Sugar and Spice . . . Not Always Nice

2020 ◽  
pp. 149-158
Author(s):  
Crista Cerrone ◽  
Michael J. Stoner
Keyword(s):  
Respiratory Failure ◽  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Metabolic Pathways ◽  
Clinical Symptoms ◽  
Onset Diabetes ◽  
Patient’S History ◽  
New Onset

The case of a tachypneic 8-year-old exemplifies the diversity of etiologies for tachypnea and is a good reminder to avoid conformation bias given a patient’s history. In this case, the child has new onset diabetes and is in diabetic ketoacidosis (DKA). DKA is due to a deranged metabolism given the lack of insulin, leading to hyperglycemia, ketosis, and acidosis as well as dehydration. The chapter highlights the treatment including diligent rehydration and correction of acidosis. This is accomplished by restoring typical metabolic pathways with insulin all while closely monitoring and correcting changes in glucose and electrolytes. Finally, clinical symptoms are monitored closely to avoid pitfalls, which can include altered metal status, respiratory failure, cerebral edema, coma, and death.

Cerebral Edema During Treatment of Diabetic Ketoacidosis in an Adult With New Onset Diabetes

2005 ◽  
Vol 2 (1) ◽  
pp. 055-058 ◽  
Author(s):  
Patrick J. Troy ◽  
Roger P. Clark ◽  
Sri G. Kakarala ◽  
Jocelyn Burns ◽  
Isaac E. Silverman ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Onset Diabetes ◽  
New Onset

scholarly journals New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Monica N. Naguib ◽  
Jennifer K. Raymond ◽  
Alaina P. Vidmar
Keyword(s):  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Systolic Function ◽  
Hemodynamic Instability ◽  
Case Presentation ◽  
Onset Diabetes ◽  
Potential Trigger ◽  
Inflammatory Syndrome ◽  
New Onset

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

scholarly journals New Onset of DiabetEs in aSsociation with pancreatic ductal adenocarcinoma (NODES Trial): protocol of a prospective, multicentre observational trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037267
Author(s):  
Dóra Illés ◽  
Emese Ivány ◽  
Gábor Holzinger ◽  
Klára Kosár ◽  
M Gordian Adam ◽  
...  
Keyword(s):  
High Risk ◽  
Early Detection ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Clinical Symptoms ◽  
Risk Group ◽  
High Risk Group ◽  
Ductal Adenocarcinoma ◽  
Onset Diabetes ◽  
Dismal Prognosis ◽  
New Onset

IntroductionPancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis with an overall 5-year survival of approximately 8%. The success in reducing the mortality rate of PDAC is related to the discovery of new therapeutic agents, and to a significant extent to the development of early detection and prevention programmes. Patients with new-onset diabetes mellitus (DM) represent a high-risk group for PDAC as they have an eightfold higher risk of PDAC than the general population. The proposed screening programme may allow the detection of PDAC in the early, operable stage. Diagnosing more patients in the curable stage might decrease the morbidity and mortality rates of PDAC and additionally reduce the burden of the healthcare.Methods and analysisThis is a prospective, multicentre observational cohort study. Patients ≥60 years old diagnosed with new-onset (≤6 months) diabetes will be included. Exclusion criteria are (1) Continuous alcohol abuse; (2) Chronic pancreatitis; (3) Previous pancreas operation/pancreatectomy; (4) Pregnancy; (5) Present malignant disease and (6) Type 1 DM. Follow-up visits are scheduled every 6 months for up to 36 months. Data collection is based on questionnaires. Clinical symptoms, body weight and fasting blood will be collected at each, carbohydrate antigen 19–9 and blood to biobank at every second visit. The blood samples will be processed to plasma and analysed with mass spectrometry (MS)-based metabolomics. The metabolomic data will be used for biomarker validation for early detection of PDAC in the high-risk group patients with new-onset diabetes. Patients with worrisome features will undergo MRI or endoscopic ultrasound investigation, and surgical referral depending on the radiological findings. One of the secondary end points is the incidence of PDAC in patients with newly diagnosed DM.Ethics and disseminationThe study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (41085-6/2019). We plan to disseminate the results to several members of the healthcare system includining medical doctors, dietitians, nurses, patients and so on. We plan to publish the results in a peer-reviewed high-quality journal for professionals. In addition, we also plan to publish it for lay readers in order to maximalise the dissemination and benefits of this trial.Trial registration numberClinicalTrials.gov NCT04164602

New-onset diabetes mellitus presenting with diabetic ketoacidosis after pediatric liver transplantation

2009 ◽  
Vol 13 (5) ◽  
pp. 536-539 ◽  
Author(s):  
Seyed Mohsen Dehghani ◽  
Saman Nikeghbalian ◽  
Ahad Eshraghian ◽  
Mahmood Haghighat ◽  
Mohammad Hadi Imanieh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Liver Transplantation ◽  
Diabetic Ketoacidosis ◽  
Pediatric Liver Transplantation ◽  
Pediatric Liver ◽  
Onset Diabetes ◽  
New Onset Diabetes Mellitus ◽  
New Onset

scholarly journals Pembrolizumab-Induced Diabetes Mellitus Presenting as Diabetic Ketoacidosis in a Patient With Metastatic Colonic Adenocarcinoma

2020 ◽  
Vol 8 ◽  
pp. 232470962095133
Author(s):  
Asim Kichloo ◽  
Michael S. Albosta ◽  
Shane McMahon ◽  
Kimberly Movsesian ◽  
Farah Wani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
T Cells ◽  
T Cell ◽  
Insulin Therapy ◽  
Diabetic Ketoacidosis ◽  
T Cell Activation ◽  
Immune Checkpoint ◽  
Colonic Adenocarcinoma ◽  
Onset Diabetes ◽  
New Onset

Immunotherapy drugs are gaining popularity in the treatment of certain malignancies due to the success of these agents in recent clinical trials. Pembrolizumab is an immune checkpoint inhibitor that acts via binding to programmed cell death 1 (PD-1) receptors on T-cells, allowing for the constitutive activation of T-cells to fight malignant tumor cells. Immune checkpoint molecules such as PD-1 act to inhibit T-cell function, promoting tolerance to self-antigens. Inhibition of these molecules may lead to increased T-cell activation against cancer cells, but also against healthy tissue, leading to the side effects of these medications known as immune-related adverse events. In this article, we present the case of a 77-year-old female with a history of metastatic colonic adenocarcinoma presenting with new-onset diabetes mellitus and diabetic ketoacidosis in the setting of receiving pembrolizumab chemotherapy. Our patient was treated with hydration, insulin therapy, and management of her electrolytes, ultimately being discharged with the need for home insulin therapy to manage her new-onset diabetes. There are no current guidelines for the management or surveillance of patients receiving pembrolizumab chemotherapy, and further research should be done to determine which patients are at highest risk to developing this rare but potentially lethal side effect.

scholarly journals New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Nabila Chekhlabi ◽  
Amal Haoudar ◽  
Nadia Echcharii ◽  
Said Ettair ◽  
Nezha Dini
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Asymptomatic Infection ◽  
Acute Onset ◽  
Thoracic Imaging ◽  
Intravenous Insulin ◽  
Insulin Requirements ◽  
Onset Diabetes ◽  
Potential Trigger ◽  
New Onset

Background and Aims. There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. Results. Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. Conclusion. COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

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