates and medical care.Type 1 diabetes showed an apparent increase in incidence,possibly owing to a direct damage of the virus to theβ-cell.Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital.Most children with diabetes(both type 1 and type 2)did not show a worsening in metabolic control during the first lockdown,possibly owing to a more controlled diet by their parents.Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic,especially because the downloading of data allowed for the practice of telemedicine.Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice.The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.
文摘BACKGROUND Diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is rising.Due to the complexity of its management and the need for rigorous monitoring,many DKA patients are managed in the intensive care unit(ICU).However,studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes.It is,therefore,essential to identify suitable candidates for ICU care in DKA patients.AIM To evaluate factors that predict the requirement for ICU care in DKA patients.METHODS This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation,Doha,Qatar,between January 2015 and March 2021.All adult patients(>14 years)fulfilling the American Diabetes Association criteria for DKA diagnosis were included.RESULTS We included 922 patients with DKA in the final analysis,of which 229(25%)were managed in the ICU.Compared to non-ICU patients,patients admitted to ICU were older[mean(SD)age of 40.4±13.7 years vs 34.5±14.6 years;P<0.001],had a higher body mass index[median(IQR)of 24.6(21.5-28.4)kg/m2 vs 23.7(20.3-27.9)kg/m2;P<0.030],had T2DM(61.6%)and were predominantly males(69%vs 31%;P<0.020).ICU patients had a higher white blood cell count[median(IQR)of 15.1(10.2-21.2)×103/uL vs 11.2(7.9-15.7)×103/uL,P<0.001],urea[median(IQR)of 6.5(4.6-10.3)mmol/L vs 5.6(4.0-8.0)mmol/L;P<0.001],creatinine[median(IQR)of 99(75-144)mmol/L vs 82(63-144)mmol/L;P<0.001],C-reactive protein[median(IQR)of 27(9-83)mg/L vs 14(5-33)mg/L;P<0.001]and anion gap[median(IQR)of 24.0(19.2-29.0)mEq/L vs 22(17-27)mEq/L;P<0.001];while a lower venous pH[mean(SD)of 7.10±0.15 vs 7.20±0.13;P<0.001]and bicarbonate level[mean(SD)of 9.2±4.1 mmol/L vs 11.6±4.3 mmol/L;P<0.001]at admission than those not requiring ICU management of DKA(P<0.001).Patients in the ICU group had a longer LOS[median(IQR)of 4.2(2.7-7.1)d vs 2.0(1.0-3.9)d;P<0.001]and DKA duration[median(IQR)of 24(13-37)h vs 15(19-24)h,P<0.001]than those not requiring ICU admission.In the multivariate logistic regression analysis model,age,Asian ethnicity,concurrent coronavirus disease 2019(COVID-19)infection,DKA severity,DKA trigger,and NSTEMI were the main predicting factors for ICU admission.CONCLUSION In the largest tertiary center in Qatar,25%of all DKA patients required ICU admission.Older age,T2DM,newly onset DM,an infectious trigger of DKA,moderate-severe DKA,concurrent NSTEMI,and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.
