Diabetes tipo 1 en pediatría durante la pandemia por COVID-19: tiempo de evolución de síntomas y formas de presentación en un centro de referencia / Type 1 diabetes in pediatrics during the COVID-19 pandemic: Time from symptom onset and forms of presentation at a referral hospital

Introducción. La pandemia por COVID-19 afectó la atención de pacientes con diabetes mellitus tipo 1 (DM1). Además, se reportó un aumento de cetoacidosis diabética (CAD) como forma de diagnóstico. Objetivos. Evaluar si durante la pandemia por COVID-19 se modificaron el tiempo de evolución de síntomas, las causas de hospitalización por DM1 y la proporción de formas graves, y describir la infección por SARS-CoV-2 en estos pacientes. Población y métodos. Estudio transversal que incluyó pacientes menores de 19 años hospitalizados por DM1 en un centro pediátrico de referencia de marzo de 2018 a agosto de 2019 (prepandemia) y de marzo de 2020 a agosto de 2021 (pandemia). Resultados. Se analizaron 231 internaciones, 135 prepandemia y 96 en pandemia. Los pacientes con debut diabético presentaron menor tiempo de evolución de síntomas en pandemia que en prepandemia (18,8 ± 10,2 vs. 52,1 ±12,1 días, respectivamente; p <0,001). Las hospitalizaciones por todas las formas de debut diabético y el debut con CAD fueron más frecuentes en pandemia que en prepandemia (59,4 % vs. 39,3 %; OR 2,3; IC95% 1,3-3,8; p = 0,003); y (40,6 % vs. 20,7 %; OR 2,6; IC95% 1,4-5,2; p = 0,006) respectivamente. La proporción de formas graves de CAD no se modificó entre ambos períodos (48,1 % vs. 59,9 %; p = 0,3). Solo 6 pacientes presentaron infección por SARS-CoV-2; 3 fueron formas graves. Conclusión. Durante la pandemia, disminuyó el tiempo de evolución de síntomas y aumentó la frecuencia de hospitalizaciones por debut de DM1, con mayor proporción de CAD. No se modificó la proporción de formas graves de CAD

Introduction. The COVID-19 pandemic impacted on the health care of patients with type 1 diabetes mellitus (DM1). An increase in diabetic ketoacidosis (DKA) as a form of diagnosis was reported. Objectives. To assess whether there were changes in the time from symptom onset, the causes of hospitalization due to DM1, and the proportion of severe forms, and to describe SARS-CoV-2 infection in these patients. Population and methods. Cross-sectional study in patients younger than 19 years hospitalized due to DM1 from March 2018 to August 2019 (pre-pandemic) and from March 2020 to August 2021 (pandemic). Results. The assessment included 135 hospitalizations in the pre-pandemic period and 96 during the pandemic. The time from symptom onset during the pandemic in those with debutof diabetes was shorter than in the pre-pandemic period (18.8 ± 10.2 versus 52.1 ± 12.1 days, respectively; p < 0.001). Hospitalizations due to all forms of diabetes debut and debut with DKA were more common during the pandemic than before it (59.4% versus 39.3%; odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3­3.8; p = 0.003 and 40.6% versus 20.7%; OR: 2.6; 95% CI: 1.4­5.2; p = 0.006, respectively). Severe forms of DKA did not change between both periods (48.1% versus 59.9%; p = 0.3). Only 6 patients developed SARS-CoV-2 infection; 3 were severe. Conclusion. During the pandemic, the time from symptom onset decreased and the frequency of hospitalizations due to debut of DM1 increased. The proportion of severe forms of DKA did not change.

