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Belal MM, Khalefa BB, Rabea EM, Aly Yassin MN, Bashir MN, Abd El-Hameed MM, Elkoumi O, Saad SM, Saad LM, Elkasaby MH. Low dose insulin infusion versus the standard dose in children with diabetic ketoacidosis: a meta-analysis. Future Sci OA 2024; 10:FSO956. [PMID: 38827803 PMCID: PMC11140676 DOI: 10.2144/fsoa-2023-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/13/2023] [Indexed: 06/05/2024] Open
Abstract
Aim: This systematic review aims to consolidate findings from current clinical trials that compare the effectiveness of insulin infusion at 0.05 IU/kg/h versus 0.1 IU/kg/h in managing pediatric diabetic ketoacidosis. Methods: We searched several databases, including PubMed, Embase, Scopus, Cochrane Central and Web of Science. Our primary outcomes were time to reach blood glucose ≤250 mg/dl and time to resolution of acidosis. Secondary outcomes included rate of blood glucose decrease per hour, incidence of hypoglycemia, hypokalemia, treatment failure, and cerebral edema. Results & conclusion: The present study establishes that a low insulin dose exhibits comparable efficacy to the standard dosage for managing pediatric patients suffering from diabetic ketoacidosis, with a lower incidence of complications.
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Affiliation(s)
- Mohamed Mohamed Belal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Basma Badrawy Khalefa
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Ain shams University, Cairo, Egypt
| | - Eslam Mohammed Rabea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Mazen Negmeldin Aly Yassin
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed Nabih Bashir
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Malak Mohamed Abd El-Hameed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Ash Sharqia, Egypt
| | - Omar Elkoumi
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Suez University, Suez, Egypt
| | - Saad Mohamed Saad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Loubna Mohamed Saad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Mohamed Hamouda Elkasaby
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Scutca AC, Jugănaru I, Nicoară DM, Brad GF, Bugi MA, Asproniu R, Cristun LI, Mărginean O. Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus. J Clin Med 2024; 13:2582. [PMID: 38731111 PMCID: PMC11084164 DOI: 10.3390/jcm13092582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Although most cases of new-onset type 1 diabetes mellitus (T1DM) are managed without serious events, life-threatening complications do arise in a subset of patients. Our objective was to assess the correlation between elevated SIRI values and adverse events related to the onset of T1DM. (2) Methods: This retrospective study, spanning ten years, included 187 patients with new-onset T1DM divided into three groups based on SIRI tertiles. The primary outcome was the occurrence of acute complications during hospital admission, while the secondary outcome was prolonged Intensive Care Unit (ICU) admission. (3) Results: Patients with high SIRI values were more likely to experience higher disease activity, leading to longer ICU admission times and more frequent complications. Multivariate logistic regression analysis revealed that the SIRI was independently associated with acute complications (p = 0.003) and prolonged ICU length of stay (p = 0.003). Furthermore, receiver operating characteristic analysis demonstrated the SIRI's superior predictive accuracy compared to venous pH (AUC = 0.837 and AUC = 0.811, respectively) and to the individual component cell lineages of the SIRI. (4) Conclusions: These findings emphasize the potential utility of the SIRI as a prognostic marker in identifying patients at increased risk during T1DM hospital admissions.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Meda-Ada Bugi
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Raluca Asproniu
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Lucian-Ioan Cristun
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
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Caschera L, Fiore G, Nava S, Criscuolo S, Lo Russo FM, Casale S, Conte G, Platania G, Costa A, Carrabba G, Locatelli M, Triulzi FM. Diabetic ketoacidosis with central nervous system involvement: Conventional and advanced magnetic resonance neuroimaging findings. Neuroradiol J 2024:19714009241248745. [PMID: 38654625 DOI: 10.1177/19714009241248745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Diabetic ketoacidosis (DKA) is a serious complication in children with diabetes mellitus type 1 (DM1). In rare and severe cases DKA may be complicated by cerebral edema, central brain herniation and cerebral infarctions. We present the magnetic resonance imaging findings in a child with DKA and central nervous system involvement; diffusion tensor imaging (DTI) and functional MRI (fMRI) were performed to assess the white matter integrity of sensory pathways and cortical sensory processing. Conventional imaging showed bilateral uncal herniation, effacement of the perimesencephalic cisterns, wide ischemic lesions in the posterior cerebral artery (PCA) territories, sagging brainstem and Duret's hemorrhage consistent with signs of central brain herniation and intracranial hypertension. Advanced MRI showed a possible left-sided cortical reorganization for sensory function, with underlying left cortico-talamic and cortico-spinal pathways less severely impaired. Knowledge of the full framework in these conditions is of vital importance for timely patient management; advanced neuroimaging techniques may be considered as prognostic indicators in those cases with extensive involvement of eloquent brain areas.
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Affiliation(s)
- Luca Caschera
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giorgio Fiore
- Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
- Unit of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Simone Nava
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | | | - Francesco M Lo Russo
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Silvia Casale
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giulia Platania
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Antonella Costa
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Giorgio Carrabba
- Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - Marco Locatelli
- Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
| | - Fabio Maria Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
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Liu Y, Mo W, Wang H, Shao Z, Zeng Y, Bi J. Feature selection and risk prediction for diabetic patients with ketoacidosis based on MIMIC-IV. Front Endocrinol (Lausanne) 2024; 15:1344277. [PMID: 38601206 PMCID: PMC11004357 DOI: 10.3389/fendo.2024.1344277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Diabetic ketoacidosis (DKA) is a frequent acute complication of diabetes mellitus (DM). It develops quickly, produces severe symptoms, and greatly affects the lives and health of individuals with DM.This article utilizes machine learning methods to examine the baseline characteristics that significantly contribute to the development of DKA. Its goal is to identify and prevent DKA in a targeted and early manner. Methods This study selected 2382 eligible diabetic patients from the MIMIC-IV dataset, including 1193 DM patients with ketoacidosis and 1186 DM patients without ketoacidosis. A total of 42 baseline characteristics were included in this research. The research process was as follows: Firstly, important features were selected through Pearson correlation analysis and random forest to identify the relevant physiological indicators associated with DKA. Next, logistic regression was used to individually predict DKA based on the 42 baseline characteristics, analyzing the impact of different physiological indicators on the experimental results. Finally, the prediction of ketoacidosis was performed by combining feature selection with machine learning models include logistic regression, XGBoost, decision tree, random forest, support vector machine, and k-nearest neighbors classifier. Results Based on the importance analysis conducted using different feature selection methods, the top five features in terms of importance were identified as mean hematocrit (haematocrit_mean), mean hemoglobin (haemoglobin_mean), mean anion gap (aniongap_mean), age, and Charlson comorbidity index (charlson_comorbidity_index). These features were found to have significant relevance in predicting DKA. In the individual prediction using logistic regression, these five features have been proven to be effective, with F1 scores of 1.000 for hematocrit mean, 0.978 for haemoglobin_mean, 0.747 for age, 0.692 for aniongap_mean and 0.666 for charlson_comorbidity_index. These F1 scores indicate the effectiveness of each feature in predicting DKA, with the highest score achieved by mean hematocrit. In the prediction of DKA using machine learning models, including logistic regression, XGBoost, decision tree, and random forest demonstrated excellent results, achieving an F1 score of 1.000. Additionally, by applying feature selection techniques, noticeable improvements were observed in the experimental performance of the support vector machine and k-nearest neighbors classifier. Conclusion The study found that hematocrit, hemoglobin, anion gap, age, and Charlson comorbidity index are closely associated with ketoacidosis. In clinical practice, these five baseline characteristics should be given with the special attention to achieve early detection and treatment, thus reducing the incidence of the disease.
