No abstract available.
Eating ; Humans ; Ketosis

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

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

Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

Diabetic ketoacidosis (DKA) is one of the most serious acute metabolic complications of diabetes. The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA. Not all patients with ketoacidosis have DKA, and other situations can result in metabolic acidosis and ketonemia, like starvation ketosis, alcoholic ketoacidosis or ingestion of drugs such as salicylate, methanol, ethylene glycol. We report a case of acetone intoxication that was misdiagnosed as diabetic ketoacidosis.
Acetone ; Acidosis ; Alcoholics ; Diabetic Ketoacidosis ; Eating ; Ethylene Glycol ; Ethylenes ; Humans ; Hyperglycemia ; Ketosis ; Methanol ; Starvation

Diabetic ketoacidosis is an acute complication of diabetic mellitus. The most common triggering factors are infection, insulin therapy omission and the onset of the disease, but if these are excluded, other less frequent etiologic factors must be ruled out. We report a case of 22-year-old woman with Graves' disease presented as diabetic ketoacidosis. She was diagnosed type 1 diabetes mellitus at 13 years old and continually has been treated with insulin therapy until now. She typically showed tachycardia at rest in spite of correction of metabolic acidosis. Hyperthyroidism worsens glycemic control in diabetic patients and may precipitate diabetic ketoacidosis. Hyperthyroidism always should be investigated in diabetic patients presenting diabetic ketoacidosis without obvious triggering factors.
Acidosis ; Adolescent ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis* ; Female ; Graves Disease ; Humans ; Hyperthyroidism* ; Insulin ; Ketosis ; Tachycardia ; Young Adult

Sodium glucose cotransporter 2 (SGLT2) inhibitor has been recently reported of diabetic ketoacidosis due to accumulation of ketone bodies in patients with severe dehydration caused from such like diarrhea even though the patient had normal glucose level. This is a case of ketoacidosis in normal glucose level as production of ketone bodies is stimulated in liver with increased secretion of glucagon by stimulation of α cells in pancreas due to increase of lipolysis caused from reducing insulin and by SGLT2 inhibitor among patients who are under concurrent insulin and SGLT2 inhibitor. Thus, insulin dosage reduction requires caution in order to control blood glucose level on combined treatment of SGLT2 inhibitor in a patient who is administering insulin because the patient may be caused ketoacidosis in normal blood glucose level.
Blood Glucose ; Dehydration ; Diabetic Ketoacidosis* ; Diarrhea ; Glucagon ; Glucose* ; Humans ; Insulin* ; Ketone Bodies ; Ketosis ; Lipolysis ; Liver ; Pancreas ; Sodium*

Various structural lesions as well as metabolic derangements cause choreoballism. Hyperglycemia can induce diverse neurologic dysfunctions. There are few case reports of dyskinesias associated with hyperglycemia or diabetic ketoacidosis. A 19-year-old girl with insulin dependent diabetes mellitus presented with bilateral choreoballism. She had diabetic ketoacidosis. Her dyskinesia improved with control of high blood glucose and ketoacidosis. Though she had bilateral basal ganglia calcification, the chance of its contribution to dyskinesia was very slim. We advise physicians to keep in mind that treatable hyperglycemia can cause dyskinesia.
Basal Ganglia* ; Blood Glucose ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Dyskinesias ; Female ; Humans ; Hyperglycemia ; Insulin ; Ketosis ; Neurologic Manifestations ; Young Adult

Sodium-glucose cotransporter 2 inhibitors are antidiabetic drugs that increase urinary glucose excretion by inhibiting proximal tubular reabsorption of glucose in the kidney. Some sodium-glucose cotransporter 2 inhibitors have been shown to afford effective glycemic control and to decrease the risks of major adverse cardiovascular events. However, these drugs may increase the risk of diabetic ketoacidosis. This is a rare complication that occurs in less than 0.1% of treated patients with type 2 diabetes. The condition may be euglycemic, and is triggered by controllable precipitating factors such as surgery, infection, and insulin reduction or omission. It is important to understand individual patient profiles and to prevent diabetic ketoacidosis by appropriate prescribing, by withholding sodium-glucose cotransporter 2 inhibitors when indicated, and by counseling patients on sick day management.
Counseling ; Diabetic Ketoacidosis ; Glucose ; Humans ; Hypoglycemic Agents ; Insulin ; Ketone Bodies ; Ketosis* ; Kidney ; Precipitating Factors ; Sick Leave ; Sodium-Glucose Transporter 2