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Lee B. Bockus Zain Ul Abideen Asad Amna Mohyud Din Chaudhary Ahmed Awab 《The American journal of the medical sciences》2019,357(2):164-167
The presenting symptoms of diabetic ketoacidosis (DKA) include abdominal pain, polyuria and nausea. Diabetes has well known chronic ocular complications like glaucoma, cataracts and retinopathy. We report a case of reversible blindness as a presenting manifestation of DKA that has been reported in literature only 3 times previously. Our objective is to highlight a rare manifestation of a common disease. A 59-year-old male presented with painless vision loss for 3 days and was found to have DKA. The blindness was completely reversed with insulin and bicarbonate treatment. The dramatic presentation and reversibility of blindness was found to be intimately tied with the pH of the patient's serum. Our report gives mechanistic insight for this interesting condition. Clinicians should be aware of reversible blindness as a complication of DKA. Timely correction of the severe acidosis and other metabolic disturbances of DKA may be instrumental in preventing permanent vision loss. 相似文献
84.
目的 比较分析暴发性1型糖尿病及经典1型糖尿病的临床特征,探讨暴发性1型糖尿病的发病机制.方法 入选2005年9月至2009年9月在我院内分泌科住院的以酮症酸中毒为首发症状的暴发性1型糖尿病患者6例(暴发性1型糖尿病组)和以酮症酸中毒为首发症状的初发经典1型糖尿病患者24例(经典1型糖尿病组),回顾性分析两组患者的临床特征,包括发病年龄、糖尿病病程、咽痛、咳嗽、发热等流感样症状、恶心、呕吐、腹痛等消化道症状、入院时随机血糖、糖化血红蛋白、C肽、丙氨酸转氨酶、肌酸激酶、肌酐、血钾、白细胞计数等.计量资料和计数资料分别采用t检验或x2检验进行统计分析.结果 与经典1型糖尿病组相比,暴发性1型糖尿病组发病年龄升高[分别为(46±6)、(19±6)岁,t=9.89,P<0.01],糖尿病病程明显缩短[分别为(3.5±2.7)、(52.5±32.6)d,t=3.63,P<0.01],咽痛、咳嗽、发热等流感样症状明显增多[分别为50%(3/6)、0(0/24),x2=13.33,P<0.01],恶心、呕吐、腹痛等消化道症状亦增多[分别为83%(5/6)、0(0/24),x2=24.00,P<0.01].与经典1型糖尿病组相比,暴发性1型糖尿病组入院时随机血糖升高[分别为(44±7)、(23±4)mmol/L,t=9.22,P<0.01],糖化血红蛋白降低[分别为(7.1±1.0)%、(14.4±2.2)%,t=7.66,P<0.01],餐后2 h C肽减少[分别为(0.21±0.17)、(0.58±0.39)μg/L,t=2.29,P<0.05],丙氨酸转氨酶增高[分别为(206±124)、(10±2)U/L,t=8.18,P<0.01],肌酸激酶升高[分别为(1038±447)、(79±10)U/L,t=11.11,P<0.01],肌酐增加[分别为(179±39)、(55±16)μmol/L,t=12.33,P<0.01],血钾升高[分别为(5.2±0.7)、(3.4±0.8)mmol/L,t=5.07,P<0.01],白细胞计数增多[分别为(21.0±8.1)×109个/L、(6.0±1.9)×109个/L,t=8.64,P<0.01].结论 暴发性1型糖尿病患者存在胰岛β细胞功能衰竭,代谢紊乱更为严重,免疫反应更加强烈,容易导致多脏器功能损害. 相似文献
85.
True euglycemic diabetic ketoacidosis [blood glucose <200 mg/dl (11.1 mmol/l)] is relatively uncommon and in type 1 diabetes
can be caused by starvation of any cause in conjunction with an intercurrent illness. We report a case of euglycemic diabetic
ketoacidosis precipitated by starvation resulting from severe depression in a patient with type 1 diabetes. He was acidotic
with ketonuria, but his blood glucose was only 105 mg/dl (5.8 mmol/l). He was rehydrated, the acidosis was corrected, and
his depression was later treated. This case involves the complex interplay among type 1 diabetes, depression, ketoacidosis,
and starvation physiology resulting in glucose concentrations in keeping with euglycemic diabetic ketoacidosis. The case also
highlights that even in the absence of hyperglycemia, acid/base status should be assessed in an ill patient with diabetes,
and in cases of euglycemic diabetic ketoacidosis, the diagnosis of depression should be considered as a cause for suppressed
appetite and anorexia. 相似文献
86.
