scholarly journals Spontaneous Pneumothorax as a Complication in Concomitant Diabetic Ketoacidosis and Pulmonary Tuberculosis: A Case Report

2021 ◽  
pp. 7-12
Author(s):  
Filbert Riady Adlar ◽  
Willy Anthony
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diabetic Ketoacidosis ◽  
Spontaneous Pneumothorax ◽  
Gas Analysis ◽  
Prior History ◽  
Pulmonary Tb ◽  
Drainage Fluid ◽  
Secondary Spontaneous Pneumothorax ◽  
Arterial Blood ◽  
The Right

Secondary spontaneous pneumothorax (SSP) can occur as a complication of several underlying diseases such as pulmonary tuberculosis (TB) or, rarely, diabetic ketoacidosis (DKA). As diabetes mellitus (DM) is significantly prevalent in tuberculosis patients, it is possible to have both TB and DKA concurrently. However, there has not been any documentation of SSP as a complication in concomitant DKA and pulmonary TB. In this report, we described a 30-year-old female who presented to the emergency department with a chief complaint of shortness of breath that had intensified since a day before. She was diagnosed with pulmonary TB 1 week before and had started on her anti-tuberculosis drugs regimen. Prior history of DM was not known. Physical examination showed a slight decrease in consciousness, tachycardia, tachypnea, Kussmaul breathing, decreased lung sounds in the right hemithorax and hyperresonant on percussion. Laboratory results showed leukocytosis and hyperglycemia, ketones were positive on urinalysis and arterial blood gas analysis indicated metabolic acidosis. Chest X-ray revealed pneumothorax in the right hemithorax. She was diagnosed with pneumothorax of the right hemithorax, DKA, sepsis and pulmonary TB. Treatment involved prompt placement of chest tube drainage, fluid rehydration, intravenous insulin, antibiotic, sodium bicarbonate and anti-tuberculosis drugs. Her condition improved after 9 days of uneventful hospitalization. We discussed how concomitant presence of both DKA and pulmonary TB can increase the likelihood of developing secondary spontaneous pneumothorax.

scholarly journals Clinical and aetiological spectrum of spontaneous pneumothorax in adults in Sub-Himalayan: a prospective study at tertiary care institute

2018 ◽  
Vol 4 (2) ◽  
pp. 22
Author(s):  
Ajay Sharma ◽  
Ashok Sharma ◽  
Pramod Jaret ◽  
Malay Sarkar ◽  
Sanjeev Sharma
Keyword(s):  
Pulmonary Tuberculosis ◽  
Prospective Study ◽  
Spontaneous Pneumothorax ◽  
Tertiary Care ◽  
Primary Spontaneous Pneumothorax ◽  
Age Group ◽  
Outcome Indicators ◽  
Secondary Spontaneous Pneumothorax ◽  
A Prospective Study ◽  
Aetiological Spectrum

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The spontaneous pneumothorax has been classified as major cause of morbidity and mortality among respiratory diseases. The objectives of the study were to determine the incidence and aetiology of spontaneous pneumothorax and to assess the clinical profile of affected patients admitted in our institute</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A hospital based prospective study was conducted in year 2011-12 in the Department of Medicine, IGMC Shimla (H.P.) India. During study period the total admissions were 7335 out of which 30 patients were diagnosed as spontaneous pneumothorax and treated as cases under study. The data was collected on proforma includes demographic profile, probable cause, clinical and outcome indicators of Spontaneous Pneumothorax, master chart framed and analysed into frequency percentage. </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Incidence of spontaneous pneumothorax was found to be 408.99/yr/100000 admissions in the department of medicine. Incidence of primary spontaneous pneumothorax was 81.79/yr/100000 admissions. Incidence of secondary spontaneous pneumothorax was 327.19/yr/100000 admissions. Majority of the patients of primary spontaneous pneumothorax were of the 20-29yrs age group. Higher proportions of cases were from male gender (93.33%). Secondary pneumothorax patients were mostly of 50 to 59 years age group. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by Pulmonary tuberculosis (33.33%)</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Spontaneous pneumothorax was more common in men. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by pulmonary tuberculosis (33.33%). </span></p><p class="abstract"> </p>

scholarly journals Euglycemic diabetic ketoacidosis in type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitors. A report on two cases

