Validation of data from electronic data warehouse in diabetic ketoacidosis: Caution is needed

Aims

This study validated enterprise data warehouse (EDW) data for a cohort of hospitalized patients with a primary diagnosis of diabetic ketoacidosis (DKA).

Prevalence of double diabetes in youth onset diabetes patients from east Delhi and neighboring NCR region

Background

It is being increasingly reported that some of the youth onset diabetes patients cannot be classified clearly as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on usual criteria and the term double diabetes (DD) coined for these cases.

Early detection of euglycemic ketoacidosis during thoracic surgery associated with empagliflozin in a patient with type 2 diabetes: A case report

We report the first case of intraoperatively detected euglycemic diabetic ketoacidosis (DKA) associated with sodium–glucose cotransporter 2 inhibitors during thoracic surgery. A 59-year-old man had a 12-year history of type 2 diabetes mellitus treated with insulin and empagliflozin. The patient developed bacterial empyema and was initiated with antibiotics at a local hospital. Owing to the persistence of his symptoms, he was transferred to our hospital after the medication of empagliflozin the day before surgery. After overnight fasting, the patient underwent thoracoscopic debridement and intrathoracic lavage surgery. During this surgery, he was noted to have euglycemic ketosis and acidosis, and diagnosed as euglycemic DKA. Immediately after the consultation in our department, the patient underwent treatment for DKA. He awoke from anesthesia normally and showed no symptoms of DKA. DKA gradually resolved over the next 24 h. Early identification and management are critical for rapid recovery from perioperative euglycemic DKA associated with sodium–glucose cotransporter 2 inhibitors, especially during thoracic surgery.     

暴发性1型糖尿病并发酮症酸中毒1例报告

1病历资料患者男,30岁。主因发热3 d,多饮、多尿1 d,于2010-04-13入院。入院3 d前无明显诱因感发热,体温波动于38～40℃,伴上腹阵发性钝痛,放射至左腰部,无咳嗽、咳痰、胸闷、胸痛、尿频、尿急、尿痛等症状,在我院门诊给予抗炎和降温对症处理(具体不详),上述症状好转。患者于入院1 d前感多饮、多尿,日饮水3000～4000 mL,日尿量3000 mL左右,日尿5～6次,夜尿4～5次,无毛发增多、皮肤紫纹、心悸、手抖、怕热、多汗等症状,于2010-04-13中午无明显诱因突感恶心、呕吐,呕吐物为咖啡样物质,量     

An Unusual Case of Butcher's Broom Precipitating Diabetic Ketoacidosis

Background

Herbal medicines are readily available and commonly perceived to be relatively harmless. Butcher's Broom is used in various medicinal preparations and contains substances having α-adrenergic−stimulating properties.

Objective

Our aim was to report a case of toxicity associated with Butcher's Broom in a diabetic patient.

Case Report

A 39-year-old woman developed diabetic ketoacidosis 5 days after beginning therapy with Butcher's Broom for mild ankle swelling. Her diabetic ketoacidosis was complicated by hyperkalemia and acidosis with a pH of 7.02. After management with intravenous fluid, insulin, and calcium gluconate, her condition stabilized and she was discharged several days later.

Conclusions

This case represents a small but potentially serious public health concern in a diabetic woman taking Butcher's Broom.     

糖尿病酮症酸中毒患者甲状腺功能状态分析

目的 分析糖尿病酮症酸中毒(DKA)患者甲状腺功能(甲功)状态.方法 选择广西医科大学第九附属医院2005年11月至2013年12月住院DKA患者93例,并按性别、年龄(≤30岁组、30 ～ 60岁组、≥60岁组)、糖尿病分型(1型糖尿病、2型糖尿病)进行分组,测定各组血清FT3、FT4、促甲状腺激素(TSH)水平,并进行比较.结果 甲功正常的病态综合征(ESS)发生率为79.6％(74/93),甲功正常为9.7％ (9/93),甲状腺功能亢进症发生率为7.5％ (7/93),亚临床甲状腺功能亢进症发生率为2.2％ (2/93),甲状腺功能减退症发生率为1.1％ (1/93).男性组DKA患者的FT3水平低于女性组(t=-2.046,P=0.044),FT4、TSH比较差异无统计学意义;1型糖尿病组FT4水平低于2型糖尿病组(t-2.352,P=0.021),但TSH高于2型糖尿病组(t=2.454,P=0.016),FT3比较差异无统计学意义(P＞0.05).1型糖尿病组低T3/T4综合征比例高于2型糖尿病组(x2 =4.443,P =0.035).低T3综合征比例随着年龄增加有增加的趋势(x2=7.081,P=0.029);低T3/T4综合征比例随着酸中毒严重程度的增加有增加的趋势(x2=6.759,P=0.034).结论 DKA患者甲功异常发生率较高,甲功异常表现形式多样,ESS最常见.     