Estudio de casos y controles sobre factores asociados a crisis hiperglucémicas en adultos diabéticos atendidos en la unidad de emergencia de un hospital general de Lima / Case-Control study on factors associated with hyperglycemic crises in diabetic adults attended in the emergency unit of a general hospital in Lima

RESUMEN Introducción: La diabetes mellitus representa un desafío significativo para la salud pública; las crisis hiperglucémicas son complicaciones serias que pueden resultar en morbilidad o muerte. Objetivo: Establecer factores asociados a las crisis hiperglucémicas (CH) en adultos diabéticos atendidos en un hospital de Lima. Métodos: Se realizó un estudio observacional, retrospectivo y analítico de casos y controles en un Hospital General de Lima entre 2015 y 2019. Se seleccionaron 186 historias clínicas (62 casos y 124 controles) mediante muestreo aleatorio simple. El desenlace fueron las CH, definidas como cetoacidosis diabética, el estado hiperosmolar hiperglucémico y el estado mixto. Las variables incluyeron edad, sexo, zona de residencia, seguro de salud, tiempo de enfermedad, comorbilidades, infecciones agudas y adherencia a la medicación. Los datos se analizaron con pruebas de Chi Cuadrado y la prueba exacta de Fisher, calculando Odds Ratios crudos (ORc) y ajustados (ORa). Resultados: En el análisis bivariado los factores que se asociaron con las CH fueron; el sexo (p=0,029), edad (p<0,001), tiempo de enfermedad (p=0,001) y adherencia a la medicación (p<0,001). No se halló relación con las variables residencia, seguro de salud, procesos infecciosos agudos y comorbilidades (p>0,05). En el análisis multivariado los factores asociados a las CH fueron la edad (ORa: 2,85; IC95%: 1,41-5,79; p=0,004) y la no adherencia a la medicación (ORa: 3,87; IC95%: 1,84-8,18; p<0,001). Conclusión: Los factores asociados a las CH son la edad y la no adherencia a la medicación.

ABSTRACT Introduction: Diabetes mellitus represents a significant public health challenge; hyperglycemic crises are serious complications that can result in morbidity or death. Objective: To establish factors associated with hyperglycemic crises (HC) in diabetic adults attended in a hospital in Lima. Methods: An observational, retrospective, and analytical case-control study was conducted in a General Hospital in Lima between 2015 and 2019. A total of 186 medical records (62 cases and 124 controls) were selected through simple random sampling. The outcome was HC, defined as diabetic ketoacidosis, hyperosmolar hyperglycemic state, and mixed state. The variables included age, sex, area of residence, health insurance, duration of disease, comorbidities, acute infections, and medication adherence. Data were analyzed using Chi-Square tests and Fisher's exact test, calculating crude (cOR) and adjusted (aOR) Odds Ratios. Results: In the bivariate analysis, factors associated with HC were sex (p=0.029), age (p<0.001), duration of disease (p=0.001), and medication adherence (p<0.001). No relationship was found with variables such as residence, health insurance, acute infectious processes, and comorbidities (p>0.05). In the multivariate analysis, factors associated with HC were age (aOR: 2.85; 95% CI: 1.41-5.79; p=0.004) and non-adherence to medication (aOR: 3.87; 95% CI: 1.84-8.18; p<0.001). Conclusion: Factors associated with HC are age and non-adherence to medication.

Causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico Nacional - Hospital Nacional / Precipiting causes of acute hyperglycemic crisis in patients in the Centro Médico Nacional - Hospital Nacional

Introducción: las crisis hiperglicémicas agudas son las emergencias endocrinológicas más frecuentes en la práctica clínica y junto a la hipoglucemia se las describe como las complicaciones metabólicas agudas graves del paciente diabético. Objetivo: identificar las causas precipitantes de crisis hiperglicémicas agudas en pacientes internados en el Centro Médico - Hospital Nacional. Metodología: estudio observacional, descriptivo, de corte transversal de pacientes internados en el Centro Médico Hospital Nacional, durante el periodo de mayo 2021 a octubre del 2023. Los datos fueron obtenidos con la revisión de las fichas clínicas. Resultados: de los 100 pacientes evaluados, la crisis hiperglicémica aguda más frecuente fue la Cetoacidosis diabética (CAD) 53 %, seguida del Estado hiperosmolar hiperglicémico (EHH) 25 % y el estado mixto 22 %. Los desencadenantes más frecuentes fueron el abandono del tratamiento, debut de la enfermedad e infecciones. La mortalidad global fue del 12 %. Conclusión: la causa más frecuente de descompensación fueron el abandono del tratamiento, la diabetes de novo y procesos infecciosos.

