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diabetic ketoacidosis with chronic kidney disease

Clement Lo, Tadashi Toyama, Ying Wang, Jin Lin, Yoichiro Hirakawa, Min Jun, Alan Cass, Carmel M Hawley, Helen Pilmore, Sunil V Badve, Vlado Perkovic, Sophia Zoungas
BACKGROUND: Diabetes is the commonest cause of chronic kidney disease (CKD). Both conditions commonly co-exist. Glucometabolic changes and concurrent dialysis in diabetes and CKD make glucose-lowering challenging, increasing the risk of hypoglycaemia. Glucose-lowering agents have been mainly studied in people with near-normal kidney function. It is important to characterise existing knowledge of glucose-lowering agents in CKD to guide treatment. OBJECTIVES: To examine the efficacy and safety of insulin and other pharmacological interventions for lowering glucose levels in people with diabetes and CKD...
September 24, 2018: Cochrane Database of Systematic Reviews
Dora E Izaguirre-Anariba, Felicia Chee, Zeyar Thet, Jesus Lanza
Mucormycosis is a rare and invasive fungal disease with high mortality rate caused by members of the order Mucorales. Mucorales species are vasotrophic organisms that may cause angioinvasive disease in immunosuppressed hosts. Risk factors include diabetic ketoacidosis, chronic kidney disease, organ or bone marrow transplantation, neutropenia, burns, malignancies, and steroid therapy. There are six different clinical presentations of mucormycosis, which includes rhino-orbital cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and miscellaneous infection...
2018: Case Reports in Infectious Diseases
Leyna Leite Santos, Fernando José Camello de Lima, Célio Fernando de Sousa-Rodrigues, Fabiano Timbó Barbosa
INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases in the world, with high morbidity and mortality rates, resulting in a greatly negative socioeconomic impact. Although there are several classes of oral antidiabetic agents, most of the patients are outside the therapeutic goal range. OBJECTIVE: To review the use of SGLT-2 inhibitors in the treatment of type 2 diabetes mellitus, focusing on their favorable and unfavorable effects, as well as on cardiovascular profile...
July 2017: Revista da Associação Médica Brasileira
Nobumasa Ohara, Ryo Koda, Hirofumi Watanabe, Noriaki Iino, Kazumasa Ohashi, Kenshi Terajima, Tetsutaro Ozawa, Yohei Ikeda, Hiroshi Sekiguchi, Hitomi Ohashi, Seigo Yamaguchi
A 65-year-old Japanese man with advanced chronic kidney disease (CKD) developed acute-onset type 1 diabetes mellitus (T1D) that was associated with severe acute kidney injury and was manifested by generalized tonic-clonic status epilepticus. His seizures resolved without recurrence after correcting the diabetic ketoacidosis. Although hyperglycemia is an important cause of acute symptomatic seizure (ASS), patients with ketotic hyperglycemia develop ASS less frequently. In this T1D case with CKD, severe hyperglycemia in conjunction with other metabolic insults, such as uremia, hyponatremia, and hypocalcemia, probably provoked his seizure despite the severe ketonemia...
2017: Internal Medicine
Anna C Iddings, Asha N Shenoi, Alba Morales Pozzo, Stefan G Kiessling
We report the unusual case of a 5-year-old male hospitalized for management of diabetic ketoacidosis (DKA) and new-onset type 1 diabetes mellitus (T1DM) who developed acute renal injury secondary to hemolytic uremic syndrome (HUS). He was diagnosed with Shiga toxin-producing entero-hemorrhagic <i>Escherichia coli</i> (EHEC) 0157:H7-positive HUS 48 hours after being diagnosed with new-onset T1DM/DKA. His hospital course was complicated by <i>Clostridium septicum</i> sepsis with colonic perforation...
April 2017: Clinical Nephrology
Ravi Varma, Mahzuz Karim
Diabetic ketoacidosis (DKA) is a common medical emergency. The pathophysiology of DKA in patients with advanced chronic kidney disease differs significantly from patients with preserved renal function. We describe a patient with pre-dialysis renal failure who presented with DKA. This case highlights the importance of tailoring the established management guidelines appropriately.