Insulin increases serum leptin concentrations in children and adolescents with newly diagnosed Type I diabetes mellitus with and without ketoacidosis

Abstract Aims/hypothesis. The aims of this study were to analyse the changes of serum leptin in newly diagnosed children and adolescents with Type I (insulin-dependent) diabetes mellitus after insulin treatment and to examine the possible impact of ketoacidosis on these changes. Methods. Baseline serum leptin concentrations were measured in 28 newly diagnosed Type I diabetic patients [age 8.75 ± 4.05 years (means ± SD); BMI 15.79 ± 2.47 kg/m²; HbA_{1 c} 11.3 ± 1.9 %] with (n = 18) and without (n = 10) ketoacidosis before commencement of insulin treatment, at the time of diagnosis. Thereafter, during a 4-day course of continuous intravenous insulin injection to gain and maintain euglycaemia, serum leptin concentrations were assessed. Results. Baseline serum leptin concentrations, adjusted to age, BMI, sex and pubertal stage, differed among these patients. There was, however, an increase of leptin in all subjects from 1.37 ± 0.56 ng/ml (mean ± SD) up to 2.97 ± 1.52 ng/ml by 117 % (p < 0.0001) after insulin therapy. On average, peak serum leptin concentration was obtained after 42 h of insulin treatment. Further, there was no difference in the mean increase of serum leptin concentrations in the two groups, namely with and without ketoadicosis, of insulin-dependent diabetic children and adolescents. In addition, there was no correlation between serum leptin concentrations and correction of ketoacidosis during insulin treatment. Conclusions/interpretation. Insulin increases serum leptin, within 1 day, in children and adolescents with newly diagnosed Type I diabetes. Ketoacidosis does not influence this interaction between insulin and leptin. [Diabetologia (1999) 42: 1067–1070] Received: 12 April 1999 and in revised form: 20 May 1999     

End-tidal Carbon Dioxide Predicts the Presence and Severity of Acidosis in Children with Diabetes

BACKGROUND: Patients with diabetic ketoacidosis (DKA) hyperventilate, lowering their alveolar (PACO(2)) and arterial carbon dioxide (PaCO(2)). This ventilatory response lessens the severity of their acidemia in a predictable way. Because end-tidal CO(2) (ETCO(2)) closely approximates PaCO(2), measured ETCO(2) levels should allow for predictions about the presence and severity of acidosis in diabetic patients. OBJECTIVES: 1) To evaluate the relationship between measured serum bicarbonate (HCO(3)) and ETCO(2) measured via nasal capnography in children with suspected DKA; and 2) to assess the ability of capnography to predict DKA. METHODS: Children being evaluated in a pediatric emergency department for suspected DKA (known or suspected diabetes presenting with hyperglycemia with or without ketonuria) were enrolled in a cross-sectional, prospective, observational study. Prior to the availability of venous HCO(3) results, ETCO(2) values were measured using a Nellcor NPB-70 Handheld Capnograph. RESULTS: Forty-two patients were enrolled. Linear regression analysis revealed a significant relationship between HCO(3) and ETCO(2) (R(2) = 0.80, p < 0.0001). Mean ETCO(2) was 37 torr (95% CI = 35.5 to 37.9 torr) in the children without DKA and 22 torr (95% CI = 17.4 to 26.9 torr) in the children with DKA (p < 0.0001). An ETCO(2) cut-point of <29 torr correctly classified the most patients (95%), with a sensitivity of 0.83 (95% CI = 0.52 to 0.98) and a specificity of 1.0 (95% CI = 0.88 to 1.0). No patient with an ETCO(2) of > or =36 torr had DKA, for a sensitivity of 1.0 (95% CI = 0.74 to 1.0). CONCLUSIONS: End-tidal CO(2) is linearly related to HCO(3) and is significantly lower in children with DKA. If confirmed by larger trials, cut-points of 29 torr and 36 torr, in conjunction with clinical assessment, may help discriminate between patients with and without DKA, respectively.     

高敏C-反应蛋白在酮症或酮症酸中毒起病的2型糖尿病患者的检测意义

目的了解自发酮症或酮症酸中毒起病的2型糖尿病患者的免疫炎性反应和胰岛8细胞损害程度。方法检测以自发酾症或酮症酸中毒起病的2型糖尿病患者血清高敏c-反应蛋白（hs—CRP）、抗谷氨酸脱羧酶（GAD）抗体的水平,及空腹胰岛素、c-肽及餐后2h胰岛素、c-肽水平。用酶联免疫吸附试验（ELISA）法测定hs—CRP的水平,胰岛素（Ins）、C-肽、GAD抗体用化学发光法检测。结果①自发酮症或酮症酸中毒起病的2型糖尿病患者患者血清hs—cRP与对照组（32382．11±1685．68ng／ml比10775．25±1615．77ng／ml）相比明显增高,差异有统计学意义（P〈0．05）。（2）以酮症酸中毒起病的2型糖尿病患者外周血GAD抗体阳性率（14．0％）,与对照组（13．3％）比较,差异无统计学意义（P〉0．05）。③自发酮症或酮症酸中毒起病的2型糖尿病患者外周血空腹胰岛素、c-肽、餐后2h胰岛素、餐后2hc-肽水平明显低于对照组差异有统计学意义（P〈0．05）。结论机体免疫炎症反应是促使2型糖尿病患者自发酮症或酮症酸中毒的重要机制,是导致2型糖尿病患者急性胰岛β细胞损伤的主要原因。     

Type 2 diabetes presenting as diabetic ketoacidosis in adolescence.

We report two black adolescent subjects who presented with diabetic ketoacidosis, but who lacked autoimmune markers and demonstrated clinical and biochemical characteristics more typical of Type 2 diabetes, including obesity, acanthosis nigricans, positive family history for Type 2 diabetes, and Type 2 diabetic dyslipidaemia. Subsequent to acute presentation, insulin was discontinued in both subjects and excellent glycaemic control was achieved with metformin therapy alone. Four months following acute presentation, both had adequate C-peptide responses to intravenous glucagon. Type 2 diabetes can present as diabetic ketoacidosis in obese adolescent subjects.