Introduction: hyperglycemic crises are the most frequent endocrinological emergencies in clinical practice and, along with hypoglycemia, are described as serious acute metabolic complications in diabetic patients. Objective: to identify the precipiting causes of acute hyperglycemic crisis in hospitalized patients in the Centro Médico Nacional - Hospital National. Methodology: this was an observational, descriptive, cross -sectional study of patients hospitalized at the Centro Médico Nacional - Hospital National, from May 2021 to October 2023. The data were obtained from a review of the clinical records. Results: Of the 100 patients evaluated, the most frequent acute hyperglycemic crisis was diabetic ketoacidosis (CAD) 53 %, followed by the hyperglycemic hyperosmolar state (EHH) 25 % and the mixed state 22 %. The most frequent triggers were the abandonment of treatment, disease debut and infections. Global mortality was 12 %. Conclusion: the most frequent causes of decompensations were abandoning treatment, novo diabetes and infectious processes.

Research progress on inducement and pathogenesis of euglycemic diabetic ketoacidosis / 重庆医学

Euglycemic diabetic ketoacidosis(euDKA)is a rare acute metabolic disorder syndrome,its characteristics include metabolic acidosis with a high anion gap,positive ketones in blood or urine,and blood glucose＜13.9 mmol/L.Due to low blood sugar level,euDKA is easy to be missed or delayed treatment in clinical work,resulting in serious consequences.In recent years,many cases of euDKA have been reported,but its inducements and pathogenesis are not fully understood.This article reviews the common inducements and pathogenesis of euDKA.

Clinical features of rhino-orbital-cerebral mucormycosis with bilateral cranial nerves paralyze as the clinical manifestation(report of one case) / 临床神经病学杂志

Objective To investigate the clinical features of rhino-orbital-cerebral mucormycosis(ROCM)with bilateral cranial nerve palsies as the clinical manifestation.Methods The related clinical data about ROCM with bilateral cranial nerve palsy as a clinical manifestation was collected,analyzed as well as discussed in the manuscript.And the relevant literatures were reviewed.Results This patient was a healthy young man with new-onset diabetes and diabetic ketoacidosis.The patient developed rapidly with acute onset,bilateral blindness,blepharoptosis and extraocular muscle paralysis.The presence of mucormycosis was confirmed by CSF second-generation sequencing,fungal fluorescent staining and culture.Although effective antifungal therapy was performed early,but the patient quickly presented with cerebral hemorrhage and herniation.Eventually,the patient died after discharge.Conclusions ROCM is a rare and high-mortality infectious disease.This case indicated that the clinicians should consider the presence of ROCM in patients with diabetes/diabetic ketoacidosis when the bilateral cranial nerves paralysis are the clinical symptom,whicn can not be explained by other lesions.CSF next-generation sequencing is helpful for rapid diagnosis.

Case analysis of abnormal increase in blood glucose after targeted combination chemotherapy in a patient with colon cancer / 药物流行病学杂志

