Reversible supraventricular tachycardia complicating diabetic ketoacidosis in an adult patient: A case report

Diabetic ketoacidosis (DKA) is a commonly encountered serious acute metabolic complication of diabetes mellitus (DM) in adolescents and young adults. It is traditionally associated with poorly treated or newly diagnosed type 1 DM, however, in the setting of type 2 DM, inadequate insulin treatment, non-compliance to treatment, newly diagnosed DM, acute illnesses, drugs, and extreme stress can precipitate DKA. We report the case of a 42-year-old known diabetic of 7 years duration with a family history of DM who presented with a two-week history of difficulty in breathing, polyuria, and vomiting. On further examination, pulse rate was 220 beats per minute, respiratory rate 40 cycles per minute, temperature 38.4’C. Random blood sugar was 18.1mmol/l with ketonuria ++. Severe acidosis and mild hypokalemia were noted with her electrocardiogram (ECG) showing supraventricular tachycardia. She was managed and discharged in stable condition with a normal ECG after 20 days on admission to continue basal and pre-meal insulin at home. Adequate diabetic education was conducted and follow-up with endocrinology and cardiology units was advised.

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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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Diabetic Ketoacidosis (DKA) Induced Cerebral Edema Complicating Small Chronic Subdural Hematoma/Hygroma/ at Zewuditu Memorial Hospital: A Case Report

10.21203/rs.3.rs-1050848/v1 ◽

2021 ◽

Author(s):

Mestet Yibeltal Shiferaw ◽

Tsegazeab Laeke T/Mariam ◽

Abenezer Tirsit Aklilu ◽

Yemisirach Bizuneh Akililu ◽

Bethelhem Yishak Worku

Keyword(s):

Cerebral Edema ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Newly Diagnosed ◽

Midline Shift ◽

Subdural Hygroma ◽

The Status ◽

History Of ◽

Type 1 Dm

Abstract BackgroundWhile both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma.Case summaryThis study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment.ConclusionDKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

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Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181005113448 ◽

2019 ◽

Vol 15 (9) ◽

pp. 906-910

Author(s):

Hongzhang Zhu ◽

Shi-Ting Feng ◽

Xingqi Zhang ◽

Zunfu Ke ◽

Ruixi Zeng ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Stable Condition ◽

Resonance Imaging ◽

Mri Findings ◽

Cutis Verticis Gyrata ◽

Essential Form ◽

History Of ◽

Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

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Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

Clinics and Practice ◽

10.3390/clinpract11020031 ◽

2021 ◽

Vol 11 (2) ◽

pp. 216-218

Author(s):

Marta Brandão Calçada ◽

Luís Fernandes ◽

Rita Soares Costa ◽

Sara Montezinho ◽

Filipa Martins Duarte ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Ketoacidosis ◽

Drug Class ◽

Clinical Suspicion ◽

Laboratory Findings ◽

Sodium Glucose Cotransporter ◽

History Of ◽

High Degree ◽

Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

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Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

BMJ Case Reports ◽

10.1136/bcr-2021-245024 ◽

2021 ◽

Vol 14 (12) ◽

pp. e245024

Author(s):

Ajay Chikara ◽

Sasidhar Reddy Karnati ◽

Kailash Chand Kurdia ◽

Yashwant Sakaray

Keyword(s):

Abdominal Pain ◽

Stable Condition ◽

Paraduodenal Hernia ◽

Inferior Mesenteric Vein ◽

Anterior Border ◽

Initial Reduction ◽

Contrast Enhanced ◽

History Of ◽

Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

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P006: Characterizing patients with newly-diagnosed diabetes mellitus in the emergency department: A one-year health records review

CJEM ◽

10.1017/cem.2017.208 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S79

Author(s):

H. Ali Khan ◽

K. Gushulak ◽

M. Columbus ◽

I.G. Stiell ◽

J.W. Yan

Keyword(s):

