Euglycemic Diabetic Ketoacidosis A Dreaded Complication in Post-Operative Patients In ICU

2020 ◽  
Vol 7 (1) ◽  
pp. 34-36
Author(s):  
Dr. Wasim Feroz ◽  
Dr. Sandeep Nale ◽  
Dr. H S Rawat
Keyword(s):  
Diabetic Ketoacidosis ◽  
Blood Sugar ◽  
Interbody Fusion ◽  
Ketone Bodies ◽  
Posterior Lumbar Interbody Fusion ◽  
Serum Glucose ◽  
Glucose Levels ◽  
Life Threatening ◽  
Sugar Levels ◽  
Euglycemic Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life threatening metabolic disorder and a known complication of Diabetes mellitus, caused by insulin deficiency or insulin resistance, which allows the catabolism of free fatty acids into ketone bodies, with high blood sugar levels. A rare variant of it is, euglycemic diabetic ketoacidosis (EKDA). We report a case of 60 year old female who was posted for Posterior lumbar interbody fusion (PLIF) and had this complication postoperatively. We believe that this case would serve as a reminder to all practitioners and intensivist to consider ketosis in a diabetic patient despite their serum glucose levels being within the normal range and all anaesthetist to consider the use of insulin during the intra op period even the blood sugar level is normal in peri operative period. This case report summarizes, in brief, the etiology, pathophysiology and treatment of EDKA.

scholarly journals Sodium-glucose cotransporter-2-induced euglycemic diabetic ketoacidosis unmasks latent autoimmune diabetes in a patient misdiagnosed with type 2 diabetes mellitus: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Brian Vadasz ◽  
Mattan Arazi ◽  
Yousef Shukha ◽  
Ofir Koren ◽  
Riad Taher
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Autoimmune Diabetes ◽  
Serum Glucose ◽  
Glucose Levels ◽  
Latent Autoimmune Diabetes ◽  
Sodium Glucose Cotransporter ◽  
Life Threatening ◽  
Euglycemic Diabetic Ketoacidosis

Abstract Background Euglycemic diabetic ketoacidosis is an uncommon but life-threatening complication associated with the use of sodium-glucose cotransporter 2 inhibitors that causes lower than expected blood glucose levels typically seen in diabetic ketoacidosis. Case presentation We present a case of 64-year-old Caucasian male patient previously diagnosed with type 2 diabetes treated with a sodium-glucose cotransporter 2 inhibitor who developed severe ketoacidosis. Serum glucose levels on initial presentation were slightly above normal baseline level. The patient was revealed to have latent autoimmune diabetes in adults. Conclusion This case highlights the importance of prescribing sodium-glucose cotransporter 2 inhibitors to the correct patient population and the significance of accurately differentiating between various types of diabetes.

scholarly journals Euglycemic Diabetic Ketoacidosis in the ICU: 3 Case Reports and Review of Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Pablo Lucero ◽  
Sebastián Chapela
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Ketone Bodies ◽  
Case Reports ◽  
Type I ◽  
Diagnostic Challenge ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Sodium Glucose Cotransporter ◽  
Euglycemic Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus, both type I and type II, as well as other types with diabetes such gestacional diabetes mellitus. It is characterized by blood glucose levels greater than 250 mg/dL and metabolic acidosis (pH < 7.3 and serum bicarbonate < 15 mEq/dL) with an increased anion gap and the presence of ketone bodies in the blood or urine. Within this pathology, there is a subgroup of pathologies which are characterized by being present with no signs of hyperglycemia, posing a diagnostic challenge due to the absence of the main sign of the pathology and the diversity of their pathophysiology. In this article, we will present 3 clinical cases with 3 different forms of clinical presentation: a case of DKA in pregnancy, a case of DKA associated with the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and a third case related to sepsis, together with a narrative review of the literature on the topic.

scholarly journals Euglycemic Diabetic Ketoacidosis Precipitated by SGLT-2 Inhibitor Use, Pericarditis, and Fasting: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 389-392
Author(s):  
Rebecca Mendelsohn ◽  
Anabelle Taveras ◽  
Benjamin Mazer ◽  
Lisa Clayton
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Oral Intake ◽  
Serum Glucose ◽  
Acute Pericarditis ◽  
Sodium Glucose Cotransporter ◽  
Life Threatening ◽  
Underlying Causes ◽  
Euglycemic Diabetic Ketoacidosis

Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Less prevalent is euglycemic DKA (eDKA)—DKA with serum glucose less than 200 mg/dL; however, it is increasing in frequency with the introduction of sodium glucose cotransporter 2 (SGLT-2) inhibitors for treatment of type 2 diabetes. Case Report: We report a case of SGLT-2 inhibitor-associated eDKA presenting with concurrent acute pericarditis. Discussion: Our case suggests that the cause of eDKA can be multifactorial when decreased oral intake occurs in the setting of an acute cause of physiologic stress. Conclusion: Prompt recognition of eDKA in the emergency department may allow earlier diagnosis and treatment directed at one or more of its underlying causes.

scholarly journals Improvement of Diet Behavior in Clients with Diabetes Mellitus Through Health Education

2020 ◽  
Vol 4 (2) ◽  
pp. 41-46
Author(s):  
Siti Utami Dewi ◽  
Deinera Rachel Furtunah F. D
Keyword(s):  
Diabetes Mellitus ◽  
Health Education ◽  
Blood Sugar ◽  
Eating Habits ◽  
Health Problems ◽  
Serum Glucose ◽  
Glucose Levels ◽  
Sugar Levels ◽  
The Stability

Diabetes mellitus (DM) is a disease that is a problem in public health. DM is a metabolic disorder characterized by hyperglycemia (an increase in serum glucose levels) due to lack of the hormone insulin, decreased effect of insulin and or both. Diet or diet is an important determinant that determines obesity and insulin resistance, so the provision of health education is a way to maintain the stability of insulin in DM clients. This case study aims to get an overview of the implementation of health education in improving the eating habits of DM clients. The method used is descriptive in the form of case studies with the criteria that the subject is a family with diabetes mellitus health problems through health education intervention about diet. The results of the case study showed that there was a decrease in blood sugar levels, good motivation of the families in implementing the DM diet, and behavioral changes by 76% (good category) in subject I, as far as subject II behavior change was 80% (good category ) Based on the results of this case study it is expected that nurses through health cadres are able to monitor the implementation of DM diet in families with optimal DM health problems. Keywords: Diabetes Mellitus, Blood Sugar Levels, Implementation of A Diet of Diabetes Mellitus

scholarly journals UJI AKTIVITAS ANTIDIABETES KOMBINASI EKSTRAK ETANOL DAUN ECENG GONDOK (Eichhornia crassipes (Mart.)Solms) DAN DAUN SINTRONG (Crassocephalum crepidioides (Benth.) S. Moore) PADA MENCIT

2021 ◽  
Vol 4 (1) ◽  
pp. 44-53
Author(s):  
Andri Priyoherianto ◽  
◽  
Panji Ratih Suci ◽  
Putri Rizki Cahya Fatimah ◽  
Atik Nur Wijayanti
Keyword(s):  
Blood Glucose ◽  
Blood Sugar ◽  
Water Hyacinth ◽  
Leaf Extract ◽  
Positive Control ◽  
Negative Control ◽  
Glucose Levels ◽  
Normal Limits ◽  
Blood Glucose Levels ◽  
Sugar Levels

Diabetes mellitus is a chronic metabolic disorder that occurs due to destruction of pancreatic ? cells characterized by blood glucose levels that exceed normal limits. The purpose of this study was to determine the therapeutic effect of the combination of water hyacinth leaf extract and Sintrong leaf in reducing blood glucose levels in alloxan-induced experimental animals. Water hyacinth leaf powder and Sintrong leaves were extracted using the maceration method with 70% ethanol as a solvent. A total of 25 mice were divided into 5 groups, namely negative control CMC-Na 0.5%, positive control glibenclamide 0.00065 mg / g BW, water hyacinth leaf extract 17.5 mg / kg BW, Sintrong leaf extract 10.5 mg/ kg BW and a combination of water hyacinth leaf extract 17.5 mg / kg BW and sintrong leaf 10.5 mg / kg BW. The results showed that a single extract of water hyacinth and Sintrong leaves was able to reduce blood sugar levels for 7 days. The combination dose was effective in reducing blood sugar levels with a combination dose of 17.5 mg/ kg water hyacinth leaf extract in combination for 7 days.