2018 ◽  
Vol 13 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Antonio Burgio ◽  
Maurizio Alletto ◽  
Salvatore Amico ◽  
Umberto Castiglione ◽  
Giovanni Fulco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Sodium Glucose Cotransporter ◽  
Arterial Blood Gas Analysis

Sodium-glucose cotransporter 2 inhibitors are a new second-line medication in the management of hyperglycemia in type 2 diabetes. These drugs can be associated with the development of diabetic ketoacidosis (DKA) with normal or moderately increased blood glucose levels. This is a life-threatening clinical condition termed euglycemic DKA (euDKA), of which the diagnosis can be delayed due to the relative euglycemia. We report on two patients with type 2 diabetes who presented to the Emergency Department with malaise, nausea and vomiting. Both patients had been taking dapagliflozin for at least six months. A risk factor for the development of ketoacidosis, namely heavy alcohol consumption, was found in one of the patients. Arterial blood gas analysis showed severe metabolic acidosis with increased anion gap, positive serum and urine ketones and normal arterial lactate. The patients were treated in Internal Medicine with intravenous fluids, insulin, sodium bicarbonate and potassium. Dapagliflozin was stopped. Both patients recovered uneventfully. Even in the absence of significant hyperglycemia, accurate interpretation of arterial blood gas analysis and serum ketones should lead to correct diagnosis of euDKA.

scholarly journals TO STUDY THE VARIOUS ETIOLOGICAL FACTORS OF SPONTANEOUS PNEUMOTHORAX AT TERTIARY CARE CENTER JAIPUR, RAJASTHAN, INDIA

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Mukesh Kumar Mandawariya ◽  
Dr. Nalin Joshi ◽  
Dr. S.P. Agnihotri ◽  
Rekha Mandawariya
Keyword(s):  
Pulmonary Tuberculosis ◽  
Spontaneous Pneumothorax ◽  
Care Center ◽  
Tertiary Care ◽  
Exclusion Criteria ◽  
Common Cause ◽  
Secondary Spontaneous Pneumothorax ◽  
Common Causes ◽  
Males And Females ◽  
The Given

Background: Primary spontaneous pneumothoraces (PSP) affect patients who do not have clinically apparent lung disorders.  Secondary pneumothoraces occur in the setting of underlying pulmonary disease.  Methods: A total of 100 patients, including both males and females, admitted during the given period to the hospital with a diagnosis of spontaneous Pneumothorax (SP) were included in the study after applying to the inclusion and exclusion criteria. Results: COPD was the most common cause (45.6%) followed by Tuberculosis (30%). Silicosis was seen in 18.9% of SSP cases. Other less common causes were Bronchiectasis (3.3%), Pneumonia (1.1%) and Malignancy (1.1%). Conclusion:  Secondary spontaneous pneumothorax is far more common than primary spontaneous pneumothoraces and COPD is the predominant underlying cause of secondary spontaneous pneumothorax followed by pulmonary tuberculosis. We also found that silicosis is a significant contributor to secondary spontaneous pneumothorax, after COPD and pulmonary tuberculosis. Keywords: COPD, TB, Etiology

scholarly journals Profil hasil pemeriksaan foto toraks pada pasien pneumotoraks di Bagian / SMF Radiologi FK Unsrat RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2015 – Agustus 2016

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Windy D.P. Masengi ◽  
Elvie Loho ◽  
Vonny Tubagus
Keyword(s):  
Medical Records ◽  
Spontaneous Pneumothorax ◽  
Pleural Cavity ◽  
Secondary Data ◽  
Descriptive Study ◽  
Age Group ◽  
X Ray ◽  
Secondary Spontaneous Pneumothorax ◽  
Chest X Ray ◽  
The Right