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Affiliation(s)
- Yang Liu
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Wei Mo
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - He Wang
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Zixin Shao
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yanping Zeng
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jianlu Bi
- Endocrinology, The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Endocrinology, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
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Kumar M, Dixit R, Kapoor R, Singh S. From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2024; 37:170-173. [PMID: 38167416 DOI: 10.1515/jpem-2023-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Abdominal pain is a common presentation in patients of diabetic ketoacidosis (DKA). However, this pain generally resolves with resolution of dehydration and acidosis. Persistence of abdominal pain even after resolution of ketosis and acidosis should warrant careful reassessment to find evidence of sepsis and concomitant abdominal pathology. CASE PRESENTATION We report a rare case of type 1 diabetes mellitus in a 15 year old girl diagnosed 6 months ago who presented with mild DKA (pH 7.24, HCO3 - 13.5 mmol/L). Her hospital course was extremely stormy and despite best of our efforts she succumbed due to colonic ischemia and perforation peritonitis. CONCLUSIONS A high index of suspicion for gut ischemia or perforation should be kept if DKA is associated with septic shock and there is suboptimal response to standard treatment. Mesenteric ischemia can occur in pediatric patients even with mild DKA having very poor diabetes control.
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Affiliation(s)
- Mritunjay Kumar
- Department of Pediatrics, All India Institute of Medical Sciences - Raebareli, Raebareli, Uttar Pradesh, India
| | - Rini Dixit
- Department of Pediatrics, All India Institute of Medical Sciences - Raebareli, Raebareli, Uttar Pradesh, India
| | - Rohit Kapoor
- Department of Paediatric Surgery, All India Institute of Medical Sciences - Raebareli, Raebareli, Uttar Pradesh, India
| | - Sunita Singh
- Department of Paediatric Surgery, All India Institute of Medical Sciences - Raebareli, Raebareli, Uttar Pradesh, India
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Kostopoulou E, Sinopidis X, Fouzas S, Gkentzi D, Dassios T, Roupakias S, Dimitriou G. Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls. Diagnostics (Basel) 2023; 13:2602. [PMID: 37568965 PMCID: PMC10416834 DOI: 10.3390/diagnostics13152602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia, and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline and Scopus databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, between DKA and hyperosmolar hyperglycaemic state (HHS), and between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration, restoration of shifting electrolyte disorders and addressing underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention, and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency.
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Affiliation(s)
- Eirini Kostopoulou
- Department of Paediatrics, University of Patras, 26504 Patras, Greece; (X.S.); (S.F.); (D.G.); (T.D.); (S.R.); (G.D.)
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7
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Dyńka D, Kowalcze K, Charuta A, Paziewska A. The Ketogenic Diet and Cardiovascular Diseases. Nutrients 2023; 15:3368. [PMID: 37571305 PMCID: PMC10421332 DOI: 10.3390/nu15153368] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide "rescue fuel" for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.
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Affiliation(s)
| | | | | | - Agnieszka Paziewska
- Institute of Health Sciences, Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (D.D.); (K.K.); (A.C.)
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8
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Hilal F, Mahdi E, Nada A. Hemorrhagic stroke: Uncommon complication of diabetic ketoacidosis in pediatric patients. Radiol Case Rep 2022; 17:4059-4063. [PMID: 36065248 PMCID: PMC9440358 DOI: 10.1016/j.radcr.2022.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a well-known complication of type 1 diabetes mellitus. Diabetic ketoacidosis predisposes patients into devastating neurological complications. The most common neurologic complication is cerebral edema. Stroke either ischemic or hemorrhagic are uncommon complications of DKA with worse patient's outcome. Hemorrhagic stroke can manifest as subarachnoid or intraparenchymal hemorrhage. We present a 14-year-girl presented with DKA and complicated with both subarachnoid and intraparenchymal hemorrhages. Owing to early diagnosis and prompt treatment the patient had good outcome.
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Affiliation(s)
- Fathi Hilal
- Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212, USA
| | - Eman Mahdi
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ayman Nada
- Department of Radiology, University of Missouri, One Hospital Dr, Columbia, MO 65212, USA
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9
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Sharma S, Adhikari A, Adhikari S, Poudel S, Bk R, Mainali G, Yadav SK. Successful medical management of diabetic ketoacidosis at first presentation in a child with type 1 diabetes: A case report. Ann Med Surg (Lond) 2022; 79:103981. [PMID: 35860061 PMCID: PMC9289310 DOI: 10.1016/j.amsu.2022.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shriya Sharma
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
- Corresponding author.
| | | | | | - Sabin Poudel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Reshu Bk
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Gaurab Mainali
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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10
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Patrick S, Satar HA, Wan Hitam WH. Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.cr.225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This was a rare case of preseptal cellulitis with an unexpected complication by cerebral venous sinus thrombosis. A 73-year-old woman with poorly controlled diabetes mellitus presented with a week history of swelling and redness on the left upper eyelid and right forehead, associated with poor oral intake, lethargy, and fever. She was generally lethargic with poor verbal response. She had cellulitis of the left upper eyelid and right forehead with the left upper eyelid necrosis. Computed tomography venography of the brain revealed thrombosis of the right transverse sinus, right sigmoid sinus, and right internal jugular vein. She later developed left upper eyelid and right forehead abscesses. Incision, drainage, and wound debridement were performed. She was treated with intravenous antibiotics and anticoagulant. After 1 week of treatment, the preseptal and forehead cellulitis had resolved. However, she passed away due to aspiration pneumonia with respiratory failure on day-13 of hospitalization.
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Iwasaki H, Jiang SX. Diabetic ketoacidosis-associated gangrenous ischaemic colitis masquerading as acute pancreatitis and differentiated using computed tomography. Oxf Med Case Reports 2022; 2022:omac002. [PMID: 35198225 PMCID: PMC8858393 DOI: 10.1093/omcr/omac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/13/2021] [Accepted: 01/03/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Diagnosis of an acute abdomen during an episode of diabetic ketoacidosis (DKA) is crucial for providing appropriate treatments and obtaining favourable outcomes, but may be difficult due to its considerable overlap with multiple intra-abdominal diseases in terms of clinical course and laboratory findings. In this study, we presented a case showing signs of an acute abdomen with sharp rises in serum pancreatic biochemical markers during the treatment of DKA with pyelonephritis. Contrast-enhanced computed tomography (CT) was performed to confirm the onset of acute pancreatitis; however, pneumatosis intestinalis and poor enhancement of the rectal wall were detected, indicating the presence of rectal infarction. Hartmann’s procedure was immediately performed, and histological examination of the resected specimen revealed gangrenous ischaemic colitis. The present case highlights DKA as a risk factor of ischaemic colitis and the role of contrast-enhanced CT in the differential diagnosis of an acute abdomen in hyperglycaemic crisis.
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Affiliation(s)
- Hiroaki Iwasaki
- Department of Internal Medicine, Toshiba Rinkan Hospital, Sagamihara 252-0385, Japan
| | - Shi-Xu Jiang
- Department of Pathology, Toshiba Rinkan Hospital, Sagamihara 252-0385, Japan
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12
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Abdou M, Hassan MM, Hassanein SA, Elsebaie EH, Shamma RA. Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience. Front Endocrinol (Lausanne) 2022; 13:814991. [PMID: 35360079 PMCID: PMC8963467 DOI: 10.3389/fendo.2022.814991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. OBJECTIVES This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. METHODS This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. RESULTS Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. CONCLUSION An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.
