Hyperketonemia: Clinical features and diagnosis of Diabetic Ketoacidosis

Diets that boost ketone production are increasingly used for treating several neurological disorders. Elevation in ketones in most cases is considered favorable, as they provide energy and are efficient in fueling the body's energy needs.Several physiological and pathological triggers, such as fasting, ketogenic diet, and diabetes cause an accumulation and elevation of circulating ketones. Complications of the brain, kidney, liver, and microvasculature were found to be elevated in diabetic patients who had elevated ketones compared to those diabetics with normal ketone levels. Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management.

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COVID-19 Infection with Refractory Diabetic Ketoacidosis- A case Report

The Journal of Medical Research ◽

10.31254/jmr.2021.7206 ◽

2021 ◽

Vol 7 (2) ◽

pp. 54-56

Author(s):

Reshmi Mishra ◽

◽

Jyoti Ranjan Behera ◽

P. Ramkumar ◽

Mukesh Kumar Jain ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Metabolic Acidosis ◽

Diabetic Ketoacidosis ◽

Vital Organ ◽

Increased Risk ◽

Life Threatening ◽

Life Threatening Complication ◽

New Onset

Diabetic ketoacidosis is an acute life-threatening complication of type 1 diabetes. Sometimes it is the first presentation in an undiagnosed child. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) and diabetes mellitus are very much interrelated as diabetes mellitus is associated with an increased risk of severe COVID19 at the same time, many cases of new-onset diabetes had been diagnosed. Hyperglycemia, metabolic acidosis, and ketonemia are classical presentations. It is essential to correct the acidosis and fluid correction and insulin therapy in these patients, leading to vital organ dysfunction. In refractory metabolic acidosis, renal replacement therapy may help

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MON-LB126 A Benign and Favorable Diagnosis: Glycogen Hepatopathy Causing Transient Transaminitis During Diabetic Ketoacidosis in Type 1 Diabetes Mellitus

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2329 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Alice Yau ◽

Pramma Elayaperumal ◽

Ashvin Butala ◽

Gul Bahtiyar ◽

Giovanna Rodriguez

Keyword(s):

Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Distinct Pattern ◽

Diabetic Patients ◽

African American Female ◽

Nonalcoholic Fatty Liver ◽

Glucose Levels ◽

Glycogen Storage Diseases ◽

Type 1 Dm

Abstract Background: Transient transaminitis is a rarely discussed complication of uncontrolled diabetes mellitus (DM). Known as glycogenic hepatopathy (GH), it is belived to be caused by build-up of glycogen in hepatocytes. Recognized as benign and reversible, GH is associated with hepatomegaly (>90% cases) and primarily seen in patients with type 1 DM during periods of inadequate hyperglycemic control. Differential diagnoses include glycogen storage diseases, nonalcoholic fatty liver disease, hepatosclerosis, autoimmune hepatitis, hemochromatosis, Wilson disease, and acute viral hepatitis.1 Case Report: A 26-year-old African American female with type 1 DM and sickle cell presented on multiple occasions to the emergency department with abdominal pain associated with nausea, vomiting and diarrhea. Initial labs consistently included glucose levels >600 mg/dL (70-105 mg/dL), elevated anion gap ranging 20-40s mEq/L (5-15 mEq), and severe metabolic acidosis reflective of diabetic ketoacidosis (DKA). Labs were also significant for repeated mild transaminitis despite adequate fluid hydration. After several admissions, we observed a distinct pattern of mild transaminitis that directly fluctuated with her levels of blood glucose. With some minor lag, the patient’s liver enzymes normalized when her glucose levels normalized and DKA resolved. Further work-up ruled out more common etiologies of liver injury. Multiple abdominal ultrasounds and CT scans showed a normal sized liver without obvious structural abnormalities. Labs were significant for negative hepatitis B and hepatitis C; several negative anti-smooth muscle, anti-nuclear antibody, centromere antibody, and liver kidney microsomal type 1 antibody; normal levels of ceruloplasmin and alpha 1 anti-trypsin; low iron levels 23 ug/dL (60-180 ug/dL); borderline low IgG 627 mg/dL (700-1600 mg/dL). We hypothesized that the patient likely had GH by exclusion of other liver pathologies and given the context of transient transaminitis during DKA. Conclusion: GH is a benign and favorable diagnosis in diabetic patients with elevated transaminases.1 Given the small number of cases of GH reported, there is a need to record and analyze more patients with likely GH in order to better understand the condition. Appropriate clinician awareness of GH can also eliminate the need for time consuming and costly workup. References:1. Sherigar, Jagannath M et al. “Glycogenic Hepatopathy: A Narrative Review”. World Journal Of Hepatology, vol 10, no. 2, 2018, pp. 172-185. Baishideng Publishing Group Inc., doi:10.4254/wjh.v10.i2.172.

