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Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion:A case report and review of literature

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World Journal of Clinical Cases 2021年第15期9卷 3787-3795页

作者： Yi-Chung Chen Su-Ju Tsai Department of Physical Medicine and Rehabilitation Chung Shan Medical University HospitalTaichung 40201Taiwan

BACKGROUND diabetic ketoacidosis(DKA)is a serious complication of type 1 diabetes mellitus(T1DM).Very rarely does DKA lead to cerebral edema,and it is even rarer for it to result in cerebral *** internal carotid artery occlusion(BICAO)is also rare and can cause fatal ***,case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very *** this study,we present a patient with BICAO,T1DM,hypertension,and hyperlipidemia,who had a catastrophic bilateral cerebral infarction after a DKA *** briefly introduce BICAO and the mechanisms by which DKA results in cerebral *** SUMMARY A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata,bilateral frontal lobe,and parietal lobe with right hemiplegia and Broca’s *** had a history of hypertension for 5 years,hyperlipidemia for 4 years,hyperthyroidism for 3 years,and T1DM for 31 *** first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery *** was admitted to our ward for rehabilitation due to prior stroke *** took place on hospital day *** hospital day 6,she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery *** weeks of aggressive treatment,she remained in a coma and on mechanical ventilation due to respiratory *** discussion with her family,compassionate extubation was performed on hospital day 29 and she *** DKA can lead to cerebral infarction due to several *** people with existing BICAO and several stroke risk factors such as hypertension, T1DM,hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.

关键词： Type 1 diabetes mellitus diabetic ketoacidosis Bilateral internal carotid artery occlusion Cerebral infarction Case report

Acute esophageal necrosis as a complication of diabetic ketoacidosis:A case report

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World Journal of Clinical Cases 2021年第31期9卷 9571-9576页

作者： Kasey Moss Tahrin Mahmood Robert Spaziani Department of Internal Medicine McMaster UniversityHamilton L8S 4L8OntarioCanada Division of Gastroenterology McMaster UniversityHamilton L8S 4L8OntarioCanada

BACKGROUND Acute esophageal necrosis(AEN)is a rare condition that has been associated with low volume states,microvascular disease,gastrointestinal(GI)mucosal damage,and impaired GI *** has been linked in case reports with diabetic ketoacidosis(DKA)and is commonly associated with GI bleeding(GIB).CASE SUMMARY We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric ***,there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset.A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist(GLP-1 RA),though they have not been previously connected to DKA or *** patient was subsequently treated with high dose proton pump inhibitors,GLP-1 RA was discontinued,and an insulin regimen was *** patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal *** This report highlights AEN in the absence of overt GIB,emphasizing the importance of early consideration of EGD.

关键词： Acute esophageal necrosis Gurvits syndrome Acute necrotizing esophagitis Black Esophagus diabetic ketoacidosis Glucagon-like peptide-1 receptor agonists

Predictors of acute gastrointestinal bleeding in diabetic ketoacidosis:a retrospective observational study in minority population

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Gastroenterology Report 2017年第4期5卷 293-297,I0002页

作者： Kanthi Rekha Badipatla Preeti Jadhav Sushma Vaddigiri Bharat Bajantri Amandeep Singh Chaitanya Chandrala Vijay S Are Suresh Kumar Nayudu Department of Medicine Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Gastroenterology Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Pulmonary and Critical Care Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Cardiology Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA

Background:diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical *** attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding(AGIB)and acute upper AGIB(AUGIB)in patients with ***:We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December *** collected demographic,clinical,laboratory,endoscopy and hospitalization details using an electronicmedical-record *** were divided into two groups based on the occurrence of gastrointestinal ***:A total of 234 patients with DKA were admitted during this period,of which 27(11.5%)patients had documented *** majority of patients had hematemesis(n=22,9.4%)except two had rectal and three had occult *** did not notice any difference in age,gender and ethnicity distribution between the two *** was no difference in the serum levels of electrolytes,anion gap,pH and hemoglobin A1C between the two ***,patients with AGIB had significantly higher initial blood glucose levels(738 vs 613 mg/dL,p=0.014).There was also increased mortality(7.4%vs 4.8%)in patients with AGIB,but this did not reach statistical ***:We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with *** also noted increased in-patient mortality in patients with DKA who had AGIB,even though statistically *** aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB,thereby reducing mortality during hospitalization in patients with DKA.

关键词： diabetic ketoacidosis gastrointestinal bleeding mortality

Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state

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World Journal of Clinical Cases 2022年第32期10卷 11702-11711页

作者： Esraa Mamdouh Hassan Hisham Mushtaq Esraa Elaraby Mahmoud Sherley Chhibber Shoaib Saleem Ahmed Issa Jain Nitesh Abbas B Jama Anwar Khedr Sydney Boike Mikael Mir Noura Attallah Salim Surani Syed A Khan Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States Medicine St.Vincent's Medical CenterBridgeportCT 06606United States Medicine College of MedicineUniversity of SharjahSharjah 27272United Arab Emirates Medicine Mercy Catholic Medical CenterDarbyPA 19025United States Medicine Mayo HospitalLahore 54000PunjabPakistan Medicine Medical University of the AmericasNevisWest Indies Medicine BronxCare Health SystemBronxNY 10457United States Medicine University of Minnesota Medical SchoolMinneapolisMN 55455United States Medicine&Pharmacology Texas A&M University Health Science CenterCollege StationTX 77843United States Anesthesiolgy Mayo ClinicRochesterMN 55905United States

diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and *** major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional *** has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom ***,there is a lack of large-scale studies that help define how hyperglycemic crises should be *** article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.