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Affiliation(s)
- Marise Abdou
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
- *Correspondence: Marise Abdou,
| | - Mona M. Hassan
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Samah A. Hassanein
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Eman H. Elsebaie
- Public Health and Community Medicine Department, Cairo University, Cairo, Egypt
| | - Radwa A. Shamma
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
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13
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Schwartz DD, Banuelos R, Uysal S, Vakharia M, Hendrix KR, Fegan-Bohm K, Lyons SK, Sonabend R, Gunn SK, Dei-Tutu S. An Automated Risk Index for Diabetic Ketoacidosis in Pediatric Patients With Type 1 Diabetes: The RI-DKA. Clin Diabetes 2022; 40:204-210. [PMID: 35669298 PMCID: PMC9160557 DOI: 10.2337/cd21-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Identifying patients at high risk for diabetic ketoacidosis (DKA) is crucial for informing efforts at preventive intervention. This study sought to develop and validate an electronic medical record (EMR)-based tool for predicting DKA risk in pediatric patients with type 1 diabetes. Based on analysis of data from 1,864 patients with type 1 diabetes, three factors emerged as significant predictors of DKA: most recent A1C, type of health insurance (public vs. private), and prior DKA. A prediction model was developed based on these factors and tested to identify and categorize patients at low, moderate, and high risk for experiencing DKA within the next year. This work demonstrates that risk for DKA can be predicted using a simple model that can be automatically derived from variables in the EMR.
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Affiliation(s)
- David D. Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Corresponding author: David D. Schwartz,
| | - Rosa Banuelos
- Texas Children’s Hospital Quality Outcomes and Analytics, Houston, TX
| | - Serife Uysal
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Mili Vakharia
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kristen R. Hendrix
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Piedmont Physicians Endocrinology, Columbus, GA
| | - Kelly Fegan-Bohm
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sarah K. Lyons
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rona Sonabend
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sheila K. Gunn
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Selorm Dei-Tutu
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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14
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Sakou II, Soldatou A, Seretis A, Karanasios E, Paltoglou G, Karavanaki K. Markedly elevated troponin and NT-proBNP and myocardial dysfunction in an adolescent with severe diabetic ketoacidosis: a case report. Clin Pediatr Endocrinol 2022; 31:192-198. [PMID: 35928382 PMCID: PMC9297169 DOI: 10.1297/cpe.2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/16/2022] [Indexed: 12/04/2022] Open
Abstract
Severe diabetic ketoacidosis (DKA), rarely, may be associated with elevated troponin and
proBNP levels in adults with a history of diabetes. However, few cases have reported this
association in children with severe and complicated DKA. We describe a case of severe DKA
(pH: 6.89, HCO3: 6.5) in a 14-yr-old female adolescent in which the symptoms of DKA were
presented days before the diagnosis. The patient was under the effect of acidosis
(Kussmaul respiration) for 12 h before admission to our hospital, where she was admitted
in a critical clinical condition. After successful treatment with DKA with intensive
intravenous fluid and regular insulin, the patient presented with abnormal cardiac rhythm,
disturbance of interventricular septum motility, a mild decrease in left ventricular
systolic function, negative T waves in leads III and aVF, and a marked increase in
troponin and brain natriuretic peptide (NT-proBNP) levels. All abnormal findings
completely resolved within 8 days after the initiation of DKA treatment. The phenomenon in
our case was transient, and the patient had a good long-term outcome. However, it
represents a challenge for clinicians; therefore, emphasis should be given to cardiac
monitoring during the course of severe and prolonged DKA in children and adolescents.
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Affiliation(s)
- Irine-Ikbale Sakou
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | - Aristeidis Seretis
- Cardiology Deparment, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | | | - George Paltoglou
- University Research Institute of Maternal and Child Health and Precision Medicine, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
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15
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Basta C, Ramones K, Agarwal S, Marino G, Ghanny S. Severe hypertriglyceridemia: A rare complication of diabetic ketoacidosis in a 3-year-old with SARS-CoV-2 infection. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021; 22:100099. [PMID: 34751241 PMCID: PMC8566196 DOI: 10.1016/j.jecr.2021.100099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Children commonly present in diabetic ketoacidosis (DKA) secondary to Type 1 diabetes mellitus. Electrolyte imbalances and cerebral edema are common complications in the pediatric age group; however, patients may also have additional metabolic disturbances such as hyperlipidemia. We report a case of a pediatric patient with new-onset type 1 Diabetes Mellitus (DM) and DKA complicated by severe hypertriglyceridemia with recent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case presentation A three-year-old male noted to be SARS-CoV-2 positive, presented with hyperglycemia, metabolic acidosis, and ketosis consistent with DKA. Patient was later found to have severe hypertriglyceridemia (greater than 5680 mg/dL). He was managed with intravenous (IV) fluids and IV insulin replacement with improvement of triglycerides. Conclusion Severe hypertriglyceridemia in DKA, though rare in the pediatric population, responds very well to IV insulin therapy. This case also highlights possible need for early lipid screening in DKA patients with SARS-CoV-2 positive status.
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16
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Akcan N, Uysalol M, Kandemir I, Soydemir D, Abali ZY, Poyrazoglu S, Bas F, Bundak R, Darendeliler F. Evaluation of the Efficacy and Safety of 3 Different Management Protocols in Pediatric Diabetic Ketoacidosis. Pediatr Emerg Care 2021; 37:e707-e712. [PMID: 30907846 DOI: 10.1097/pec.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Management protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA. METHODS Fluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours. RESULTS The medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy. CONCLUSIONS Severity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.
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Affiliation(s)
- Nese Akcan
- From the Department of Pediatric Endocrinology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | | | | | | | - Zehra Yavas Abali
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ruveyde Bundak
- Department of Pediatric Endocrinology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Feyza Darendeliler
- Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Ren L, Wei C, Wei F, Ma R, Liu Y, Zhang Y, Wang W, Du J, Bai L, Xue Y, Cui S. A case report of rhabdomyolysis and osteofascial compartment syndrome in a patient with hypothyroidism and diabetes. BMC Endocr Disord 2021; 21:212. [PMID: 34689788 PMCID: PMC8543899 DOI: 10.1186/s12902-021-00868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypothyroidism is frequent and has various forms of muscle involvement. We report the diagnosis and treatment of a case of rhabdomyolysis, bilateral osteofascial compartment syndrome (OCS) of the lower extremities, and peroneal nerve injury causing bilateral foot drop in a diabetic patient with hypothyroidism. CASE PRESENTATION A 66-year-old man with diabetes for 22 years was admitted because of drowsiness, tiredness, facial swelling, and limb twitching for 2 months, and red and swollen lower limb skin for 3 days. Serum creatinine kinase (CK), CK-MB, myoglobin (Mb), blood glucose, and HbA1c were elevated. TSH, thyroid peroxidase antibodies, and antithyroglobulin antibodies were elevated. FT3 and FT4 were low. Urine was dark brown. He was diagnosed with hypothyroidism, rhabdomyolysis, and OCS. CK, CK-MB, and Mb returned to normal after treatment with thyroid hormone, insulin, albumin infusion, ceftriaxone, ulinastatin, and hemofiltration, and the redness and swelling of the lower limbs were relieved, but the patient developed dropping feet. The patient recovered well but had to undergo rehabilitation. CONCLUSION Hypothyroidism may induce rhabdomyolysis, OCS, and other complications. This case reminds us of the importance of screening for hypothyroidism and strengthens the clinicians' understanding of the disease.
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Affiliation(s)
- Lijue Ren
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Cuiying Wei
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China.
| | - Feng Wei
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Ruiting Ma
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yan Liu
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yonghong Zhang
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Wei Wang
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Jing Du
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Lin Bai
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yexia Xue
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Shaohua Cui
- Intensive Care Unit, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014010, Inner Mongolia, China
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18
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Arora S, Gupta S, Jesrani G, Saini R, Gupta M. Diabetes Ketoacidosis Complicating as Wrist Drop: A Case Report on Acute Motor Neuropathy. Cureus 2021; 13:e17081. [PMID: 34527468 PMCID: PMC8432426 DOI: 10.7759/cureus.17081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is an acute and major complication of diabetes mellitus. Neurological complications can be seen at any time during the course of illness and range from decreased consciousness to ischemic or hemorrhagic stroke. Acute neuropathy is very rare in this milieu. Here, we report a case of a 40-year-old patient, who developed a left-sided wrist drop after being treated for DKA. The nerve conduction velocity studies demonstrated decreased action potential amplitude in only the motor component of the left radial nerve. Other possible causes of the complaint were ruled out and the patient was managed with cock-up splint, vitamin B1 and B6 supplementation, and physiotherapy. Despite all these measures, the patient had minimal improvement. Thus, close monitoring of patients is crucial to identify these infirmities, even after the acute condition has resolved.
