Euglycemic Diabetic Ketoacidosis in COVID-19 Patient Caused by Empagliflozin: A Case Report from Intensive Care Unit

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Al-Taie N ◽  
◽  
Stingl H ◽  
Fuchs W ◽  
Waechter H ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
The Other ◽  
The Novel ◽  
High Blood Glucose ◽  
Novel Coronavirus ◽  
Euglycemic Diabetic Ketoacidosis

The novel coronavirus - Severe Acute Respiratory Syndrome coronavirus 2 - is responsible for mainly respiratory disease (COVID-19). On the other hand, Diabetic Ketoacidosis (DKA) is a life-threating complication. The usual form of DKA is caused by insulin deficiency and is characterized by high blood glucose (usually more than 250mg/dl or 14mmol/L), ketonemia, low pH, and low serum bicarbonate. The other form of DKA is the euglycemic DKA, which occurs in patients with blood glucose lower than 250mg/dl (14mmol/L). This case report describes a patient that presented to the intensive care unit with Covid-19 pneumonia and euglycemic DKA.

scholarly journals A Case of Multifactorial Diabetic Ketoacidosis Acquired in the Intensive Care Unit: A Case Report

Cureus ◽  
2019 ◽  
Author(s):  
Ceressa T Ward ◽  
Babar Fiza ◽  
Amit Prabhakar ◽  
Gaurav Budhrani ◽  
Vanessa Moll
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Diabetic Ketoacidosis

Evaluation of a Computerized Insulin Dosing Tool for the Treatment of Diabetic Ketoacidosis

2019 ◽  
Vol 33 (6) ◽  
pp. 768-773 ◽  
Author(s):  
Aubrey A. Defayette ◽  
Lisa M. Voigt ◽  
Kimberly T. Zammit ◽  
Jamie N. Nadler ◽  
Brian P. Kersten
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Diabetic Ketoacidosis ◽  
Chart Review ◽  
Unit Length ◽  
Primary Diagnosis ◽  
Gap Closure ◽  
Dosing Strategy

Purpose: Computerized insulin dosing tools (CIDT) have been shown to improve the care of critically ill patients with hyperglycemia. Application of a CIDT in addition to a diabetic ketoacidosis (DKA) order set for the treatment of DKA has not been evaluated. Our goal was to determine the effects the CIDT would have on the treatment of a patient with DKA. Methods: In this retrospective, pre–post chart review, a provider-driven insulin dosing strategy (pregroup) was compared to the CIDT (postgroup) with 24-hour pharmacist monitoring. The CIDT utilized an equation that incorporated a patient’s most recent blood glucose (BG) value and recommended a rate of insulin (units/hour) every hour. Results: All baseline characterizes were similar between the 2 groups. There were no significant differences in average time to anion gap closure (≤ 12 mEq/L) or intensive care unit length of stay between the pregroup and postgroup (12.5 [6] hours vs 10.5 [7] hours, P = 0.235; 40.6 [24] hours vs 40.8 [24] hours, P = 0.945). Although not statistically significant, 17 hypoglycemic events (BG < 70 mg/dL) occurred in the pregroup with 4 being severe (BG < 50 mg/dL) while 5 hypoglycemic events occurred in the postgroup, none of which were severe. Conclusion: This study suggests, when compared to a provider-driven insulin dosing strategy, the CIDT with 24-hour pharmacist monitoring is efficacious and safe for treatment of patients with a primary diagnosis of DKA.

Effects of Different Blood Glucose Levels on Critically Ill Patients in an Intensive Care Unit

2015 ◽  
Vol 25 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Li Kang ◽  
Juan Han ◽  
Qun-Cao Yang ◽  
Hui-Lin Huang ◽  
Nan Hao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fasting Blood Glucose ◽  
Apache Ii Score ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels

<b><i>Aims:</i></b> We explore the infection incidence and possible prognostic outcome relevance for patients with different blood glucose levels in an intensive care unit (ICU). <b><i>Methods:</i></b> A total of 98 cases were enrolled and divided into three groups based on average fasting blood glucose levels (group A: ≤6.1 mmol/l; group B: 6.1-10 mmol/l; group C: ≥10 mmol/l). <b><i>Results:</i></b> There were no statistical differences in the time to ICU admission, the indwelling durations of gastric tubes, urinary or deep vein catheters, tracheal intubations and tracheotomies, or the length of ventilator use (all p > 0.05). No evident difference in the multiple organ dysfunction syndrome rate was found between the three groups (p = 0.226). The infection and mortality rates between the groups showed significant differences (all p < 0.05). Furthermore, the difference of respiratory system infections was statistically significant among the three groups (p = 0.008), yet no such statistical difference was observed among groups regarding nonrespiratory system infections (p = 0.227). <b><i>Conclusions:</i></b> Critically ill patients with a high blood glucose level were positively correlated with a relatively high APACHE II score and more serious degree of disease, as well as a higher incidence of respiratory infection during their ICU stay than those with lower blood glucose levels (<10 mmol/l).

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.

scholarly journals Post-surgical Euglycemic Diabetic Ketoacidosis in a Patient on Empagliflozin in the Intensive Care Unit

Cureus ◽  
2019 ◽  
Author(s):  
Fernand Bteich ◽  
Ghassan Daher ◽  
Aniruddh Kapoor ◽  
Edward Charbek ◽  
Ghassan Kamel
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Diabetic Ketoacidosis ◽  
Euglycemic Diabetic Ketoacidosis

scholarly journals Invasive Non-typhoidal Salmonella Sepsis in Top-up Fed Five-Month-Old Infant: Case Report

2021 ◽  
Author(s):  
Shazia Naaz ◽  
Vivek Hada ◽  
Swathi Suravaram ◽  
Lakshmi Jyothi Tadi ◽  
Mohammad Wajid
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Case Report ◽  
Gastrointestinal Disease ◽  
Invasive Disease ◽  
The Other ◽  
Contaminated Food ◽  
The Common ◽  
Infant Case

Non-typhoidal Salmonella (NTS) are generally associated with self-limiting gastrointestinal disease, often acquired through the ingestion of contaminated food and it seldom requires antimicrobial therapy for treatment. Extra-intestinal manifestations could be localised infection leading to septic arthritis, osteomyelitis. In complicated invasive disease, there could be bronchopneumonia with or without bacteraemia leading to mortality. Invasive NTS infections are infrequently reported in India. The S. Typhimurium is one of the common serovars associated with invasive disease and its virulence factors are responsible for causing the disease. S. enteridies, S. Dublin are the other serovars which are commonly responsible for invasive NTS infection. It is difficult to diagnose invasive disease without appropriate bacteriological culture based method. With emergence to resistance to antimicrobials the treatment of this condition is also becoming challenging. In this case report, a five-month-old infant presented with cough fever, stuffed nose dyspnoea and was diagnosed as bronchopneumonia. Mechanical ventilation was required for five days along with admission to intensive care unit. Invasive NTS infection was diagnosed using automated blood culture and the child responded to intravenous antimicrobial chemotherapy.

Myxoedema coma precipitated by diabetic ketoacidosis and neuroleptic drugs: case report in an intensive care unit

2007 ◽  
Vol 2 (2) ◽  
pp. 147-149 ◽  
Author(s):  
C. Cappelli ◽  
B. Stanga ◽  
A. Paini ◽  
E. Gandossi ◽  
D. Cumetti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Neuroleptic Drugs

Ranitidine Induced Thrombocytopenia: A Case report

2016 ◽  
Vol 2 (1) ◽  
pp. 60-61
Author(s):  
Kanad Deepak ◽  
Nishant Verma ◽  
Umesh Kumar ◽  
Megha Garg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Joint Pain ◽  
The Other ◽  
Critically Ill Patient ◽  
Drug Related Problems ◽  
H2 Receptor Antagonist ◽  
Set Up ◽  
Time Of Admission

Ranitidine is H2 receptor antagonist. In some critically ill patient it induces thrombocytopenia, which is a rare drug related problems arise during treatment in intensive care unit (ICU) set up. We are going to present a case of 18 year old boy, which had fever and joint pain at the time of admission. Intravenous ceftriaxone, Paracetamol and Ranitidine was administered. Repeated lab investigations showed decrease in WBC and Platelet counts. After excluding the other causes, it was concluded that Ranitidine was the cause of thrombocytopenia.

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