关键词： diabetic ketoacidosis Hyperosmolar Coma Diabetes Metabolic acidosis Hypernatremia Hyperosmolar hyperglycemia state

Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis

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World Journal of Diabetes 2023年第3期14卷 271-278页

作者： Adeel Ahmad Khan Fateen Ata Phool Iqbal Mohammed Bashir Anand Kartha Department of Endocrinology Hamad Medical CorporationDoha 00000Qatar Department of Medicine Metropolitan Hospital CenterNew YorkNY 10595United States Department of Medicine Hamad Medical CorporationDoha 00000Qatar

BACKGROUND diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is *** to the complexity of its management and the need for rigorous monitoring,many DKA patients are managed in the intensive care unit(ICU).However,studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient *** is,therefore,essential to identify suitable candidates for ICU care in DKA *** To evaluate factors that predict the requirement for ICU care in DKA *** This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation,Doha,Qatar,between January 2015 and March *** adult patients(>14 years)fulfilling the American Diabetes Association criteria for DKA diagnosis were *** We included 922 patients with DKA in the final analysis,of which 229(25%)were managed in the *** to non-ICU patients,patients admitted to ICU were older[mean(SD)age of 40.4±13.7 years vs 34.5±14.6 years;P<0.001],had a higher body mass index[median(IQR)of 24.6(21.5-28.4)kg/m2 vs 23.7(20.3-27.9)kg/m2;P<0.030],had T2DM(61.6%)and were predominantly males(69%vs 31%;P<0.020).ICU patients had a higher white blood cell count[median(IQR)of 15.1(10.2-21.2)×103/uL vs 11.2(7.9-15.7)×103/uL,P<0.001],urea[median(IQR)of 6.5(4.6-10.3)mmol/L vs 5.6(4.0-8.0)mmol/L;P<0.001],creatinine[median(IQR)of 99(75-144)mmol/L vs 82(63-144)mmol/L;P<0.001],C-reactive protein[median(IQR)of 27(9-83)mg/L vs 14(5-33)mg/L;P<0.001]and anion gap[median(IQR)of 24.0(19.2-29.0)mEq/L vs 22(17-27)mEq/L;P<0.001];while a lower venous pH[mean(SD)of 7.10±0.15 vs 7.20±0.13;P<0.001]and bicarbonate level[mean(SD)of 9.2±4.1 mmol/L vs 11.6±4.3 mmol/L;P<0.001]at admission than those not requiring ICU management of DKA(P<0.001).Patients in the ICU group had a longer LOS[median(IQR)of

关键词： diabetic ketoacidosis Type 1 diabetes mellitus Type 2 diabetes mellitus Intensive care unit Critical care outcomes Length of stay

Euglycemic diabetic ketoacidosis:A missed diagnosis

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World Journal of Diabetes 2021年第5期12卷 514-523页

作者： Prashant Nasa Sandeep Chaudhary Pavan Kumar Shrivastava Aanchal Singh Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of Endocrinology NMC Specialty HospitalDubai 7832United Arab Emirates Department of Internal Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse *** DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes *** the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has *** other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage *** pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin *** DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine *** diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic *** DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin *** dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia.

关键词： diabetic ketoacidosis Sodium/glucose co-transporter-2 inhibitors Pregnancy with diabetic ketoacidosis Diabetes complications Pregnancy in diabetes Ketosis Metabolic acidosis

Sodium-glucose Cotransporter-2 Inhibitors induced euglycemic diabetic ketoacidosis:A meta summary of case reports

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World Journal of Diabetes 2023年第8期14卷 1314-1322页

作者： Deven Juneja Prashant Nasa Ravi Jain Omender Singh Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of Internal Medicine College of Medicine and Health SciencesAl Ain 15551Abu DhabiUnited Arab Emirates Department of Critical Care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia