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Affiliation(s)
- Shreya Arora
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Shivani Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Gautam Jesrani
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Ruchika Saini
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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19
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Bassell JL, Swenson DW, Serrano-Gonzalez M, Topor LS. Cerebral oedema and dural sinus thrombosis in an adolescent with diabetic ketoacidosis. BMJ Case Rep 2021; 14:e241690. [PMID: 33837035 PMCID: PMC8043037 DOI: 10.1136/bcr-2021-241690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Julia L Bassell
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David W Swenson
- Center for Pediatric Imaging, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Monica Serrano-Gonzalez
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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20
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The Incidence of Erosive Esophagitis as a Complication of Pediatric Diabetic Ketoacidosis. Case Rep Endocrinol 2021; 2021:6636383. [PMID: 33747574 PMCID: PMC7954629 DOI: 10.1155/2021/6636383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Gastrointestinal (GI) symptoms commonly occur during diabetic ketoacidosis (DKA) and typically resolve with treatment. However, GI complications can persist after DKA resolves. The incidence of upper GI bleeding during DKA in adults has been described, with erosive esophagitis one of the most common lesions. The incidence of GI bleeding or erosive esophagitis in children with DKA has not been previously reported. We performed a retrospective chart review of DKA admissions in children 0 to <18 years with type 1 diabetes mellitus (T1DM) at a pediatric hospital between January 2009 and July 2016. Among 395 episodes of DKA over 7.5 years, erosive esophagitis occurred during two DKA admissions (0.5%) and there were no episodes of GI bleeding. Case presentations. Both episodes of erosive esophagitis occurred in adolescent males with known T1DM who presented with severe DKA. Both developed odynophagia after resolution of DKA and were readmitted for DKA recurrence. Upper endoscopy for both patients showed erosive esophagitis. Biopsies were negative for infection, though candida was found during one patient's endoscopy. Both had resolution of their esophagitis symptoms with medication management; neither has had recurrence. Conclusion Erosive esophagitis, a rare complication of pediatric DKA, can manifest with odynophagia or substernal chest pain. This complication can lead to DKA recurrence, likely due to increased insulin resistance from inflammation and pain and from reduced oral intake and insulin administration. Patients with odynophagia associated with DKA should be monitored closely to allow timely evaluation and treatment of esophagitis.
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21
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Chirayath SR, Bhavani N, Vinayan KP, Praveen VP, Nair S. Rare neurological complications associated with critically ill pediatric diabetic ketoacidosis—a report of two cases. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Temporal patterns of hospitalizations for diabetic ketoacidosis in children and adolescents. PLoS One 2021; 16:e0245012. [PMID: 33411822 PMCID: PMC7790255 DOI: 10.1371/journal.pone.0245012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/19/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives To examine the temporal patterns of hospitalizations with diabetic ketoacidosis (DKA) in the pediatric population and their associated fiscal impact. Methods The Texas Inpatient Public Use Data File was used to identify hospitalizations of state residents aged 1month-19 years with a primary diagnosis of DKA during 2005–2014. Temporal changes of population-adjusted hospitalization rates and hospitalization volumes were examined for the whole cohort and on stratified analyses of sociodemographic attributes. Changes in the aggregate and per-hospitalization charges were assessed overall and on stratified analyses. Results There were 24,072 DKA hospitalizations during the study period. The population-adjusted hospitalization rate for the whole cohort increased from 31.3 to 35.9 per 100,000 between 2005–2006 and 2013–2014. Hospitalization volume increased by 30.2% over the same period, driven mainly by males, ethnic minorities, those with Medicaid insurance and uninsured patients. The aggregate hospital charges increased from approximately $69 million to $130 million between 2005–2006 and 2013–2014, with 66% of the rise being due to increased per-hospitalization charges. Conclusions There was progressive rise in pediatric DKA hospitalizations over the last decade, with concurrent near-doubling of the associated fiscal footprint. Marked disparities were noted in the increasing hospitalization burden of DKA, born predominantly by racial and ethnic minorities, as well as by the underinsured and the uninsured. Further studies are needed to identify scalable preventive measures to achieve an equitable reduction of pediatric DKA events.
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23
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Nasser S, Vialichka V, Biesiekierska M, Balcerczyk A, Pirola L. Effects of ketogenic diet and ketone bodies on the cardiovascular system: Concentration matters. World J Diabetes 2020; 11:584-595. [PMID: 33384766 PMCID: PMC7754168 DOI: 10.4239/wjd.v11.i12.584] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Ketone bodies have emerged as central mediators of metabolic health, and multiple beneficial effects of a ketogenic diet, impacting metabolism, neuronal pathologies and, to a certain extent, tumorigenesis, have been reported both in animal models and clinical research. Ketone bodies, endogenously produced by the liver, act pleiotropically as metabolic intermediates, signaling molecules, and epigenetic modifiers. The endothelium and the vascular system are central regulators of the organism’s metabolic state and become dysfunctional in cardiovascular disease, atherosclerosis, and diabetic micro- and macrovascular complications. As physiological circulating ketone bodies can attain millimolar concentrations, the endothelium is the first-line cell lineage exposed to them. While in diabetic ketoacidosis high ketone body concentrations are detrimental to the vasculature, recent research revealed that ketone bodies in the low millimolar range may exert beneficial effects on endothelial cell (EC) functioning by modulating the EC inflammatory status, senescence, and metabolism. Here, we review the long-held evidence of detrimental cardiovascular effects of ketoacidosis as well as the more recent evidence for a positive impact of ketone bodies—at lower concentrations—on the ECs metabolism and vascular physiology and the subjacent cellular and molecular mechanisms. We also explore arising controversies in the field and discuss the importance of ketone body concentrations in relation to their effects. At low concentration, endogenously produced ketone bodies upon uptake of a ketogenic diet or supplemented ketone bodies (or their precursors) may prove beneficial to ameliorate endothelial function and, consequently, pathologies in which endothelial damage occurs.
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Affiliation(s)
- Souad Nasser
- Carmen Laboratory, INSERM Unit 1060—Lyon 1 University, Pierre Benite 69310, France
| | - Varvara Vialichka
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
- The University of Lodz Doctoral School of Exact and Natural Sciences, Lodz 90-237, Poland
| | - Marta Biesiekierska
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
| | - Aneta Balcerczyk
- Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz 90-236, Poland
| | - Luciano Pirola
- Carmen Laboratory, INSERM Unit 1060—Lyon 1 University, Pierre Benite 69310, France
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24
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Jasser‐Nitsche H, Haidl H, Cvirn G, Pohl S, Gallistl S, Fröhlich‐Reiterer E, Schlagenhauf A. Increased tissue factor activity promotes thrombin generation at type 1 diabetes onset in children. Pediatr Diabetes 2020; 21:1210-1217. [PMID: 32691481 PMCID: PMC7589270 DOI: 10.1111/pedi.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In type 1 diabetes (T1D), a prothrombotic status due to elevated coagulation factors coincides with metabolic derailment. In a previous study, we discovered altered thrombin generation profiles in children with T1D. These alterations are potentially most pronounced at T1D onset and ameliorated after insulin treatment. We tested this hypothesis in a longitudinal study, measuring thrombin generation together with coagulation parameters in children at T1D onset and during follow-up. MATERIALS AND METHODS Twenty-three children (12 female, age: 9.4 [2.7-17.3] years; median [range]) were tested at T1D onset and after long-term insulin treatment. Thrombin generation was measured using calibrated automated thrombography. Tissue factor (TF) activity and tissue factor pathway inhibitor (TFPI) activity were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS A procoagulant shift was observed in thrombin generation traces at T1D onset compared to follow-up (time to peak: 5.67 [4.11-7.67] min vs 6.39 [4.89-10.44] min, P < .001). These alterations at T1D onset coincided with increased TF activity (5.18 [0.01-12.97] pmol/L vs 2.67 [0.04-10.41] pmol/L, P < .05) and increased TFPI activity (0.051 [0.038-0.074] U/mL vs 0.035 [0.026-0.056] U/mL, P < .05). CONCLUSION The procoagulant shift in thrombin generation at T1D onset is a result of increased TF activity, but this effect is partially counterbalanced by increased TFPI levels. Elevated TF and TFPI levels hint to a fragile hemostatic balance at the endothelial lining of blood vessels. Additional prothrombotic stimuli may tip over this balance explaining the increased thrombotic risk of children with T1D.