This article introduced a case of colon cancer patient who developed abdominal pain with nausea and vomiting after two cycles of using bevacizumab combined with fluorouracil.The perfect examination founded that the blood sugar rose abnormally to 40 mmol·L-1,the pH of blood gas was 7.24,the actual bicarbonate was 4 mmol·L-1,ketone body 3+,and urine sugar 3+.It was judged as mild diabetes ketoacidosis.After a large amount of fluid infusion,insulin treatment,and dual insulin treatment,The patient's blood gas analysis,ketone bodies,and urine sugar have all been normal,and their fasting blood sugar is controlled at 8.6 mmol·L1.The patient's condition was stable while long term use of insulin aspart was necessary.According to the association evaluation method of the National ADR Monitoring Center,the author evaluated the association of diabetes ketoacidosis,and assessed that diabetes ketoacidosis"may"be caused by the combined use of bevacizumab and fluorouracil.Through consulting domestic and foreign literature,the author analyzed and summarized tumor related glucose metabolism abnormalities,realized that abnormal blood glucose caused by chemotherapy drugs or chemotherapy adjuvant drugs can not be ignored,especially in tumor patients with diabetes history or pre diabetes.Hope the analysis can provide a certain reference for similar reactions.

Rare and severe adverse reaction diabetic ketoacidosis induced by bevacizumab：one case report / 中国药房

OBJECTIVE To provide reference for the safe use of bevacizumab in cancer patients. METHODS The diagnosis and treatment of a 65-year-old female lung adenocarcinoma patient with diabetic ketoacidosis （DKA） induced by bevacizumab was retrospectively analyzed， and the possible mechanisms and causes were analyzed based on literature review. RESULTS & CONCLUSIONS The diagnosis and treatment process of patients were analyzed， and DKA caused by other drugs and disease factors were excluded. DKA was considered to be caused by the use of bevacizumab according to Naranjo’s ADR evaluation scale； the acidosis of the patient improved rapidly after one hemodialysis treatment. DKA caused by bevacizumab is rare in clinic， clinicians should be aware that bevacizumab may affect pancreatic function and induce DKA， and early detection and treatment should be achieved to improve the prognosis.

Acute pancreatitis complicated with diabetic ketoacidosis following COVID-19 mRNA vaccination: a case report / Journal of Rural Medicine

Objective: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination has substantially reduced mortality and hospitalization rates worldwide, with rare adverse events reported in clinical settings. Herein, we present a case of acute pancreatitis complicated by diabetic ketoacidosis (DKA) following the third COVID-19 vaccination dose.Patient: A 72-year-old male with a history of diabetes mellitus developed generalized fatigue, mild epigastric pain, nausea, and frequent vomiting after receiving the COVID-19 vaccine.Results: Blood analysis revealed elevated levels of pancreatic enzymes, hyperglycemia, and acidemia. Computed tomography revealed evidence of acute pancreatitis, leading to a diagnosis of both DKA and acute pancreatitis. Treatment with a large volume of saline and intravenous insulin improved both DKA and acute pancreatitis. After a thorough examination, no other factors capable of causing acute pancreatitis were identified. Hence, we concluded that acute pancreatitis was induced by COVID-19 vaccination.Conclusion: Acute pancreatitis is a rare but potentially life-threatening adverse event associated with COVID-19 vaccination. Delaying the treatment or diagnosis of acute pancreatitis can increase mortality risk in patients with both acute pancreatitis and DKA. Hence, it is crucial for healthcare professionals to consider the potential occurrence of acute pancreatitis and DKA following COVID-19 vaccination.

A Case of Type 2 Diabetes with Ipragliflozin Administration Developing Euglycemic Diabetic Ketoacidosis Due to Reduced Food Intake Following Colonoscopy / 日本プライマリ・ケア連合学会誌

The patient was an 80-year-old woman with type 2 diabetes mellitus taking ipragliflozin. She underwent a colonoscopy one week prior to admission. After the colonoscopy, she felt exhausted and lost her appetite. On the day of admission, she was admitted to the emergency department because of abdominal pain and repeated vomiting. Physical examination and chest and abdominal CT were performed; however, no cause was identified for the abdominal pain or vomiting. Blood gas analysis showed high anion gap metabolic acidosis. Serum ketones were elevated to 6,045/μL and plasma glucose concentration was 182 mg/dL. We diagnosed ipragliflozin-induced euglycemic diabetic ketoacidosis (euDKA) and discontinued the drug. Ketoacidosis improved with administration of intravenous fluids and insulin injections. Her abdominal pain and vomiting improved. It is important to recognise that patients taking SGLT2 inhibitors may develop euDKA, as in this case, due to fasting after colonoscopy or reduced food intake after the procedure, and to discontinue SGLT2 inhibitors at least 2 days before the procedure.