Diabetic Ketoacidosis ◽

Type Ii Diabetes ◽

Type I ◽

Type Ii ◽

Newly Diagnosed ◽

Health Records ◽

The Mean ◽

One Year ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes

Introduction: Diabetes mellitus is an increasingly prevalent chronic condition that is usually managed in an outpatient setting. However, the emergency department (ED) plays a crucial role in the management of diabetic patients, particularly for those who are presenting with newly diagnosed diabetes. Little research has been done to characterize the population of patients presenting to the ED with hyperglycemia with no previous diagnosis of diabetes. The objective of this study was to describe the epidemiology, treatment, and outcomes of patients who were newly diagnosed with diabetes in the ED and to compare those with newly diagnosed type I versus type II diabetes. Methods: A one-year health records review of newly diagnosed diabetes patients ≥18 years presenting to one of four tertiary care EDs was conducted. All patients with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were screened, but only those who did not have a previous history of diabetes were included. Trained research personnel collected data on patient characteristics, management, disposition, and outcome. Descriptive statistics were used to summarize the data where appropriate. Results: Of 645 patients presenting with hyperglycemia in the study period, 112 (17.4%) were newly diagnosed diabetes patients. Of these patients, 30 (26.8%) were later diagnosed with type I diabetes and 82 (73.2%) were diagnosed with type II diabetes. For the newly diagnosed type I patients the mean (SD) age was 27.6 (9.9) and the mean (SD) age for type II patients was 52.4 (14.1). Of all the new onset patients, 26.8% were diagnosed with diabetic ketoacidosis. The percentage of patients diagnosed with diabetic ketoacidosis was higher in type I than type II (63.3% vs 13.4%; P<0.01). A total of 49 (43.8%) patients were admitted to the hospital, and more patients with type I were admitted compared to those with type II (66.7% vs 35.4 %; P<0.01). Conclusion: Limited research has been done to describe patients newly diagnosed with diabetes in the ED. Patients with type I were found to be more likely to present to the ED with serious symptoms requiring admission to hospital. Our findings demonstrate that the ED may have a strong potential role for improving diabetic care, by providing future opportunities for education and follow-up in the ED to reduce complications, particularly in type I.

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Congenital Toxoplasmosis presenting as multiple ring enhancing lesions in brain on neuroimaging

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183552 ◽

2018 ◽

Vol 5 (5) ◽

pp. 2020

Author(s):

Pareshkumar A. Thakkar ◽

Aakashi Shah ◽

Bakul B. Javadekar ◽

Saurabh Modasia

Keyword(s):

Ct Scan ◽

Past History ◽

Stable Condition ◽

Congenital Toxoplasmosis ◽

Cellular Reaction ◽

Protein Levels ◽

Elevated Protein ◽

Intravenous Antibiotics ◽

History Of ◽

Multiple Ring

We report a case of congenital toxoplasmosis in a male child who presented at 1 month 21 days of life. He had a past history of meningitis on third day of life which resolved with intravenous antibiotics. This time, the child presented with progressive enlargement of head and CSF (Cerebrospinal fluid) showed elevated protein levels with cellular reaction and CT scan showed dilated ventricular system with aqueductal obstruction and multiple ring-enhancing lesions in bifrontal and bioccipital regions with a right porencephalic cyst. Repeat CSF after 14 days of intravenous antibiotics showed elevated protein with no cellular reaction. Fundus examination was normal. Toxoplasma blood serology (IgG and IgM) in baby and mother were positive. The child received treatment with Pyrimethamine, Clindamycin, Folinic acid and Prednisolone. CSF parameters got normalized and multiple ring-enhancing lesions disappeared on repeat CT scan. He underwent a Ventriculo-Peritoneal shunt surgery for the hydrocephalus and was discharged in a stable condition.

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A case of diabetic ketoacidosis in a patient with COVID‐19 and newly diagnosed type 1 diabetes

Clinical Case Reports ◽

10.1002/ccr3.4881 ◽

2021 ◽

Vol 9 (9) ◽

Author(s):

Keitaro Ishii ◽

Hirotsugu Suwanai ◽

Taishi Saito ◽

Naoki Motohashi ◽

Masaru Hirayama ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Newly Diagnosed

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ECAST Syndrome (Exercise Collapse Associated with Sickle Cell Trait): First Knock of Sickle Cell in a Young Bodybuilder

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i56a33887 ◽

2021 ◽

pp. 74-78

Author(s):