87.
《Primary Care Diabetes》2021,15(5):793-798
AimTo minimize the spread of COVID-19, the Kingdom of Saudi Arabia (KSA) enforced a nationwide lockdown. We aimed to explore whether the manner in which Saudi patients with type 1 diabetes (T1D) manage their disease has changed during this unparalleled lockdown.MethodsAn online survey exploring the effect of lockdown on T1D outcomes was distributed among T1D patients residing in KSA during lockdown.ResultsA total of 1010 patients responded to the survey. Around 40% reported communicating with their physicians during lockdown. Age, level of education, residence, previous visits to diabetes education clinics, last HbA1c value, and average monthly income were all significantly associated with communication with the treating physician (p = 0.008, p < 0.001, p < 0.001, p = 0.002, p < 0.001, and p < 0.001, respectively). Age, level of education, and average monthly income were significantly associated with experiencing severe hypoglycemia (p = 0.036, p = 0.03, and p < 0.001, respectively), while average monthly income and level of education were significantly associated with experiencing diabetic ketoacidosis (DKA) (p < 0.001 and p = 0.0039, respectively); during lockdown. Patients who communicated with their physicians reported lower rates of severe hypoglycemia compared to those who did not (25.2% vs 30.7%, respectively).ConclusionAge and level of education were significantly associated with communication with the treating physician, and experiencing severe hypoglycemia and DKA; in patients with T1D during the lockdown period in Saudi Arabia. Keeping two-way virtual communication channels between physicians and their T1D patients should be encouraged. 相似文献
88.
《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2021,15(6):102313
BackgroundHyperosmolar diabetic ketoacidosis (H-DKA), a distinct clinical entity, is the overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).AimWe describe the clinical presentation, metabolic aberrations, and associated morbidity/mortality of these cases with H-DKA. We highlight the problem areas of medical care which require particular attention when caring for pediatric diabetes patients presenting with H-DKA.MethodsIn our study we reviewed the literature back to 1963 and retrieved twenty-four cases meeting the criteria of H-DKA: glucose >600 mg/dL, pH < 7.3, bicarbonate <15 mEq/L, and serum osmolality >320 mOsm/kg, while adding three cases from our institution.ResultsAverage age of presentation of H-DKA was 10.2 years ± 4.5 years in females and 13.3 years ± 4 years in males, HbA1c was 13%. Biochemical parameters were consistent with severe dehydration: serum osmolality = 394.8±55 mOsm/kg, BUN = 48±22 mg/dL, creatinine = 2.81±1.03 mg/dL. Acute kidney injury, present in 12 cases, was the most frequent end-organ complication.ConclusionMulti-organ involvement with AKI, rhabdomyolysis, pancreatitis, neurological and cardiac issues such as arrhythmias, are common in H-DKA. Aggressive fluid management, insulin therapy and supportive care can prevent acute and long term adverse outcomes in children and adolescents. 相似文献
89.
Pituitary gigantism, a condition of endogenous growth hormone (GH) hypersecretion prior to epiphyseal closure, is a rare condition.
In the adult condition of GH excess, acromegaly, the occurrence of type 2 diabetes mellitus (T2DM) and diabetic ketoacidosis
(DKA) have been reported, with resolution following normalization of GH levels. We report the case of a 16-year-old male with
pituitary gigantism due to a large invasive suprasellar adenoma who presented with T2DM and DKA. Despite surgical de-bulking,
radiotherapy and medical treatment with cabergoline and pegvisomant, GH and insulin-like growth factor-I (IGF-I) levels remained
elevated. However, the T2DM and recurrent DKA were successfully managed with metformin and low-dose glargine insulin, respectively.
We review the pathophysiology of T2DM and DKA in growth hormone excess and available treatment options. 相似文献
90.
Jennifer VanderWeele Teresa Pollack Diana Johnson Oakes Colleen Smyrniotis Vidhya Illuri Priyathama Vellanki Kevin OLeary Jane Holl Grazia Aleppo Mark E. Molitch Amisha Wallia 《Journal of diabetes and its complications》2018,32(7):650-654