Cetoacidosis diabética secundaria a inmunoterapia / Diabetic ketoacidosis secondary to immunotherapy

Resumen Los inhibidores de puntos de control inmune (ICIs) son anticuerpos monoclonales cada vez más utilizados en tratamientos oncológicos. A medida que aumenta la experiencia en el uso de inmunoterapia, se conoce cada vez más su perfil de seguridad y los efectos adversos inmunomediados. Entre ellos se encuentra la cetoaci dosis diabética (CAD), complicación infrecuente, grave y potencialmente mortal. En este trabajo describimos los casos de tres pacientes que se presentaron con episo dios de CAD durante el tratamiento con ICIs, dos de los cuales manifestaron con formas fulminantes, llevando un curso agudo con valores de hemoglobina glicosilada inicialmente normales. Asimismo, realizamos una revi sión de la literatura sobre la CAD asociada a ICIs a fines de resaltar la importancia de advertir estas complica ciones potencialmente fatales e instaurar rápidamente la terapéutica apropiada.

Abstract Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that are increasingly used in cancer treat ments. As experience in the use of immunotherapy increases, more is known about its safety profile and immune-mediated adverse effects. Among them is dia betic ketoacidosis (DKA), a rare but serious fatal compli cation of treatment. In this paper we describe the cases of three patients who presented with episodes of DKA during treatment with ICIs, two of which manifested with fulminant forms, leading to an acute course with initially normal glycosylated hemoglobin values. In ad dition, we conducted a review of the literature on DKA associated with ICIs in order to highlight the importance of noticing these potentially fatal complications and promptly establishing appropriate therapy.

Caracterización de las complicaciones intrahospitalarias de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional de Itauguá, Paraguay, en 2015-2022

Introducción: las complicaciones más graves de la diabetes mellitus son la cetoacidosis diabética y el estado hiperglucémico hiperosmolar, muchas veces se observan alteraciones clínicas y laboratoriales que abarcan los dos espectros y que denominamos estado mixto, representan cerca del 50% de las hospitalizaciones en el servicio de urgencias en pacientes diabéticos. Objetivo: determinar las complicaciones intrahospitalarias y los desenlaces de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional, Itauguá, Paraguay, en el periodo 2015-2022. Metodología: se aplicó un diseño de cohortes retrospectivas. Se seleccionaron pacientes con diagnósticos de diabetes mellitus tipo 1 y tipo 2, mayores de 18 años, de ambos sexos, agrupados en tres cohortes que corresponden a cada una de las descompensaciones agudas de la diabetes mellitus. La muestra estuvo conformada por 180 pacientes distribuidos en tres grupos de cohortes con 60 pacientes cada una. Resultados: 51% correspondió al sexo masculino. Se halló mayor desarrollo de eventos cardiovasculares, infecciones intrahospitalarias, requerimiento de cuidados intensivos y mortalidad en la cohorte con estado hiperosmolar. Conclusión: la cohorte con estado hiperosmolar hiperglucémico se caracterizó por la mayor cantidad de complicaciones.

Introduction: The most serious complications of diabetes mellitus are diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Clinical and laboratory alterations are often observed that cover both spectrums and which we call a mixed state. They represent close to 50% of hospitalizations in the service. of emergencies in diabetic patients. Objective: To determine in-hospital complications and outcomes of hyperglycemic states in adult patients admitted to the Hospital Nacional, Itauguá, Paraguay, in the period 2015-2022. Methodology: A retrospective cohort design was applied. Male and female patients with diagnoses of type 1 and type 2 diabetes mellitus, who were over 18 years of age, were selected and grouped into three cohorts that corresponded to each of the acute decompensations of diabetes mellitus. The sample was made up of 180 patients distributed into three cohort groups with 60 patients each. Results: Fifty one percent were male. A greater development of cardiovascular events, hospital-acquired infections, intensive care requirements and mortality were found in the cohort with hyperosmolar state. Conclusion: the cohort with hyperglycemic hyperosmolar state was characterized by the highest number of complications.