BACKGROUND Sodium-glucose cotransporter-2 inhibitors(SGLT2i)are commonly prescribed to manage patients with diabetes *** agents may rarely lead to the development of euglycemic diabetic ketoacidosis(EDKA),which may complicate the disease course of these *** To analyze the demographic profile,predisposing factors,symptomology,clinical interventions and outcomes of patients presenting with EDKA secondary to SGLT2i use by reviewing the published case reports and *** We performed a systematic search of PubMed,Science Direct,Google Scholar and Reference Citation Analysis databases using the terms“canagliflozin”OR“empagliflozin”OR“dapagliflozin”OR“SGLT2 inhibitors”OR“Sodium-glucose cotransporter-2”AND“euglycemia”OR“euglycemic diabetic ketoacidosis”OR“metabolic acidosis”.The inclusion criteria were:(1)Case reports or case series with individual patient details;and(2)Reported EDKA secondary to ***,the data were filtered from the literature published in the English language and on adults(>18 years).We excluded:(1)Conference abstracts;and(2)Case reports or series which did not have individual biochemical *** the case reports and case series were *** data extracted included patient demographics,clinical symptomatology,clinical interventions,intensive care unit course,need for organ support and *** Overall,108 case reports and 17 cases series with 169 unique patients that met all the inclusion criteria were *** majority of patients were females(54.4%,n=92),and the commonly reported symptoms were gastrointestinal(nausea/vomiting 65.1%,abdominal pain 37.3%)and respiratory(breathlessness 30.8%).One hundred and forty-nine(88.2%)patients had underlying type II diabetes,and the most commonly involved SGLT-2 inhibitor reported was empagliflozin(46.8%).A triggering factor was reported in most patients(78.7%),the commonest being acute severe infection(37.9%),which included patients with sepsis,coronavirus

关键词： Canagliflozin Empagliflozin Euglycemia Diabetes mellitus diabetic ketoacidosis Sodium-glucose cotransporter-2 inhibitors Sodium-glucose cotransporter-2

Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in COVID-19-infected patients: A systematic review of case reports

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World Journal of Clinical Cases 2023年第24期11卷 5700-5709页

作者： Anwar Khedr Hussam Al Hennawi Muhammed Khuzzaim Khan Aalaa Eissa Mikael Mir Ibtisam Rauf Jain Nitesh Salim Surani Syed Anjum Khan Department of Medicine Bronx Care Health SystemBronxNY 10457United States Department of Internal Medicine Jefferson Abington HospitalAbingtonPA 19001United States Department of Internal Medicine Dow University of Health ScienceKarachi 74200Pakistan Department of Medicine Kafrelsheikh UniversityKFS 33511Egypt Department of Medicine University of MinnesotaMinneapolisMN 55455United States Department of Medicine St.George’s UniversitySchool of MedicineSt.George SW170REGrenada Department of Critical Care Mayo Clinic Health SystemMankatoMN 56001United States Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States Department of Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States

BACKGROUND diabetic ketoacidosis(DKA)manifests as hyperglycemia,metabolic acidosis,and ***,euglycemic DKA(eu-DKA)conceals severe DKA with glucose levels below 200 mg/***-glucose cotransporter-2(SGLT2)inhibitors can induce eu-DKA in diabetic ***,coronavirus disease 2019(COVID-19)-infected individuals with diabetes using SGLT2 inhibitors face an augmented risk of eu-DKA due to the direct toxic impact of the virus on pancreatic *** study aims to comprehensively investigate the association between SGLT2 inhibitors and eu-DKA in COVID-19 patients through meticulous case report ***,we endeavor to examine the outcomes and treatment approaches for COVID-19-infected diabetics receiving SGLT2 inhibitors,providing indispensable insights for healthcare professionals managing this specific patient *** To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case *** We conducted an exhaustive search across prominent electronic databases,including PubMed,SCOPUS,Web of Science,and Google *** search encompassed the period from December 2019 to May 2022,incorporating published studies and *** search terms employed encompassed“SGLT2 inhibitors”,“euglycemic DKA”,“COVID-19”,and related *** incorporating these diverse sources,our objective was to ensure a thorough exploration of the existing literature on this subject,thereby augmenting the validity and robustness of our *** Our search yielded a total of seven case reports and one case series,collectively comprising a cohort of twelve *** reports detailed instances of eu-DKA in individuals with ***,all twelve patients were utilizing SGLT2 as their primary anti-diabetic *** admission,all oral medications were promptly discontinued,and the patients were initiated on intravenous insulin therapy to effectively ma

关键词： Sodium-glucose transporter 2 inhibitors COVID-19 SARS-CoV-2 diabetic ketoacidosis Euglycemic diabetic ketoacidosis Diabetes mellitus

Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report

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World Journal of Hepatology 2022年第11期14卷 1977-1984页

作者： Vitoria Mikaelly da Silva Gomes Gustavo de Sousa Arantes Ferreira Luise Cristina Torres Rubim de Barros Barbara Moreira Ribeiro Trindade dos Santos Lorenna Paulinelli Bahia Vieira Department of General Surgery Hospital das Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 30130100Minas GeraisBrazil Instituto de Cardiologia do Distrito Federal Brasilia 70673900Distrito FederalBrazil Department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and *** HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may *** are associated with disruption of microvasculature,such as in diabetic *** HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic *** SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic *** then developed jaundice,thrombocytopenia,and a marked elevation of serum *** ultrasound of the liver showed the presence of multiple irregular *** investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous *** lesions were considered highly suggestive of a primary neoplasm of the *** the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest *** results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated *** months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging *** This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.

关键词： Hepatic infarction Non-occlusive infarcts diabetic ketoacidosis Pseudotumor of the liver Liver infarcts Case report