Abstract: Radiology examination especially chest x-ray can enforce various kinds of pulmonary diseases inter alia pneumothorax. Pneumothorax is defined as the presence of air in the pleural cavity. The causes of pneumothorax are very diverse ranging from idiopathic, infection, trauma, and iatrogenic. This study was aimed to obtain the profile of chest x-ray in patients with pneumothorax. This was a retrospective descriptive study by using secondary data from the medical records at the Department of Radiology Prof. Dr. R. D. Kandou Hospital Manado from January 2015 to August 2016. Samples were the medical records of patients that were radiologically diagnosed as pneumothorax. There were 41 patients that were diagnosed radiologically as pneumothorax. The majority of cases were male (90.2%), age group >50 years (36.6%), location of lesion in the right hemithorax (53.7%), and secondary spontaneous pneumothorax as the etiology (43,9 %). Conclusion: In this study, pneumothorax was more common among males, age group of ≥50 years, and secondary spontaneous pneumothorax as the etiology of pneumothorax.Keywords: pneumothorax, radiology, chest x-ray Abstrak: Pemeriksaan radiologi khususnya foto toraks dapat menegakkan berbagai macam diagnosis penyakit paru, salah satunya ialah pneumotoraks. Pneumotoraks adalah terdapatnya udara bebas didalam rongga pleura dengan penyebab yang sangat beragam mulai dari idiopatik, infeksi, trauma, maupun iatrogenik. Penelitian ini bertujuan untuk mengetahui profil hasil pemeriksaan foto toraks pada pasien pneumotoraks. Jenis penelitian ialah deskriptif retrospektif dengan pengambilan data di Bagian Radiologi RSUP Prof. Dr. R. D. Kandou Manado pada bulan Januari 2015 sampai dengan Agustus 2016. Sampel yaitu data rekam medik pasien yang didiagnosis pneumotoraks secara radiologis sebanyak 41 pasien. Yang tersering ditemukan ialah pasien laki-laki sebanyak 37 orang (90,2%), kelompok usia >50 tahun sebanyak 15 orang (36,6%), lokasi lesi hemitoraks deksra sebanyak 22 kasus (53,7%), serta etiologi pneumotoraks spontan sekunder sebanyak 18 kasus (43,9%). Simpulan: Pada penelitian ini didapatkan pneumotoraks paling banyak pada laki-laki, kelompok usia ≥50 tahun, dengan pneumotoraks spontan sekunder sebagai etiologi tersering. Kata kunci: pneumotoraks, radiologi, foto toraks

scholarly journals Euglycemic diabetic ketoacidosis in type 2-diabetes mellitus treated with SGLT2 inhibitors - a report on two cases

2019 ◽  
Author(s):  
Antonio Burgio ◽  
Maurizio Alletto ◽  
Salvatore Amico ◽  
Umberto Castiglione ◽  
Giovanni Fulco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Sglt2 Inhibitors ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new second-line medication in the management of hyperglycemia in type 2 diabetes. These drugs can be associated with the development of diabetic ketoacidosis (DKA) with normal or moderately increased blood glucose levels. This is a life-threatening clinical condition termed euglycemic DKA, of which the diagnosis can be delayed due to the relative euglycemia. We report on two patients with type 2 diabetes who presented to the Emergency Department with malaise, nausea and vomiting. Both patients had been taking dapagliflozin for at least six months. A risk factor for the development of ketoacidosis, namely heavy alcohol consumption, was found in one of the patients. Arterial blood gas analysis showed severe metabolic acidosis with increased anion gap, positive serum and urine ketones and normal arterial lactate. The patients were treated in Internal Medicine with intravenous fluids, insulin, sodium bicarbonate and potassium. Dapagliflozin was stopped. Both patients recovered uneventfully. Even in the absence of significant hyperglycemia, accurate interpretation of arterial blood gas analysis and serum ketones should lead to correct diagnosis of euDKA.

scholarly journals Seorang Penderita Siliko Tuberkulosis dengan Penyulit Pneumotoraks

2019 ◽  
Vol 2 (3) ◽  
pp. 76
Author(s):  
Winariani Koesoemoprodjo ◽  
Vinodini Merinda
Keyword(s):  
Spontaneous Pneumothorax ◽  
Silica Content ◽  
Spectrophotometric Analysis ◽  
Collapse Lung ◽  
Alveolar Epithelial ◽  
Secondary Spontaneous Pneumothorax ◽  
Lung Tuberculosis ◽  
Trapped Lung ◽  
Fibrotic Band ◽  
The Right