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Affiliation(s)
- Hildegard Jasser‐Nitsche
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Harald Haidl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Gerhard Cvirn
- Otto Loewi Research Center, Physiological ChemistryMedical University of GrazGrazAustria
| | - Sina Pohl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Siegfried Gallistl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Elke Fröhlich‐Reiterer
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Axel Schlagenhauf
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
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Bridwell RE, Larson NP, Wray J, Cibrario A, Oliver J. Pediatric Cirrhotic Variceal Bleed Precipitating Diabetic Ketoacidosis. Cureus 2020; 12:e11124. [PMID: 33240717 PMCID: PMC7682908 DOI: 10.7759/cureus.11124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cirrhosis and its associated complications such, as variceal bleeding, are rare in children, carrying significant morbidity and mortality. Leading causes of cirrhosis in the pediatric population include infection, neoplasm, and metabolic and genetic disorders, which is in contrast to the adult population. Acute gastrointestinal bleeding, as seen with variceal bleeding, has been previously associated with diabetic ketoacidosis through a multifactorial relationship. The case was complicated by hypovolemic shock whose resuscitation and subsequent transfusion was associated with cardiac overload. We highlight the need for balanced, judicious resuscitation in these individuals as well as the need for heightened awareness of coexisting pathologies such as diabetic ketoacidosis.
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Sagy I, Zimhony-Nissim N, Brandstaetter E, Lipnitzki I, Musa H, Rosen Y, Barski L. Outcomes of diabetic ketoacidosis in a tertiary centre with restricted intensive care unit bed capacity. Intern Med J 2020; 51:948-954. [PMID: 32253805 DOI: 10.1111/imj.14842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is an acute metabolic condition, sometimes requiring admission to an intensive care unit (ICU). AIMS To investigate the outcomes of DKA patients admitted to a hospital with restricted ICU capacity. METHODS We included all DKA patients above age 18 who were admitted to a tertiary hospital during 2004-2017. We conducted multivariate logistic regression analysis adjusted for ICU bed availability to analyse parameters associated with ICU admission, and a composite outcome of mortality, DKA recurrence and mechanical ventilation. RESULTS Among 382 DKA patients in our cohort, 94 (24.6%) were admitted to the ICU. The in-hospital mortality was 4.7%. Low bicarbonate (<10 mmoL/L) and pH (<7) levels at presentation were associated with ICU admission (P < 0.001 for both). In multivariate models availability of beds in the ICU was not associated with ICU admission, mortality or DKA recurrence of any type. CONCLUSION In a setting of limited ICU capacity, DKA treatment does not necessarily require admission to the ICU. When the rising rates of diabetes mellitus and the associated elevated rates of DKA are taken into account, our results highlight the importance of including step-down units when devising local protocols for care of these patients.
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Affiliation(s)
- Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel.,Internal Medicine Division, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Noa Zimhony-Nissim
- Clinical Research Center, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Evgenia Brandstaetter
- Internal Medicine Division, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Inna Lipnitzki
- Internal Medicine Division, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Hadeel Musa
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Yakov Rosen
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Rehovot, Israel
| | - Leonid Barski
- Internal Medicine Division, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
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Cerebral Edema in Diabetic Ketoacidosis - Fluid Shifts and Shifting Paradigms. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Oluwayemi IO, Oyedeji OA, Adeniji EO, Ajite AB, Babatola AO, Adeniyi AT, Ogundare EO, Olatunya OS, Ayeni TO, Ajibola AE. A Ten-Year Review of the Pattern and Outcome of Childhood Diabetes in Two State Teaching Hospitals in South-West Nigeria. Diabetes Metab Syndr Obes 2020; 13:4051-4057. [PMID: 33149644 PMCID: PMC7604912 DOI: 10.2147/dmso.s275987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Childhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease. METHODS This is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software. RESULTS A total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05). CONCLUSION Type 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.
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Affiliation(s)
- Isaac Oludare Oluwayemi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
- Correspondence: Isaac Oludare OluwayemiDepartment of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, NigeriaTel +2348034052536 Email
| | - Olusola Adetunji Oyedeji
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Science, LAUTECH, Osogbo, Osun State, Nigeria
| | - Emmanuel Oluwatosin Adeniji
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Science, LAUTECH, Osogbo, Osun State, Nigeria
| | - Adebukola Bidemi Ajite
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Adefunke Olarinre Babatola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Adewuyi Temidayo Adeniyi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Science, LAUTECH, Osogbo, Osun State, Nigeria
| | - Ezra Olatunde Ogundare
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Oladele Simeon Olatunya
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | | | - Ayotunde Emmanuel Ajibola
- Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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Is lactic acidosis predictive of outcomes in pediatric diabetic ketoacidosis? Am J Emerg Med 2019; 38:329-332. [PMID: 31704063 DOI: 10.1016/j.ajem.2019.158449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The objective of this study was to investigate the significance and prevalence of lactic acidosis in pediatric diabetic ketoacidosis (DKA) presenting to the emergency department. METHODS A retrospective cohort study of children (age ≤ 21 years) presenting to a tertiary care emergency department in DKA from December 1, 2015 to December 1, 2018. Patients needed to have DKA requiring admission to the pediatric intensive care unit and have had a lactate level collected while in the emergency department to be included. RESULTS 92 patients resulting in 113 encounters had DKA and a lactate level collected in the emergency department. The mean lactate level was 3.5 mmol/L (±SD 2.1). 72 (63.7%) encounters had lactic acidosis (p < 0.001). There was no significant association between the presence of lactic acidosis and pediatric intensive care unit length of stay (p = 0.321), hospital length of stay (p = 0.426), morbidity (p = 0.552) and mortality (p = 1.000). Initial glucose levels were significantly higher in the patients presenting with lactic acidosis (p = 0.001). CONCLUSIONS Lactic acidosis is a common finding in pediatric DKA patients presenting to the emergency department. Serum lactate alone should not be used as an outcome predictor in pediatric DKA.
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Al-Azzawi OFN, Razak MKA, Al Hammady SJ. Rhabdomyolysis; is it an overlooked DKA complication. Diabetes Metab Syndr 2019; 13:3047-3052. [PMID: 30041918 DOI: 10.1016/j.dsx.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rhabdomyolysis is considered by some studies as a rare complication of a common disorder of diabetic ketoacidosis, while others consider it as not so uncommon. The mechanism is still not clear but can be attributed to a number of factors like acidosis, hyperglycemia and electrolyte disturbances especially hypophosphatemia and hypokalaemia. Missing it may lead to more serious complications and may prolong and/or complicate full recovery of diabetic ketoacidosis. AIM The aim of this study was to measure the incidence of rhabdomyolysis among patients presented with diabetic ketoacidosis in the emergency department of Baghdad Teaching hospital, its relation to the severity of diabetic ketoacidosis and the associated electrolytes disturbances. PATIENTS AND METHODS This is a cross sectional study carried out in the emergency department of Baghdad teaching hospital/Iraq; where 43 patients with type1 diabetes presenting with diabetic ketoacidosis were included. Diabetic ketoacidosis was classified into mild, moderate and severe, and the incidence of rhabdomyolysis was calculated accordingly. Full blood investigations, urinary ketones and arterial blood gasses were done. RESULTS Rhabdomyolysis was found in 3 (6.98%) patients with more severe acidosis and urinary ketones in the setting of moderate and severe diabetic ketoacidosis. Statistically significant finding was observed with the duration of diabetes, higher serum creatinine, higher serum potassium, higher serum chloride, severe acidosis and urinary ketones. CONCLUSIONS Rhabdomyolysis incidence in this study was 6.98% of patients with more severe acidosis, urinary ketones in the setting of moderate to severe diabetic ketoacidosis and with longer duration of diabetes.
