No abstract available.
Eating ; Humans ; Ketosis

Humans ; Diabetes Mellitus ; Ketosis ; Magnetic Resonance Imaging

OBJECTIVES: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. METHODS: We measured urine NH' by enzymatic determination, UOG(=0.5 X [urine osmolality-{2 X (Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4+/-1.6mmol/L ) with AGMA. RESULTS: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p<0.05) in the acute(35.6+/-7.7mmol/L) than in the chronic(3.8+/-0.9mmol/L) group. The UOG was higher (p<0.05) in the acute(73.2+/-18.9mmol/L) than in the chronic(6.3+/-8.7mmol/L) group, but the UAG had no difference between the two groups. When both groups of the patients were considered together, urine NH concentration correlated with the UOG (r=0.90, p<0.01), but not with the UAG. While the patients with lower urine NH4+ excretion(<30mmol/d) had the UOG<40mmol/L, those with higher urine NH' excretion(>40mmol/d) had the UOG>40mmol/L. CONCLUSION: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.
Acid-Base Equilibrium* ; Acidosis* ; Ammonium Compounds* ; Humans ; Ketosis

Prurigo pigmentosa is a rare inflammatory dermatosis of unknown etiology characterized by recurrent, pruritic, erythematous papules with gross reticulate hyperpigmentation. The cause of prurigo pigmentosa is unknown. Exogenous factors, fasting, dieting, ketosis, diabetes mellitus and pregnancy have been reported to be associated with prurigo pigmentosa. We now present two cases of prurigo pigmentosa associated with dieting. These findings suggest that the ketosis produced by dieting may well contribute to the pathogenesis of prurigo pigmentosa.
Diabetes Mellitus ; Diet ; Fasting ; Hyperpigmentation ; Ketosis ; Pregnancy ; Prurigo* ; Skin Diseases

Morbidity and mortality are higher in diabetics undergoing surgery, which most often reflect various cardiovascular complications. Ketoacidosis is the most serious acute metabolic complications of diabetes perioperatively. Ketoacidosis has adverse effects such as decreased myocardial contractility and peripheral vascular tone, dehydration and electrolyte imbalances. We encountered a case of a 47 year-old man who presented with ketoacidosis and severe hypotension 15 minutes after being administered epidural anesthesia for femoro-popliteal arterial bypass surgery. This case highlights the need for anesthesiologists to consider the possibility that ketoacidosis can mimic severe hypotension due to epidural anesthesia or cardiogenic shock.
Anesthesia, Epidural* ; Dehydration ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Humans ; Hypotension* ; Ketosis ; Middle Aged ; Mortality ; Shock, Cardiogenic

Nausea and vomiting occur in up to 80% of normal pregnancies. Hyperemesis gravidarum, resulting in dehydration and ketonuria, is a more severe and disabling condition affecting up to 1.5% of pregnancies. This condition is poorly understood and treatment strategies remain largely supportive with the aims of relieving symptoms and preventing complications of the disease. Treatment is supportive with intravenous hydration, antiemetics and correction of vitamin deficiency to minimize complications. There are good data to support the safety and usefulness of some kinds of antiemetics such as antihistamine, phenothiazines metoclopromide and specific HHT3 antagonists in hyperemesis gravidarum. But there is little evidence on which to choose the optimum therapy. This review discusses the diagnosis and management of hyperemesis gravidarum and the prevention, recognition and treatment of the serious complication
Antiemetics ; Avitaminosis ; Dehydration ; Female ; Hyperemesis Gravidarum ; Ketosis ; Nausea ; Phenothiazines ; Pregnancy ; Vomiting

Alcoholic ketoacidosis is a serious metabolic abnormality that occurs in chronic alcoholics. We report a case of bilateral necrosis in the basal ganglia after alcoholic ketoacidosis in a 42-year-old female chronic alcoholics. Magnetic resonance imaging (MRI) of the patient suggested subacute infarction with subsequent necrosis of the basal ganglia, which matches with the patients neurological manifestations. Repeated alcoholic ketoacidosis in chronic alcoholics could be the cause of subacute infarction following necrotic changes in the basal ganglia.
Adult ; Alcoholics* ; Alcoholism ; Basal Ganglia* ; Female ; Humans ; Infarction ; Ketosis* ; Magnetic Resonance Imaging ; Necrosis ; Neurologic Manifestations

Mucormycosis is a relatively uncommon opportunistic fungal infection that occurs more commonly in patients with immunosuppression and diabets mellitus, particularly those with ketoacidosis. Successful therapy for rhinoorbital mucormycosis requires early diagnosis, correction of predisposing conditions, prompt use of amphotericin B, and aggressive surgical debridement. We experienced a 56-years-old poorly controlled diabetic woman with rhinoorbital mucormycosis that was successfully treated with intraconal amphotericin B irrigation and packing without exenteration.
Abscess* ; Amphotericin B* ; Debridement ; Drainage* ; Early Diagnosis ; Female ; Humans ; Immunosuppression ; Ketosis ; Mucormycosis*

BACKGROUND: Urine ketone test is commonly used to screen for diabetic ketoacidosis (DKA). Ketonuria also develops in patients with disease conditions other than DKA. However, the prevalence of DKA in patients with ketonuria is not known. We investigated the prevalence of ketonuria and characteristics of patients with ketonuria and estimated the prevalence of DKA among them to study the clinical significance of ketonuria as an indicator of DKA. METHODS: We studied 1,314 adult and 1,027 pediatric patients who underwent urinalysis. The prevalence of ketonuria in the different groups of patients, classified according to the types of their visits to the institution, was investigated, and the relationships between ketonuria and albuminuria, glycosuria, and bilirubinuria were evaluated. RESULTS: The overall prevalence of ketonuria was 9.1%. The prevalences of ketonuria in adult and pediatric patients were 4.3% and 15.2%, respectively. The prevalences of ketonuria were the highest in the adult (9.7%) and pediatric (28%) patients in the group that had visited the emergency department. Among patients with ketonuria, 7% adult and 3.8% pediatric patients showed glycosuria. CONCLUSIONS: This study showed that the prevalence of DKA in patients with ketonuria, defined as the simultaneous presence of ketone bodies and glucose in urine, was only 7%. Therefore, we concluded that ketonuria might be clinically significant as an indicator of acute or severe disease status rather than of DKA.
Adult ; Albuminuria ; Diabetic Ketoacidosis ; Emergencies ; Glucose ; Glycosuria ; Humans ; Ketone Bodies ; Ketosis ; Prevalence ; Urinalysis

Hypertriglyceridemia-induced acute pancreatitis in pregnancy is not a common complication. Moreover, ketoacidosis in gestational diabetes occurs rarely. Here we report a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes that was successfully treated with insulin and supportive care. In this case, a 36-year-old woman (at 32 weeks' gestation) was diagnosed with gestational diabetes 4 weeks prior, but did not have well controlled blood sugar. She complained of severe epigastric pain concomitant with nausea and vomiting. Radiology and laboratory tests found hypertriglyceridemia (1,996 mg/dL), acute pancreatitis, and ketoacidosis with absence of fetal deceleration on a non-stress test. The patient's condition improved with insulin therapy and fluid replacement. To our knowledge, this is the first report of a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes.
Adult ; Blood Glucose ; Deceleration ; Diabetes, Gestational ; Female ; Humans ; Hypertriglyceridemia ; Insulin ; Ketosis ; Nausea ; Pancreatitis ; Pregnancy ; Vomiting