The effect of serum biochemical parameters on clinical prognosis in children presenting with diabetic ketoacidosis

SUMMARY OBJECTIVE: The aim of this study was to determine whether diabetes mellitus has a high risk of diabetic ketoacidosis-related complications. Biochemical parameters affect the resolution time of diabetic ketoacidosis. METHODS: The present study is based on a retrospective evaluation of the records of patients who presented to the Pediatrics Clinic of Adiyaman University Hospital between January 1, 2017, and October 1, 2022, with a diagnosis ofdiabetic ketoacidosis. The demographic characteristics, serum biochemical parameters, blood gas results, and time to transition to subcutaneous insulin therapy were all recorded. RESULTS: This study included 49 (49%) female and 51 (51%) male patients aged 1-17 years (mean age: 9.05±4.33 years). The average time to clinical improvement of the sample, that is, transition to subcutaneous insulin therapy, was 21.04±7.8 h. An evaluation of the presence of acute kidney injury based on serum urea and creatinine levels and eGFR values revealed no significant effect on the rate of clinical recovery (respective p-values: p=0.076, p=0.494, and p=0.884). A univariate analysis identified blood glucose (p=0.025), blood gas pH (p<0.001), and blood bicarbonate (p=0.004) values as prognostic factors, while a multivariate analysis revealed pH values had an independent and significant effect on the resolution time of diabetic ketoacidosis. CONCLUSION: Serum glucose, pH, and bicarbonate levels are the most important determinants of clinical prognosis in patients with diabetic ketoacidosis. These findings can serve as a guide for clinicians in the follow-up and treatment of such patients.

Diabetes mellitus tipo 1 de presentación súbita inducida por inhibidores del punto de control inmunitario en el tratamiento de cáncer avanzado. Serie de casos / Sudden onset type 1 diabetes mellitus induced by immune checkpoint inhibitors in the treatment of advanced cancer. Cases report

Tres pacientes con cáncer avanzado en tratamiento con inhibidores del punto de control inmunitario (inmune checkpoint inhibitors, ICIs), sin antecedentes de diabetes mellitus (DM), ingresaron al Servicio de Urgencias con poliuria, polidipsia y pérdida de peso, y diagnóstico de cetoacidosis diabética, sin evidencia clínica de infección. Fueron tratados con líquidos e infusión de insulina pasando luego a un régimen de insulina bolo basal que continuó después del alta. Las pruebas de detección de autoanticuerpos para DM resultaron negativas, y se les diagnosticó DM inducida por ICIs, pembrolizumab en dos de ellos y nivolumab en el otro. El propósito de esta serie de casos es demostrar el desarrollo de la DM1 en forma aguda en pacientes tratados con inhibidores de PD-1. Sobre la base de estos casos y la literatura revisada, se buscaron determinar las características clínicas, y sugerir estrategias para la identificación, control, tratamiento precoz y seguimiento de los pacientes tratados con ICIs a fin de minimizar el impacto de la disfunción autoinmune.

Three patients with advanced cancer, treated with inmune checkpoint inhibitors (ICIs), with no history of diabetes mellitus (DM), were admitted to the Emergency Department with polyuria, polydipsia, and weight loss and a diagnosis of diabetic ketoacidosis without clinical evidence of infection. They were treated with fluids and insulin infusion transitioning to a basal-bolus insulin regimen, which continued after discharge. Autoantibody detection tests for DM were negative and they were diagnosed with DM induced by ICIs, pembrolizumab in two of them, and nivolumab in another. The purpose of this case report is to show the development of DM1 in an acute form in patients treated with PD-1 inhibitors. Based on these cases and the reviewed literature, we seek to identify clinical characteristics and suggest strategies for the proper identification, control, treatment, and follow-up of patients treated with ICIs to minimize the impact of autoimmune dysfunction.