Janhavi Mahajan ◽

Dhruv Talwar ◽

Sunil Kumar ◽

Sourya Acharya ◽

Yogesh Kakde

Keyword(s):

Sickle Cell ◽

Sickle Cell Trait ◽

Vigorous Physical Activity ◽

Stable Condition ◽

Young Male ◽

Exercise Session ◽

Vigorous Exercise ◽

Mortality And Morbidity ◽

Excessive Heat ◽

History Of

ECAST Or exercise collapse associated with sickle cell trait is a rare phenomenon associated with sickle cell trait and is an important presentation of sickle cell disease in sports medicine. Collapse is seen following vigorous physical activity, which is due to excessive heat, dehydration and other factors associated with physical exercise. This rare syndrome is often missed by the treating physicians as a result of a lack of knowledge about this rare entity leading to massive underreporting. It is important to identify ECAST as a cause of the collapse in young athletes to prevent mortality and morbidity and in order to provide prompt treatment. We report a case of a 25- year-old young male who was a bodybuilder and reported to the gym after a one-year-long break due to lockdown restrictions of COVID19. After a vigorous exercise session, he collapsed in the gym and was brought to the emergency department. After proper history taking and examination, he was suspected to be a case of ECAST due to a history of a similar episode three years back which was treated as a case of exertional syncope with intravenous fluid therapy and a family history of Sickle cell trait with his mother and father both having sickle cell AS Pattern. Ultimately our patient turned out to be a case of Sickle Cell Trait with evidence of AS pattern on Hb electrophoresis and a small-sized spleen visualized on CT Scan of the abdomen. The patient was managed successfully with intravenous fluids and blood transfusion and was discharged in a stable condition. He was counseled about moderating his exercise and is doing well on follow-up.

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Characteristics of children with leprosy: Factors associated with delay in disease diagnosis

Indian Journal of Dermatology Venereology and Leprology ◽

10.25259/ijdvl_1382_20 ◽

2021 ◽

Vol 0 ◽

pp. 1-5

Author(s):

Joydeepa Darlong ◽

Karthikeyan Govindasamy ◽

Amrita Daniel

Keyword(s):

West Bengal ◽

Economic Status ◽

Uttar Pradesh ◽

Disease Diagnosis ◽

The Body ◽

Delayed Presentation ◽

Newly Diagnosed ◽

Factors Associated ◽

History Of ◽

History Of Migration

Objectives: The objectives of the study were to characterize the clinical profile of childhood leprosy presenting at tertiary leprosy care hospitals in the states of Bihar, West Bengal and Uttar Pradesh in India, and to determine the possible risk factors associated with disabilities at presentation. Methods: Subjects were children with newly diagnosed leprosy registered for treatment at tertiary Leprosy Mission Hospitals in Muzaffarpur (Bihar), Purulia (West Bengal) and Faizabad (Uttar Pradesh), India, between June and December 2019. Demographic and leprosy characteristics were collected at the time of diagnosis. Parents/guardians were interviewed on reasons for delay in presenting at the hospital. Associations between various factors and delay in diagnosis were assessed. Results: Among the 84 children, the mean (SD) age was 10 (3) years with a range of 4–14 years. There were more boys (58%) and most children were currently in school (93%), resident in rural areas (90%) and belonged to a lower socioeconomic status (68%). More children were diagnosed with multibacillary leprosy (69%), one-third of them being skin smear positive for Mycobacterium leprae. On presentation, 17% had deformity (5% grade 1 deformity and 12% grade 2), 29% had nerve involvement and skin lesions were spread across the body in half of the children. Mean (SD) duration of delay was 10.5 (9.8) months. Delayed presentation was more in boys (43% vs. 17%; P = 0.01), those without a history of migration for work compared to those who had a history of migration (40% vs. 9%; P = 0.008) and in those children who were from a poor economic status compared with those that came from a better economic status (44% vs. 7%; P = 0.001) Limitations: Because our study was conducted at tertiary care hospitals, the findings are not representative of the situation in the field. Furthermore, a comparison group of newly diagnosed adult leprosy patients with disability could have been included in the study. Conclusion: Childhood leprosy continues to occur in endemic pockets in India and a substantial number present with skin smear positivity and deformity. Guardians of these children cite many reasons for the delay in presentation.

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