scholarly journals Diazoxide use for neonatal hyperinsulinaemic hypoglycaemia in a low-resource setting: A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 338-343
Author(s):  
AO Adekoya ◽  
TE Adekanye ◽  
OO Abolurin ◽  
OO Adebawojo ◽  
FG Ajayi ◽  
...  
Keyword(s):  
Perinatal Asphyxia ◽  
Serum Insulin ◽  
Male Infant ◽  
Serum Cortisol ◽  
High Serum ◽  
Intravenous Glucose ◽  
Hyperinsulinaemic Hypoglycaemia ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Hydrocortisone Administration

The management of neonatal hyperinsulinaemic hypoglycaemia remains a major challenge in hospitalized newborns globally. Diazoxide is one of the recommended therapeutic options. We report a late preterm, male infant of a diabetic mother who suffered severe perinatal asphyxia and had persistent hypoglycaemia requiring progressively increasing intravenous glucose concentrations to as high as 12.5 mg/kg/minute along with intravenous hydrocortisone administration. A critical sample revealed inappropriately high serum insulin, inappropriately low serum cortisol and growth hormone responses. Urinalysis was negative for ketones. With the persistence of hypoglycaemia, oral diazoxide at 5 mg/kg/day with oral hydrochlorothiazide was administered. The infant was diazoxide-responsive with complete resolution of hypoglycaemia. Diazoxide therapy was discontinued after 14 days and he was discharged after one month of admission. This report emphasizes the importance of diazoxide in the management of neonatal transient hyperinsulinaemic hypoglycaemia. The availability and cost of diazoxide, as well as the endocrine and metabolic tests, are major concerns in resource-poor settings.

Glucose 250, MD Notified: A Case Report.

2020 ◽  
pp. 1-3
Keyword(s):  
Insulin Therapy ◽  
Serum Insulin ◽  
Serum Cortisol ◽  
Primary Diagnosis ◽  
Serum Glucose ◽  
High Serum ◽  
Intravenous Glucose ◽  
Glucose Levels ◽  
Normal Ranges ◽  
Low Rate

Background: Hyperglycemia is common in neonates. Insulin therapy is used to treat hyperglycemia. Threshold for treating hyperglycemia varies among the neonatal practitioners. The renal threshold for glucose is 180 mg/dl, so most practitioners wait on insulin therapy till the serum glucose level reaches 180 mg/dl. We describe a case of a neonatal hyperglycemia of greater than 250 mg/dl that was successfully managed conservatively. Clinical Findings: The neonate, who was depressed at birth, was noted to have high serum glucose levels soon after birth. Serial glucose levels within first six hours of life were persistently above 200 mg/dl. The serum cortisol was normal while serum insulin was low. Infant was provided a low rate of intravenous glucose without giving any insulin. The serum glucose declined to normal levels within 24 hours. Primary diagnosis: Stress-induced transitional hyperglycemia. Interventions: We performed a serial monitoring on serum glucose and provided intravenous dextrose solution at a very low rate. The glucose infusion rate used was only 2.6 mg/kg/min. We were able to bring down the serum glucose to normal ranges conservatively without using any insulin therapy. Outcomes: Infant responded to conservative management and serum glucose was normalized within 24-hours. Practical Recommendations: Stress-induced hyperglycemia soon after birth is transitional and could be managed conservatively without insulin therapy.

scholarly journals Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients

2018 ◽  
Vol 2018 ◽  
Author(s):  
A Veltroni ◽  
G Zambon ◽  
S Cingarlini ◽  
M V Davì
Keyword(s):  
Lipoic Acid ◽  
Serum Insulin ◽  
Strong Association ◽  
High Serum ◽  
List Type ◽  
Alpha Lipoic Acid ◽  
Hyperinsulinaemic Hypoglycaemia ◽  
C Peptide ◽  
Sulphydryl Groups ◽  
Caucasian Patients

Summary Insulin autoimmune syndrome (IAS), a rare cause of autoimmune hyperinsulinaemic hypoglycaemia, is relatively well known in Japan. The incidence in Caucasians is less than one-fifth of that reported in Japanese people, but it is becoming increasingly recognised worldwide in non-Asians as well. Drugs containing sulphydryl groups are known to be associated with the disease in genetically predisposed individuals. Moreover, several recent reports showed a direct association between the onset of IAS and the consumption of dietary supplements containing alpha-lipoic acid (LA). Insulinoma remains the most prevalent cause of hypersulinaemic hypoglycaemia in Caucasians. Consequently, primary investigation in these patients is generally focused on localisation of the pancreatic tumour, often with invasive procedures followed by surgery. We described a case of an Italian woman presenting to us with severe recurrent hypoglycaemia associated with high insulin and C-peptide levels and no evidence of pancreatic lesions at imaging diagnostic procedures. She had taken LA until 2 weeks before hospitalisation. After an evaluation of her drug history, an autoimmune form of hypoglycaemia was suspected and the titre of insulin autoantibodies was found to be markedly elevated. This allowed us to diagnose LA-related IAS, thus preventing any unnecessary surgery and avoiding invasive diagnostic interventions. Learning points: IAS is a rare cause of hyperinsulinaemic hypoglycaemia that typically affects Asian population, but it has been increasingly recognised in Caucasian patients. It should be considered among the differential diagnosis of hyperinsulinaemic hypoglycaemia to avoid unnecessary diagnostic investigations and surgery. It should be suspected in the presence of very high serum insulin levels (100–10  000  μU/mL) associated with high C-peptide levels. There is a strong association with administration of drugs containing sulphydryl groups included LA, a dietary supplement commonly used in Western countries to treat peripheral neuropathy.

Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 93-LB
Author(s):  
EDDY JEAN BAPTISTE ◽  
PHILIPPE LARCO ◽  
MARIE-NANCY CHARLES LARCO ◽  
JULIA E. VON OETTINGEN ◽  
EDDLYS DUBOIS ◽  
...  
Keyword(s):  
Dose Adjustment ◽  
Insulin Dose ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

2021 ◽  
Vol 14 (4) ◽  
pp. e239250
Author(s):  
Vijay Anand Ismavel ◽  
Moloti Kichu ◽  
David Paul Hechhula ◽  
Rebecca Yanadi
Keyword(s):  
Plastic Material ◽  
Successful Outcome ◽  
Paraduodenal Hernia ◽  
Transparent Plastic ◽  
Low Resource ◽  
Entire Small Bowel ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Right Paraduodenal Hernia ◽  
Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

scholarly journals Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting

2021 ◽  
Author(s):  
Víctor Lopez-Lopez ◽  
Ana Morales ◽  
Elisa García-Vazquez ◽  
Miguel González ◽  
Quiteria Hernandez ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan

scholarly journals Vulvar cancer: surgical management and survival trends in a low resource setting

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Navin Kumar ◽  
Mukur Dipi Ray ◽  
D. N. Sharma ◽  
Rambha Pandey ◽  
Kanak Lata ◽  
...  
Keyword(s):  
Surgical Management ◽  
Vulvar Cancer ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Darlene R. House ◽  
Yogendra Amatya ◽  
Benjamin Nti ◽  
Frances M. Russell
Keyword(s):  
Lung Ultrasound ◽  
Cumulative Sum Analysis ◽  
Resource Setting ◽  
Individual Zone ◽  
Low Resource Setting ◽  
Hands On ◽  
Level Of Training ◽  
A Prospective Study ◽  
Training Physicians ◽  
Study Physician

Abstract Background Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. Methods A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. Results Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. Conclusions Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.

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