Effectiveness of Dry Extract Mahoni Seed Consumption on Blood Sugar Level in Diabetes Mellitus

2020 ◽  
Author(s):  
Ganda Ardiansyah ◽  
◽  
Henny Purwandari ◽  
Heni Prastika Damayanti ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Treatment Group ◽  
Blood Sugar ◽  
Complementary Therapy ◽  
Health Science ◽  
Control Group ◽  
Dry Extract ◽  
Glucose Levels ◽  
Patients With Diabetes ◽  
Sugar Levels

ABSTRACT Background: An increase in blood sugar levels caused diabetes mellitus, and various other health complications. One of the herbal therapy approaches can be used by consuming mahogany seeds which are believed to reduce blood glucose levels. The purpose of this study was to determine the effectiveness of consuming mahogany seeds to reduce blood sugar levels. Subjects and Method: This was a quasi-experiment with non-randomized control group pretest-posttest design conducted on March 24-26 2020. A sample of 22 respondents was divided into 2 groups: treatment group and control group selected by purposive sampling. The data was collected by observation. The data was analysed by Paired t-test. Results: The treatment group before consuming the dry extract of Mahogany seeds (Mean= 258.27; SD= 46.98), and after consuming the dry extract of Mahogany seeds (Mean= 185.36; SD= 38.85). In the control group, before consuming the extract of Mahogany seed ekring (Mean= 224.27; SD= 14.73), and after consuming Mahogany seed extract (Mean= 213.27; SD= 6.75). It was statistically significant (p= 0.001). Conclusion: Consumption of dry extract of Mahogany seeds effectively reduces blood sugar levels in patients with Diabetes Mellitus. Consumption of mahogany seeds can be used as a complementary therapy in nursing to reduce blood sugar. Keywords: Consumption of dry extract of Mahogany Seeds, Diabetes Mellitus. Correspondence: Ganda Ardiansyah. School of health science Satria Bhakti Nganjuk, East Java. Email: gandaa- [email protected] DOI: https://doi.org/10.26911/the7thicph.05.25

scholarly journals Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report and Review of Current Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Johnny F. Jaber ◽  
Matthew Standley ◽  
Raju Reddy
Keyword(s):  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Case Reports ◽  
Anion Gap ◽  
Fetal Mortality ◽  
Glucose Levels ◽  
Elevated Glucose ◽  
High Doses ◽  
Euglycemic Diabetic Ketoacidosis ◽  
In Pregnancy

Diabetic ketoacidosis (DKA) in pregnancy is associated with high fetal mortality rates. A small percentage of DKA occurs in the absence of high glucose levels seen in traditional DKA. Prompt recognition and management is crucial. We report a case of a 30-year-old pregnant woman with type 1 diabetes mellitus admitted with euglycemic DKA (blood glucose <200 mg/dL). Initial laboratory testing revealed a severe anion gap acidosis with pH 7.11, anion gap 23, elevated β-hydroxybutyric acid of 9.60 mmol/L, and a blood glucose of 183 mg/dL—surprisingly low given her severe acidosis. The ketoacidosis persisted despite high doses of glucose and insulin infusions. Due to nonresolving acidosis, her hospital course was complicated by spontaneous intrauterine fetal demise. Euglycemia and severe acidosis continued to persist until delivery of fetus and placenta occurred. It was observed that the insulin sensitivity dramatically increased after delivery of fetus and placenta leading to rapid correction of ketoacidosis. This case highlights that severe ketonemia can occur despite the absence of severely elevated glucose levels. We discuss the mechanism that leads to this pathophysiologic state and summarize previously published case reports about euglycemic DKA in pregnancy.

scholarly journals A Clinical Case of Clozapine-Induced Fatal Diabetic Ketoacidosis

2016 ◽  
Vol 7 ◽  
pp. CMPsy.S30532
Author(s):  
Eric Romney ◽  
Vinay J. Nagaraj ◽  
Amie Kafer
Keyword(s):  
Fatty Acids ◽  
Weight Gain ◽  
Free Fatty Acids ◽  
Diabetic Ketoacidosis ◽  
Ketone Bodies ◽  
Pancreatic Beta Cell ◽  
Metabolic Effects ◽  
Psychotic Symptoms ◽  
Life Threatening ◽  
Altered Metabolism

