Normal Blood Glucose Level at Presentation does not Rule out Diabetic Ketoacidosis in a Sick Child

Background: The present study was design to assess the level of altered lipid profile, lipoprotein sub fractions, oxidative stress and antioxidants in coronary artery disease with type-2 diabetes mellitus’s patients and non diabetic patients. Methods: This case–control study included 300 subjects; out of which, 100 subjects were with normal blood glucose level and with normal ECG (Normal, N), 100 subjects were with normal blood glucose level and AMI (non-diabetic and AMI, N-AMI) and 100 subjects were with diabetes and AMI (Diabetic and AMI, D-AMI) Results: D-AMI individuals had high level of total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), and low level of high density lipoprotein (HDL) in comparison to N-AMI individuals. The cardiac markers such as Troponin I, creatine phosphokinase (CPK), creatine kinase-MB (CK-MB), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels were significantly increased in patients suffering from myocardial infarction with diabetes mellitus (DM) compared to patients of myocardial infarction without DM. The antioxidant superoxide dismutase (SOD) and glutathione (GSH) were lower in D-AMI patients than in N-AMI. However, levels of malondialdehyde (MDA) and catalase (CAT) were higher in D-AMI than in N-AMI controls. Conclusion: Our study suggested that patients with D-AMI have elevated cardiac markers and reduced antioxidants levels as compared to N-AMI patient. Keywords: Diabetes Mellitus, Acute Myocardial Infarction, Creatine Phosphokinase, Glutathione

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345. Acute Onset Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic State in Patients Taking Integrase Strand Transfer Inhibitors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.418 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S183-S184 ◽

Cited By ~ 1

Author(s):

Afua Duker Ntem-Mensah ◽

Nina Millman ◽

Niyati Jakharia ◽

Amanda Theppote ◽

Mona-Gekanju Toeque ◽

...

Keyword(s):

Weight Gain ◽

Blood Glucose ◽

Blood Glucose Level ◽

Diabetic Ketoacidosis ◽

Glucose Level ◽

Case Reports ◽

Acute Onset ◽

Anion Gap ◽

Hyperosmolar Hyperglycemic State ◽

Hba1c Levels

Abstract Background A few case reports have noted uncontrolled hyperglycemia in patients switched to dolutegravir. Several cohort studies have found increased weight gain among patients treated with integrase inhibitors (INSTI). We present clinical observations among 3 patients admitted to hospital for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) while receiving INSTIs for the management of HIV. Methods Case 1: A 44-year-old man with HIV and dyslipidemia presented with altered mental status and lethargy. A fingerstick glucose was >600 mg/dL. Chemistries revealed glucose of 1,600 mg/dL and an elevated β-hydroxybutyrate. HbA1c was 12.4%. His antiretroviral regimen consisted of cEVG/TAF/FTC for the last 3 years. Previous HbA1c levels were 5.7% and 6.2% (Figure 1). Case 2: A 55-year-old woman with HIV, hypertension, dyslipidemia, and obesity presented with polyuria and polydipsia. The blood glucose level was >1,200 mg/dL with an anion gap >30 and HbA1c of 15%. Previous HbA1c levels ranged between 5.6 and 5.8% (Figure 2). She had been taking ABC/FTC/DTG for 2 years. Case 3: A 64 yo man with a history of HIV, hypertension, and obesity presented with polyuria and polydipsia. The blood glucose level was 1,152 mg/dL with no anion gap and HbA1c of 13.4%. Six months before, he had been switched from a c/DRV- based ART regimen to ABC/FTC/DTG. Previous HbA1c levels ranged between 5.8% and 6.2% (Figure 3). Results Discussion: In the first 2 patients, the presentation with acute onset DKA occurred more than a year after being on an INSTI-based regimen; however, the latter patient presented with HHS within 6 months of being switched to an INSTI-containing regimen. The mechanism of action of INSTIs causing weight gain or an association with hyperglycemia is still under investigation. Conclusion Although the temporal onset of DKA and HHS while receiving INSTIs was not precise, the possible association of INSTIs and their direct effects on insulin resistance and diabetes warrant additional attention from post-market data. Meanwhile, providers should monitor INSTI-treated patients closely, especially those with features of metabolic syndrome. Disclosures All authors: No reported disclosures.

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