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Carson JH, Smith LE, Pandiyan P, Yagnik PJ. A Pediatric Diabetic Ketoacidosis Patient with Multisystem Complications and a Prolonged Course. Kans J Med 2019; 12:89-90. [PMID: 31489106 PMCID: PMC6710026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/05/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- John Henry Carson
- Internal Medicine/Pediatrics Residency Progam, University of Kansas School of Medicine-Wichita
| | - Lindall E. Smith
- Department of Pediatrics, University of Kansas School of Medicine-Wichita
| | - Poornima Pandiyan
- Department of Pediatrics, University of Kansas School of Medicine-Wichita
| | - Priyank J. Yagnik
- Department of Pediatrics, University of Kansas School of Medicine-Wichita
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Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:medicina55070362. [PMID: 31295949 PMCID: PMC6681342 DOI: 10.3390/medicina55070362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
Background and objective: There is an increasing risk of type 1 diabetes mellitus (T1D) among children in Croatia. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as the most severe complication. Since early recognition of cerebral edema leads to a better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in pediatric intensive care units (PICUs). The aim of this study is to investigate clinical and laboratory parameters, as well as complications in children treated in PICUs because of DKA. Materials and methods: Patients treated due to DKA in the PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: Newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data were compared between the two groups. Results: A total of 82 patients were enrolled. Those with NT1D were more often treated in the PICU, with two of them developing cerebral edema. Dehydration was the most frequent clinical sign, found in 95% of patients at admission. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between NT1D and PT1D. Additionally, there was no significant difference regarding laboratory data at admission. Conclusions: More children with NT1D required treatment in the PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life-threatening condition, treatment of patients with moderate or severe DKA in PICUs will provide necessary monitoring enabling early recognition, treatment, and better treatment outcome. To minimize the incidence of DKA among patients with NT1D, it is important to continuously carry out public health education programs aimed at early identification of signs and symptoms of T1D.
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Tomkins M, McCormack R, O’Connell K, Agha A, Merwick Á. Metabolic encephalopathy secondary to diabetic ketoacidosis: a case report. BMC Endocr Disord 2019; 19:71. [PMID: 31266485 PMCID: PMC6607531 DOI: 10.1186/s12902-019-0398-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Metabolic encephalopathy is a rare but potentially devastating complication of diabetic ketoacidosis (DKA). This case highlights the dramatic cognitive decline of a young man due to metabolic encephalopathy complicating DKA. The aims of this case report are to highlight metabolic encephalopathy as a complication of DKA and to explore the current research in diabetic related brain injury. The importance of investigation and treatment of reversible causes of encephalopathy is also demonstrated. CASE PRESENTATION A 35-year-old man with a background of type 1 diabetes mellitus (T1DM) and relapsing remitting multiple sclerosis (RRMS) presented to the emergency department (ED) in a confused and agitated state. Prior to admission he worked as a caretaker in a school, smoked ten cigarettes per day, took excess alcohol and smoked cannabis twice per week. Following initial investigations, he was found to be in DKA. Despite timely and appropriate management his neurological symptoms and behavioural disturbance persisted. Neuroimaging revealed temporal lobe abnormalities consistent with an encephalopathic process. The patient underwent extensive investigation looking for evidence of autoimmune, infective, metabolic, toxic and paraneoplastic encephalopathy, with no obvious cause demonstrated. Due to persistent radiological abnormalities a temporal lobe biopsy was performed which showed marked astrocytic gliosis without evidence of vasculitis, inflammation, infarction or neoplasia. A diagnosis of metabolic encephalopathy secondary to DKA was reached. The patient's cognitive function remained impaired up to 18 months post presentation and he ultimately required residential care. CONCLUSIONS Metabolic encephalopathy has been associated with acute insults such as DKA, but importantly, the risk of cerebral injury is also related to chronic hyperglycaemia. Mechanisms of cerebral injury in diabetes mellitus continue to be investigated. DKA poses a serious and significant neurological risk to patients with diabetes mellitus. To our knowledge this is the second case report describing this acute complication.
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Affiliation(s)
- Maria Tomkins
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Richard McCormack
- Department of Rehabilitation, National Rehabilitation Hospital, Dublin, Ireland
| | | | - Amar Agha
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Áine Merwick
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
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Smith-Jackson T, Brown MV, Flint M, Larsen M. A mixed method approach to understanding the factors surrounding delayed diagnosis of type one diabetes. J Diabetes Complications 2018; 32:1051-1055. [PMID: 30217366 DOI: 10.1016/j.jdiacomp.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 01/13/2023]
Abstract
AIMS This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39.8% vs. 24.6%), be transported by ambulance or life flight (30.7% vs. 15.3%), be hospitalized (93.7% vs. 83.9%), spend time in an Intensive Care Unit (42.2% vs. 21.3%), and be in diabetic ketoacidosis (DKA) (42.2% vs. 21.3%). Younger children were at increased risk, with higher rates of DKA and fewer days of symptoms. Many parents experienced frustration receiving a prompt diagnosis for their child, including an inability to schedule a physician appointment, proper glucose testing, and concerns being dismissed by professionals. CONCLUSION More physician and parent education is needed. Doctors should conduct glucose screenings when diabetes symptoms are present. Parents need education to recognize excessive thirst and frequent urination as reasons to seek medical treatment.
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Affiliation(s)
- TeriSue Smith-Jackson
- Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America.
| | - Mary V Brown
- Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America
| | - Matthew Flint
- Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America
| | - Merilee Larsen
- Department of Public and Community Health, Utah Valley University, 800 W. University Parkway, MS 170, Orem, UT 84058, United States of America
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Chen T, Zhang D, Bai Z, Wu S, Wu H, Xie R, Li Y, Wang F, Chen X, Sun H, Wang X, Chen L. Successful Treatment of Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Status in an Infant with KCNJ11-Related Neonatal Diabetes Mellitus via Continuous Renal Replacement Therapy. Diabetes Ther 2018; 9:2179-2184. [PMID: 30094785 PMCID: PMC6167281 DOI: 10.1007/s13300-018-0484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/20/2022] Open
Abstract
Neonatal diabetes mellitus (NDM) is a rare monogenic disorder presenting as uncontrolled hyperglycemia during the first 6 months of life. Hyperglycemic hyperosmolar state (HHS) is quite rare in NDM patients, and reported experience with this condition is limited. Continuous renal replacement therapy (CRRT) is frequently used as a mode of dialytic treatment in critically ill patients with acute renal failure, but has seldom been used in patients with diabetic ketoacidosis (DKA) and HHS. We report the case of a 2-month-old infant admitted to our hospital presenting with dyspnea and lethargy. Blood gas showed severe hyperosmotic DKA. After 21 h of fluid and insulin therapy, the baby presented with increased drowsiness and irregular respiration, which suggested cerebral edema. Moreover, the DKA and HHS were exacerbated. After 18 h of CRRT, the patient gradually recovered from DKA and HHS. The gene analysis revealed a de novo mutation (c.602G > A (p.R201H)) of the KCNJ11 gene, and oral glibenclamide successfully replaced insulin treatment in the patient.