August 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
André J Scheen
INTRODUCTION: Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) offer a new opportunity for the management of type 2 diabetes mellitus. These agents reduce hyperglycemia by decreasing the renal glucose threshold and thereby increasing urinary glucose excretion. Subsequent reduction of glucotoxicity improves beta-cell sensitivity to glucose and tissue insulin sensitivity. AREAS COVERED: This article analyzes the efficacy and safety data of canagliflozin, dapagliflozin and empagliflozin in randomized controlled trials of 24 - 104 weeks duration, compared with placebo or an active comparator, in patients treated with diet/exercise, metformin, dual oral therapy or insulin...
2015: Expert Opinion on Drug Safety
Katie Bennett
The management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research.
October 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
S Wolowacz, I Pearson, P Shannon, B Chubb, J Gundgaard, M Davies, A Briggs
AIMS: To develop a health economic model to evaluate the cost-effectiveness of new interventions for Type 1 diabetes mellitus by their effects on long-term complications (measured through mean HbA1c ) while capturing the impact of treatment on hypoglycaemic events. METHODS: Through a systematic review, we identified complications associated with Type 1 diabetes mellitus and data describing the long-term incidence of these complications. An individual patient simulation model was developed and included the following complications: cardiovascular disease, peripheral neuropathy, microalbuminuria, end-stage renal disease, proliferative retinopathy, ketoacidosis, cataract, hypoglycemia and adverse birth outcomes...
August 2015: Diabetic Medicine: a Journal of the British Diabetic Association
María M Adeva-Andany, Carlos Fernández-Fernández, David Mouriño-Bayolo, Elvira Castro-Quintela, Alberto Domínguez-Montero
Metabolic acidosis occurs when a relative accumulation of plasma anions in excess of cations reduces plasma pH. Replacement of sodium bicarbonate to patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis is useful, but there is no definite evidence that sodium bicarbonate administration to patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, is beneficial regarding clinical outcomes or mortality rate...
2014: TheScientificWorldJournal
Subhash Popli, Yijuan Sun, Hon-Lok Tang, Carl M Kjellstrand, Antonios H Tzamaloukas, Todd S Ing
BACKGROUND: Extreme hyperglycemia (serum glucose ≥ 800 mg/dL or 44.4 mmol/L) is infrequently associated with impaired consciousness in patients on maintenance dialysis. The purpose of this study was to determine features of extreme hyperglycemia that bring about coma in dialysis patients who do not have any of the potential conditions, other than hyperglycemia, that can affect the sensorium. METHODS: We analyzed 24 episodes of extreme dialysis-associated hyperglycemia in men who did not have neurological disease or sepsis...
December 2013: International Urology and Nephrology
Arnold J Felsenfeld, Barton S Levine
Hypophosphatemia can be acute or chronic. Acute hypophosphatemia with phosphate depletion is common in the hospital setting and results in significant morbidity and mortality. Chronic hypophosphatemia, often associated with genetic or acquired renal phosphate-wasting disorders, usually produces abnormal growth and rickets in children and osteomalacia in adults. Acute hypophosphatemia may be mild (phosphorus level, 2-2.5 mg/dL), moderate (1-1.9 mg/dL), or severe (<1 mg/dL) and commonly occurs in clinical settings such as refeeding, alcoholism, diabetic ketoacidosis, malnutrition/starvation, and after surgery (particularly after partial hepatectomy) and in the intensive care unit...
October 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jeffrey A Kraut, Shelly Xiaolei Xing
An increase in serum osmolality and serum osmolal gap with or without high-anion-gap metabolic acidosis is an important clue to exposure to one of the toxic alcohols, which include methanol, ethylene glycol, diethylene glycol, propylene glycol, or isopropanol. However, the increase in serum osmolal gap and metabolic acidosis can occur either together or alone depending on several factors, including baseline serum osmolal gap, molecular weight of the alcohol, and stage of metabolism of the alcohol. In addition, other disorders, including diabetic or alcoholic ketoacidosis, acute kidney injury, chronic kidney disease, and lactic acidosis, can cause high-anion-gap metabolic acidosis associated with an increased serum osmolal gap and therefore should be explored in the differential diagnosis...