Introduction Clozapine, a second generation medication, has become the atypical antipsychotic drug of choice for refractory or treatment-resistant schizophrenia. In addition to the high risk of agranulocytosis and seizures, clozapine treatment is increasingly associated with significant metabolic effects, such as hyperglycemia, central weight gain and adiposity, hypertriglyceridemia, and elevated low-density lipoprotein cholesterol. A potentially life-threatening complication of altered metabolism is diabetic ketoacidosis (DKA). This report details a case of fatal DKA in a schizophrenic patient undergoing treatment with clozapine. Case Description An African–American male in his 20s with a medical history significant for schizophrenia was presented to the psychiatric inpatient ward with severe paranoid thoughts and aggressive behavior. After trials of risperidone, olanzapine, and haloperidol—all of which failed to adequately control his psychotic symptoms—clozapine titration was initiated and he showed significant improvement. Weight gain was observed throughout hospitalization, but all blood and urine test results showed no metabolic or hematological abnormalities. The patient was discharged for outpatient treatment on clozapine (125 mg morning and 325 mg evening) along with divalproex sodium and metoprolol. Six days post-discharge, the patient died. A medical autopsy later ruled that the death was due to DKA without any evidence of contributory injuries or natural disease. Results and Conclusion Significant increase in body mass index from 28.7 to 33.5 was observed during hospitalization. The blood glucose level, measured after his death, was found to be 500 mg/dL. Altered metabolism due to clozapine can lead to dyslipidemia-mediated-pancreatic-beta-cell damage, decreased insulin secretion as well as insulin resistance. In DKA, low levels of insulin lead to an increased release of free fatty acids from adipose tissue. Acetyl coenzyme A (CoA), derived from the breakdown of free fatty acids, is metabolized by the Kreb's cycle. In hepatocytes, excess acetyl-CoA is converted into ketone bodies (acetoacetate and β-hydroxybutyrate) and released into circulation. Ketone bodies have a low p Ka value and their high serum concentrations lead to DKA. In this patient, DKA was most probably clozapine induced and had fatal consequences. Thus, recognizing potential risk factors, providing patient education, and increasing monitoring of patients on clozapine and other atypical antipsychotics are critical to prevent the life-threatening effects of DKA.

scholarly journals THE EFFECTS OF CORN FLOUR WITH TEMPEH FLOUR SUPPLEMENTATION FEEDING IN DIABETES MELLITUS WISTAR RATS TOWARD BLOOD GLUCOSE LEVEL

2017 ◽  
Vol 4 (2) ◽  
pp. 24
Author(s):  
Fatifa Asmarani ◽  
Bambang Wirjatmadi ◽  
Merryana Adriani
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Sugar ◽  
Wistar Rats ◽  
Control Group ◽  
Standard Diet ◽  
Corn Flour ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Sugar Levels

Background: Diabetes mellitus (DM) is metabolic disorder syndrome characterized by hyperglycemia due to deficiency of insulin secretion. Patients of diabetic patients increases each year, so it needs proper handling. Corn flour is a source of carbohydrates with a low glycemic index to help reduce the rise in blood sugar levels. In addition, supplementation with tempeh flour containing isoflavones act to protect cells from free radical thereby inhibiting damage cells. Fiber in tempeh affect blood glucose levels because it slows the absorption of glucose.Objective: To determine the effect supplementation of corn flour with tempeh flour on blood sugar levels in diabetes mellitus Wistar rats.Methods: The study was true experimental design with Pre-posttest control group design, samples were 20 male Wistar rats aged 2-3 months were then divided into 4 groups (T0, T1, T2, T3.) T0 was injected with alloxan as 30 mg / 150 grams of BB rats are subsequently treated with standard diet; T1 was dministered by standard diet 50% + 50% corn flour; T2 was administered by standard diet 50% + 30% + corn flour tempeh flour 20%; and T3 was administered by standard diet of corn flour 50% + 15% + 35% tempeh flour for 2 weeks. Blood glucose levels were measured with a glucose kit (GOD FS). Research data were analyzed by One Way ANOVA followed by Tukey's Post Hoc test p-value <0.05.Results: There were significant differences on blood sugar levels in all groups (p = 0.000): control group (only dietary standards), T1 (administered by standard diet 50% + corn flour 50%), T2 (administered by a standard diet 50% + cornstarch 30% tempeh flour + 20%) and T3 (administered by standard diet of corn flour 50% + 15% + 35% tempeh flour).Conclusion: corn flour with tempeh flour supplementation effect on decresing of blood sugar levels.

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