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Affiliation(s)
- Ting Chen
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Dandan Zhang
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhenjiang Bai
- Department of Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shuiyan Wu
- Department of Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiying Wu
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Rongrong Xie
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying Li
- Department of Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fengyun Wang
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiuli Chen
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Sun
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoyan Wang
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Linqi Chen
- Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
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Baszyńska-Wilk M, Wysocka-Mincewicz M, Świercz A, Świderska J, Marszał M, Szalecki M. Peripheral Neuropathy as a Complication of Diabetic Ketoacidosis in a Child with Newly Diagnosed Diabetes Type 1: A Case Report. J Clin Res Pediatr Endocrinol 2018; 10:289-293. [PMID: 29217500 PMCID: PMC6083477 DOI: 10.4274/jcrpe.5374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neurological complications of diabetic ketoacidosis are considered to be a serious clinical problem. The most common complication is cerebral edema. However, these neurological complications also include less common entities such as ischemic or hemorrhagic stroke, cerebral venous and sinus thrombosis or peripheral neuropathy. We present a case of a 9-year old girl admitted to our intensive care unit with new onset type 1 diabetes, diabetic ketoacidosis, cerebral edema, multifocal vasogenic brain lesions and bilateral lower limb peripheral paresis. The patient developed polydipsia and polyuria one week before admission. The initial blood glucose level was 1136 mg/dL and severe acidosis was present (pH 7.1; BE-25.9). Computed tomography scan showed brain edema and a hypodense lesion in the left temporal region. Brain magnetic resonance imaging revealed more advanced multifocal brain lesions. Nerve conduction studies demonstrated damage of the motor neurons in both lower limbs with dysfunction in both peroneal nerves and the right tibial nerve. With treatment and physiotherapy, the patient’s health gradually improved. Acute neuropathy after ketoacidosis is a rare complication and its pathogenesis is not clear. Patients with diabetic ketoacidosis require careful monitoring of neurological function, even after normalization of their glycemic parameters.
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Affiliation(s)
- Marta Baszyńska-Wilk
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland,* Address for Correspondence: The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland E-mail:
| | - Marta Wysocka-Mincewicz
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland
| | - Anna Świercz
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland
| | - Jolanta Świderska
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland
| | - Magdalena Marszał
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland
| | - Mieczysław Szalecki
- The Children’s Memorial Health Institute, Clinic of Endocrinology and Diabetology, Warsaw, Poland,Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland
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Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis. Case Rep Crit Care 2018; 2018:4273971. [PMID: 29973999 PMCID: PMC6008881 DOI: 10.1155/2018/4273971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/18/2018] [Indexed: 01/24/2023] Open
Abstract
Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Soon she became apneic requiring emergent endotracheal intubation. MRI brain showed cerebral edema, CPM, and subdural hemorrhage. She was extubated on day seven and exhibited mild dysmetria, ataxia, unilateral weakness, and neglect. Upon discharge she was able to ambulate with a walker and speak and eat without difficulty. Although less common than cerebral edema, CPM should be considered in DKA patients with acute neurologic deterioration. Fluid and bicarbonate therapy should be individualized, but larger studies would help guide the management. Although poor outcomes are reported in CPM, favorable outcomes are possible.
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Agrawal S, Kremsdorf R, Uysal S, Fredette ME, Topor LS. Nephrolithiasis: A complication of pediatric diabetic ketoacidosis. Pediatr Diabetes 2018; 19:329-332. [PMID: 28737266 DOI: 10.1111/pedi.12559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/19/2017] [Accepted: 06/20/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine the frequency of nephrolithiasis as a complication of diabetic ketoacidosis (DKA) in pediatrics. METHODS We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January 2009 and July 2016. We identified patients with nephrolithiasis during admission for DKA. RESULTS We identified 395 episodes of DKA over 7.5 years. Nephrolithiasis developed as a complication of DKA in 3 of those admissions (0.8%). All three patients with nephrolithiasis were males with new onset type 1 diabetes, aged 11 to 16.5 years. They all developed symptoms of nephrolithiasis after transition to subcutaneous insulin. One patient had subsequent worsening acidosis that required an additional 24 hours of IV insulin administration. CONCLUSIONS Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. Nephrolithiasis can increase insulin resistance due to increased pain and inflammation, so these patients should be monitored closely for recurrence of DKA. As patients with diabetes have increased risk of chronic kidney disease and nephrolithiasis can cause kidney injury, risk factors for nephrolithiasis should be identified and addressed to avoid subsequent kidney damage.
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Affiliation(s)
- Sungeeta Agrawal
- Division of Pediatric Endocrinology, Floating Hospital for Children at Tufts Medical Center/ Tufts University School of Medicine, Boston, Massachusetts
| | - Robin Kremsdorf
- Division of Pediatric Nephrology, Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Serife Uysal
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Pediatric Endocrinology, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island
| | - Meghan E Fredette
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Pediatric Endocrinology, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island
| | - Lisa Swartz Topor
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Pediatric Endocrinology, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island
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Abbas Q, Arbab S, Haque AU, Humayun KN. Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit. Pak J Med Sci 2018; 34:106-109. [PMID: 29643888 PMCID: PMC5856992 DOI: 10.12669/pjms.341.13875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: To describe the spectrum of complications of Diabetic Ketoacidosis (DKA) observed in children admitted with severe DKA. Methods: Retrospective review of the medical records of all children admitted with the diagnosis of severe DKA in Pediatric Intensive Care Unit (PICU) of the Aga Khan University Hospital, from January 2010 to December 2015 was done. Data was collected on a structured proforma and descriptive statistics were applied. Results: Total 37 children were admitted with complicated DKA (1.9% of total PICU admission with 1.8% in 2010 and 3.4% in 2015). Mean age of study population was 8.1±4.6 years and 70% were females (26/37). Mean Prism III score was 9.4±6, mean GCS on presentation was 11±3.8 and mean lowest pH was 7.00±0.15. Complications observed included hyperchloremia (35.94%), hypokalemia (30.81%), hyponatremia (26.70%), cerebral edema (16.43%), shock (13.35%), acute kidney injury (10.27%), arrhythmias (3.8%), and thrombotic thrombocytopenic purpura (5.4%), while one patient had myocarditis and ARDS each. 13/37 children (35%) needed inotropic support, 11/37 (30%) required mechanical ventilation while only one patient required renal replacement therapy. Two patients (5.4%) died during their PICU stay. Conclusion: Hyperchloremia and other electrolyte abnormalities, cerebral edema and AKI are the most common complications of severe DKA.
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Affiliation(s)
- Qalab Abbas
- Dr. Qalab Abbas, FCPS. Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Saba Arbab
- Dr. Saba Arbab, FCPS. Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Anwar Ul Haque
- Dr. Anwar ul Haque, MD. Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Khadija Nuzhat Humayun
- Dr. Khadija Nuzhat Humayun, FCPS. Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Hamilton H, Knudsen G, Vaina CL, Smith M, Paul SP. Children and young people with diabetes: recognition and management. ACTA ACUST UNITED AC 2017; 26:340-347. [PMID: 28345986 DOI: 10.12968/bjon.2017.26.6.340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus (type 1) is an autoimmune condition leading to absolute insulin deficiency resulting in hyperglycaemia and its associated manifestations. It is the most common type of diabetes seen in children, characterised by the 4Ts (toilet, thinner, thirsty, tired). The signs and symptoms can sometimes be non-specific and a delay or missed diagnosis may be catastrophic to the health of the child. Children with an established diagnosis of diabetes often present to the health service with issues such as hypoglycaemia, hyperglycaemia, or diabetic ketoacidosis. The condition requires life-long monitoring and strict control of blood glucose levels with insulin replacement therapy, with the aim of achieving an HbA1c level of 48 mmol/mol. There are often physical and psychosocial issues that arise from the diagnosis leading to poor control. Nurses working in different clinical settings play a vital role in raising suspicions of diabetes leading to timely diagnosis and rapid initiation of treatment. They are best placed to provide essential support in helping children and their families to come to terms with the diagnosis, as well as manage this chronic condition by addressing the common issues that arise in the ongoing management, with a particular emphasis on managing the various day-to-day challenges. Two case studies are included to highlight some of the challenges that nurses may encounter while managing children with diabetes.