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Clinical Spectrum and Management of Diabetic Ketoacidosis: Experience in A Tertiary Care Hospital

BIRDEM Medical Journal ◽

10.3329/birdem.v1i1.12380 ◽

2012 ◽

Vol 1 (1) ◽

pp. 15-20

Author(s):

MA Rahim ◽

KN Uddin ◽

S Zaman ◽

AKM Musa ◽

MR Rahman ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Tertiary Care ◽

Cross Sectional Study ◽

Electrolyte Imbalance ◽

Diabetic Patients ◽

Care Hospital ◽

Cross Sectional ◽

Number Of Patients ◽

Metabolic Complication

Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus (DM). It may be the presenting feature in type 1 DM, but more commonly it complicates previously diagnosed diabetic patients, both type 1 and type 2. If not recognized early and treated in a judicious way the outcome is often fatal. Objectives: The objectives of this study was to see the common presenting features of DKA, their precipitating causes, patterns of electrolyte imbalance, treatment requirement in early hours and to see the outcome. Materials and methods: This cross sectional study was done in BIRDEM General Hospital on fifty adult patients who presented with DKA over a period of nine months (January 2007 to September 2007). Results: Total number of patients were 50, male were 24 and female were 26 (M:F =12:13). Mean age was 27.6 ± 3.7 years. The incidence of DKA was more in known diabetic patients (32, 64%), in comparison with new cases (18, 36%). Frequency was more in poor village people (31, 62%). Vomiting (24, 48%) was the most frequent complaint, followed by fever (19, 38%), nausea (16, 32%), abdominal pain (14, 28%), weakness (13, 26%), polyuria (12, 24%) and polydypsia ( 8, 16%). Infection (18, 36%) was the most common precipitating cause, closely followed by inadherence to insulin therapy (17, 34%). In 12 (24%) cases no cause could be identified. Glycaemic control was poor, HbA1c was >7% in 98% cases. Severe acidosis (pH < 7) was less common (4, 8%) and gross electrolyte imbalance was uncommon but all patients required potassium supplementation in course of treatment. Neutrophilic leukocytosis was present in 44 (88%) cases, irrespective of presence of infection. Mortality was low (3, 6%). Conclusion: Diagnosis and treatment of DKA is not difficult if recognized early. So, high index of suspicion is necessary, particularly in previously undiagnosed cases. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12380 Birdem Med J 2011; 1(1): 15-20

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Diabetic ketoacidosis precipitated by COVID-19 in patient with newly diagnosed diabetes mellitus

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY ◽

10.22141/2224-0721.17.5.2021.241521 ◽

2021 ◽

Vol 17 (5) ◽

pp. 422-425

Author(s):

E. Xhardo ◽

P. Kapisyzi ◽

A. Rada

Keyword(s):

Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Virus Disease ◽

Pancreatic Beta Cell ◽

Stable Condition ◽

Diabetic Patients ◽

Newly Diagnosed ◽

High Blood Glucose ◽

Viral Infectious Disease

Background. Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus (DM) have been reported frequently in patients with the new corona virus disease — 2019, COVID-19. It has been associated with progressive course and worse outcome. There is scarce data on diabetic ketoacidosis (DKA) in COVID-19 infection. There has been several cases reported on COVID-19 infection precipitating a new diagnosis of type 2 DM (T2DM). However, there is a lack of evidence regarding type 1 DM (T1DM). We report a case of DKA precipitated by COVID-19 in a patient with newly diagnosed T1DM. Recently, case reports and small cross-sectional studies described diabetic patients who develop DKA when infected with COVID-19. The incidence of DKA has been found to be high in patients with T1DM and T2DM admitted to hospital with COVID-19. Case presentation. We present a 29 year-old, previously healthy man with 5 days history of fever, fatigue, vomiting, polydipsia and polyuria. His lab results showed high blood glucose, high anion gap metabolic acidosis and ketonuria diagnostic of DKA. He also tested positive for COVID-19 and his Chest CT was consistent with bilateral COVID 19 pneumonia (ground-glass opacity, consolidation, and crazy-paving pattern). He was successfully managed with intravenous fluids and insulin as per DKA protocol. He required intravenous antibiotics, steroids and oxygenotherapy for COVID-19 pneumonia. He was discharged after 14 days in stable condition. Conclusions. COVID-19 infection can be complicated by DKA and development of DM in previously non-diabetic individuals. It is possible that SARS-CoV-2 may aggravate pancreatic beta cell function and precipitate DKA. Very few cases have been reported in the literature on COVID-19 infection precipitating DKA in a newly diagnosed patient of type 1 diabetes mellitus.

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Type 1 (distal) renal tubular acidosis in a patient with Type 1 diabetes mellitus-not all cases of metabolic acidosis in Type 1 diabetes mellitus are due to diabetic ketoacidosis

Diabetic Medicine ◽

10.1111/j.1464-5491.2007.02334.x ◽

2008 ◽

Vol 25 (1) ◽

pp. 114-115 ◽

Cited By ~ 5

Author(s):

J. A. Dymot ◽

G. A. McKay

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Metabolic Acidosis ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Renal Tubular Acidosis ◽

Distal Renal Tubular Acidosis ◽

Renal Tubular

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Diabetic Ketoacidosis Revealing a Severe Hypertriglyceridemia and Acute Pancreatitis in Type 1 Diabetes Mellitus

Case Reports in Endocrinology ◽

10.1155/2019/8974619 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Fatima Zahra Zaher ◽

Imane Boubagura ◽

Sana Rafi ◽

Ghizlane Elmghari ◽

Nawal Elansari

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Biological Evolution ◽

Intravenous Insulin ◽

Severe Hypertriglyceridemia ◽

Metabolic Complication ◽

Patients With Diabetes

Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.

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