September 2011: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
H A Chakkera, J K Bodner, R L Heilman, D C Mulligan, A A Moss, K L Mekeel, M J Mazur, K Hamawi, R M Ray, G L Beck, K S Reddy
BACKGROUND: Earlier studies reporting outcomes after pancreas transplantation have included a combination of C-peptide cutoffs and clinical criteria to classify type 2 diabetes mellitus (T2DM). However, because the kidney is the major site for C-peptide catabolism, C-peptide is unreliable to discriminate the type of diabetes in patients with kidney disease. METHODS: To improve the discriminative power and better classify the type of diabetes, we used a composite definition to identify T2DM: presence of C-peptide, negative glutamic acid decarboxylase antibody, absence of diabetic ketoacidosis, and use of oral hypoglycemics...
September 2010: Transplantation Proceedings
Biff F Palmer
Hyperkalemia generally is attributable to cell shifts or abnormal renal potassium excretion. Cell shifts account for transient increases in serum potassium levels, whereas sustained hyperkalemia generally is caused by decreased renal potassium excretion. Impaired renal potassium excretion can be caused by a primary decrease in distal sodium delivery, a primary decrease in mineralocorticoid level or activity, or abnormal cortical collecting duct function. Excessive potassium intake is an infrequent cause of hyperkalemia by itself, but can worsen the severity of hyperkalemia when renal excretion is impaired...
August 2010: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Arvin Gupta, Mark Rohrscheib, Antonios H Tzamaloukas
A patient on hemodialysis for end-stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO(2) 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters...
October 2008: Hemodialysis International
Amado Andrés Belmonte
The strict control of glycaemia in the diabetic patient prevents severe long-term complications of diabetes. The most effective physiological method to control glycaemia in the type 1 diabetes patient is pancreas or pancreatic islet transplant. However, these types of transplants require chronic immunosuppressant treatment that leads to short and long term complications and are reserved for type 1 diabetic patients with life threatening complications (frequent unexplained ketoacidosis or hypoglycaemias). With regards to type 1 diabetics with end-stage nephropathy, simultaneous pancreas-kidney transplant has excellent results and makes it possible for the patient to be insulin and dialysis free...
July 2004: EDTNA/ERCA Journal
Elias S Siraj, Jonathan Myles, Saul Nurko, Adi E Mehta, S Sethu K Reddy
OBJECTIVE: To describe an unusual case of development of diabetes mellitus (DM) several years after manifestation of diabetic nephropathy and to review the related literature. METHODS: We present a case report, including detailed laboratory and pathologic findings in a 51-year-old man who was diagnosed as having DM several years after presenting with diabetic nephropathy. The pertinent literature is also reviewed. RESULTS: A 51-year-old African American man presented with proteinuria of 4 g/24 h...
July 2003: Endocrine Practice
Nada Mladina, Esad Brigic, Belkisa Colić, Mensur Hadzibeganović
The dynamic metabolism as far as bigger amount of water versus solid tissues in child demand much better skilfulness in calculating liquid input and excretion in intensive care. It is very important fact in prevention of life threatening conditions in children and adults, especially in conditions with multiorganic disorders, because their treatment is reciprocally opposite. Considering experiences of ICU UZ Gent-Belgium we made in Paediatric intensive care unit at Paediatric clinic in Tuzla unique method of monitoring liquid balance in children within specific conditions in which standard method of monitoring just the amount of planed liquid, body weight and diuresis is not reliable enough...
2002: Medicinski Arhiv
M J Cawley
A 34-year-old woman with a history of renal insufficiency induced by long-term cocaine use was admitted with acute shortness of breath remarkable for submandibular and anterior throat swelling. She required intubation, mechanical ventilation, and sedation. Sedation was administered with daily infusions of intravenous lorazepam 65, 313, and 305 mg for 3 days, respectively. Forty-eight hours into the infusion the patient experienced anion gap metabolic acidosis with hyperlactatemia, hyperosmolality, and increased osmolal gap...
September 2001: Pharmacotherapy
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