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Affiliation(s)
| | | | | | - Michelle Smith
- Paediatric Diabetes Specialist Nurse, Yeovil District Hospital
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Diabetic Ketoacidosis: Demographic Data, Clinical Profile and Outcome in a Tertiary Care Hospital. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.7649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chen YL, Weng SF, Yang CY, Wang JJ, Tien KJ. Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study. DIABETES & METABOLISM 2017; 43:223-228. [DOI: 10.1016/j.diabet.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 01/28/2023]
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Seke Etet PF, Farahna M, Satti GMH, Bushara YM, El-Tahir A, Hamza MA, Osman SY, Dibia AC, Vecchio L. Garcinia kola seeds may prevent cognitive and motor dysfunctions in a type 1 diabetes mellitus rat model partly by mitigating neuroinflammation. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.2017.14.issue-3/jcim-2016-0167/jcim-2016-0167.xml. [PMID: 28889733 DOI: 10.1515/jcim-2016-0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/21/2017] [Indexed: 01/06/2023]
Abstract
Background We reported recently that extracts of seeds of Garcinia kola, a plant with established hypoglycemic properties, prevented the loss of inflammation-sensible neuronal populations like Purkinje cells in a rat model of type 1 diabetes mellitus (T1DM). Here, we assessed G. kola extract ability to prevent the early cognitive and motor dysfunctions observed in this model. Methods Rats made diabetic by single injection of streptozotocin were treated daily with either vehicle solution (diabetic control group), insulin, or G. kola extract from the first to the 6th week post-injection. Then, cognitive and motor functions were assessed using holeboard and vertical pole behavioral tests, and animals were sacrificed. Brains were dissected out, cut, and processed for Nissl staining and immunohistochemistry. Results Hyperglycemia (209.26 %), body weight loss (-12.37 %), and T1DM-like cognitive and motor dysfunctions revealed behavioral tests in diabetic control animals were not observed in insulin and extract-treated animals. Similar, expressions of inflammation markers tumor necrosis factor (TNF), iba1 (CD68), and Glial fibrillary acidic protein (GFAP), as well as decreases of neuronal density in regions involved in cognitive and motor functions (-49.56 % motor cortex, -33.24 % medial septal nucleus, -41.8 % /-37.34 % cerebellar Purkinje /granular cell layers) were observed in diabetic controls but not in animals treated with insulin or G. kola. Conclusions Our results indicate that T1DM-like functional alterations are mediated, at least partly, by neuroinflammation and neuronal loss in this model. The prevention of the development of such alterations by early treatment with G. kola confirms the neuroprotective properties of the plant and warrant further mechanistic studies, considering the potential for human disease.
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Mercer S, Hanks L, Ashraf A. Rhabdomyolysis in Pediatric Patients With Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar State: A Case Series. Glob Pediatr Health 2017; 3:2333794X16671391. [PMID: 28229089 PMCID: PMC5308516 DOI: 10.1177/2333794x16671391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Lynae Hanks
- University of Alabama at Birmingham, AL, USA
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Farahna M, Seke Etet PF, Osman SY, Yurt KK, Amir N, Vecchio L, Aydin I, Aldebasi YH, Sheikh A, Chijuka JC, Kaplan S, Adem A. Garcinia kola aqueous suspension prevents cerebellar neurodegeneration in long-term diabetic rat - a type 1 diabetes mellitus model. JOURNAL OF ETHNOPHARMACOLOGY 2017; 195:159-165. [PMID: 27825990 DOI: 10.1016/j.jep.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 08/04/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The development of compounds able to improve metabolic syndrome and mitigate complications caused by inappropriate glycemic control in type 1 diabetes mellitus is challenging. The medicinal plant with established hypoglycemic properties Garcinia kola Heckel might have the potential to mitigate diabetes mellitus metabolic syndrome and complications. AIM OF THE STUDY We have investigated the neuroprotective properties of a suspension of G. kola seeds in long-term type 1 diabetes mellitus rat model. MATERIALS AND METHODS Wistar rats, made diabetic by single injection of streptozotocin were monitored for 8 months. Then, they were administered with distilled water or G. kola oral aqueous suspension daily for 30 days. Body weight and glycemia were determined before and after treatment. After sacrifice, cerebella were dissected out and processed for stereological quantification of Purkinje cells. Histopathological and immunohistochemical analyses of markers of neuroinflammation and neurodegeneration were performed. RESULTS Purkinje cell counts were significantly increased, and histopathological signs of apoptosis and neuroinflammation decreased, in diabetic animals treated with G. kola compared to diabetic rats given distilled water. Glycemia was also markedly improved and body weight restored to non-diabetic control values, following G. kola treatment. CONCLUSIONS These results suggest that G. kola treatment improved the general condition of long-term diabetic rats and protected Purkinje cells partly by improving the systemic glycemia and mitigating neuroinflammation.
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Affiliation(s)
- Mohammed Farahna
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia.
| | - Paul F Seke Etet
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Sayed Y Osman
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia; Department of Biochemistry and Molecular Biology, Faculty of Science and Technology, Al-Neelain University, Khartoum, Sudan
| | - Kıymet K Yurt
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Naheed Amir
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - Lorella Vecchio
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Isınsu Aydin
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Yousef H Aldebasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Azimullah Sheikh
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - John C Chijuka
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Süleyman Kaplan
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Abdu Adem
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE.
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Yaneva NY, Konstantinova MM, Iliev DI. Risk factors for cerebral oedema in children and adolescents with diabetic ketoacidosis. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1221740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Natasha Y. Yaneva
- Pediatric Intensive Care Unit, University Pediatric Hospital, Medical University of Sofia , Sofia, Bulgaria
| | - Maia M. Konstantinova
- Department for Diabetes, Clinic for Endocrinology, Diabetes and Metabolism, University Pediatric Hospital, Medical University of Sofia , Sofia, Bulgaria
| | - Daniel I. Iliev
- Pediatric Intensive Care Unit, University Pediatric Hospital, Medical University of Sofia , Sofia, Bulgaria
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Severinski S, Butorac Ahel I, Ovuka A, Verbić A. A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl. J Pediatr Endocrinol Metab 2016; 29:1001-4. [PMID: 27226096 DOI: 10.1515/jpem-2015-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/19/2016] [Indexed: 11/15/2022]
Abstract
Diabetic ketoacidosis (DKA) is a complex metabolic state characterized by hyperglycemia, metabolic acidosis and ketonuria. Cerebral edema is the most common rare complication of DKA in children. The objective of the study was to emphasize the importance of careful evaluation and monitoring for signs and symptoms of cerebral edema in all children undergoing treatment for DKA. We present a case of 11-year-old girl with a history of diabetes mellitus type I (T1DM) who presented with severe DKA complicated by hypovolemic shock, cerebral edema and hematemesis. Considering the fact that complications of DKA are rare and require a high index of clinical suspicion, early recognition and treatment are crucial for avoiding permanent damage.
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Acute Erosive Esophagitis As a Rare Complication of Severe Pediatric Diabetes Ketoacidosis. J Pediatr Gastroenterol Nutr 2016; 62:e38-9. [PMID: 27010401 DOI: 10.1097/mpg.0000000000001086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Ayed S, Bouguerba A, Ahmed P, Barchazs J, Boukari M, Goldgran-Toledano D, Bornstain C, Vincent F. Les pièges de l’acidocétose diabétique. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1113-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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