Background: Silicosis is a lung disease caused by the work because of respirable crystalline silica. Often occurs in workers mining gold, iron, tin, granite, sandstone, slate, foundries, cement, ceramics and glass. The risk of silicosis develop into lung tuberculosis (TB) is higher than patients without silicosis. Another complication of silicosis is secondary spontaneous pneumothorax. Case : A man, 45 years old with a history of work as a bricklayer for 5 years with complaints shortness of breath since three days before admitted to the hospital, chest pain in the right hemithorax, and had chronic cough. Patients is on ATD therapy. From radiographic there is collapse lung, it was shown collapse line on the right hemithorax, and fibroinfiltrat with multiple cavities on both hemithorax. Patients then got chest tube insertion and evaluation for 3 weeks, but the lung has not expanded. From thoracoscopy, there is fibrotic band on the pleural space with conclution right trapped lung. From forcep biopsy on visceral pleura showed a widened alveolar epithelial layer coated with a pile of inflammatory lymphocytes and dust pigments. From broncoscopy, there is chronic lung inflamation. Spectrophotometric analysis from BAL specimens results showed a silica content of 4.25 ppm SiO2 from left BAL an 14.34 ppm SiO2 on the right BAL. Furthurmore, this patient got pleurodesis using betadine agent and continue the ATD. Evaluation the lung is fully expanded. Conclusion : This case illustrates the secondary spontaneous pneumothorax as a complication of silicotuberkulosis. No drug has proven effective for silicosis. Treatment is aimed to the disease complications that occur, in this case is secondary spontaneous pneumothorax and lung TB. Prevention at workplaces that have a risk of silicosis is very important.

scholarly journals DIABETIC KETOACIDOSIS WITH LOWER-THAN-ANTICIPATED GLUCOSE LEVELS WITH SGLT-2 INHIBITOR CANAGLIFLOZIN: A CASE REPORT AND REVIEW OF THE LITERATURE.

2020 ◽  
pp. 1-2
Author(s):  
Ajay Budhwar ◽  
Parul Malhotra
Keyword(s):  
Case Report ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Sglt2 Inhibitor ◽  
Gas Analysis ◽  
Glucose Levels ◽  
Arterial Blood ◽  
History Of ◽  
Euglycemic Diabetic Ketoacidosis

We describe a case report of a patient who presented with euglycemic diabetic ketoacidosis (euDKA), six days after starting treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitor, Canagliflozin. ‘Euglycemic diabetic ketoacidosis’ or ‘DKA with lower-than-anticipated glucose levels’ (as recommended by AACE/ACE) is a rare, challenging and easy to miss the diagnosis A 41-year-old male with a history of type 2 Diabetes Mellitus presented with uncontrolled hyperglycemia. Canagliflozin (SGLT2 inhibitor) was added to his anti-diabetic regimen of Metformin and Sitagliptin. Six days later, he presented with symptoms of diabetic ketoacidosis with normal blood glucose of 131mg/dl. The patient was further investigated with arterial blood gas analysis and serum ketone studies, keeping in view of the potential of euglycemic diabetic ketoacidosis (euDKA) with SGLT2 inhibitor use. The clinical picture and lab values of the patient were consistent with diabetic ketoacidosis(DKA), although it is rare in type 2 DM. Blood glucose was in the normal range which could have delayed the diagnosis if the physician was not vigilant. If one had only focused on the blood glucose, then this potentially fatal condition could have been missed. However, when other causes of anion gap metabolic acidosis were excluded and the lab values of urine ketones, elevated beta-hydroxybutyrate, reduced bicarbonate, and normal lactate interpreted, it leads to the diagnosis of SGLT2 inhibitor-associated euglycemic DKA. We performed a literature review of this topic and discuss the history of euglycemic diabetic ketoacidosis, risk factors, pathophysiology, diagnosis, management, and prevention of SGLT2 inhibitor-induced euDKA.

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