Diabetic ketoacidosis complicated by acute myocardial infarction and upper gastrointestinal bleeding: a case report and literature review / 中国基层医药

Objective:To report one case of diabetic ketoacidosis complicated by acute myocardial infarction and upper gastrointestinal bleeding, and make a certain summary to its diagnosis and treatment in order to improve the treatment of these critically ill patients.Methods:One patient was admitted to Guizhou Aerospace Hospital on November 14, 2021 due to fatigue and vomiting for 2 days, and worsened symptoms accompanied by poor consciousness for 1 day. The patient was diagnosed with diabetic ketoacidosis complicated by acute myocardial infarction and upper gastrointestinal bleeding. The clinical symptoms, signs, laboratory examinations, and follow-ups of the patient were analyzed systematically and retrospectively.Results:After volume state assessment using a combined way, the patient was treated with appropriate fluid replacement, hypoglycemic, antiplatelet, anticoagulant, and acid inhibition strategies. After treatment, ketoacidosis and upper gastrointestinal bleeding were corrected, blood glucose gradually stabilized, and myocardial necrosis markers troponin and N-terminal brain natriuretic peptide precursor became normal.Conclusion:Treatments of diabetic ketoacidosis, acute myocardial infarction, and upper gastrointestinal bleeding are contradictory. Therefore, analyzing this patient's diagnosis and treatment is of great significance for improving treatment and reducing the mortality of these critically ill patients.

Pneumomediastinum secondary to diabetes ketoacidosis in high altitude: a case report / 中国综合临床

Diabetic ketoacidosis (DKA), a serious acute complication of diabetes mellitus, mainly manifests as hyperglycemia, ketosis, and acidosis. It is a metabolic syndrome resulting from insulin deficiency and increased insulin-antagonistic hormone levels. While type 2 diabetes mellitus complicated by DKA is relatively uncommon, secondary pneumomediastinum in DKA is extremely rare. Following alveolar rupture, air can travel through various routes to reach the hilum, causing anterior, middle, or posterior pneumomediastinum or even leading to intracranial epidural pneumatosis. The diagnosis of pneumomediastinum is mainly dependent on chest computed tomography findings. After the successful treatment of DKA, pneumomediastinum usually resolves spontaneously within 5-10 days with a good prognosis. One DKA patient admitted to Dege County People's Hospital developed Kussmaul respirations, followed by an increase in intra-alveolar pressure, an elevation in intra and extra-alveolar pressure difference, and protein decomposition in the alveolus wall, which promoted alveolar rupture and induced mediastinal emphysema. After rapid fluid replacement, blood glucose control with insulin, and maintenance of acid-base balance (correction DKA), the mediastinal emphysema was spontaneously absorbed. Through the analysis of the clinical data of this case, the purpose is to improve the clinicians' internal understanding of the relationship between mediastinal emphysema and DKA, avoid over-examination and over-treatment, and provide strategies for correct diagnosis and treatment.

One case report of massive ischemic intestinal necrosis at the onset of diabetes mellitus with ketoacidosis and coma in a male patient / 中华内分泌外科杂志

Diabetes mellitus with ketoacidosis and combined with coma are acute critical complications, which can be complicated with acute abdomen, such as acute pancreatitis, mesenteric thrombosis, small intestine necrosis, etc. There is no report of massive intestine necrosis in the previous literature. We present an overview and aim to improve the diagnosis of acute complications in diabetes mellitus combined with acute abdomen.

Type 4 familial partial lipodystrophy combined with recurrent diabetic ketoacidosis: a case report / 中华实用儿科临床杂志

To analyze the clinical features and genetic variants of a child with type 4 familial partial lipodystrophy (FPLD4) and the initial manifestation of diabetes.The male patient with the age of 13 years and 5 months, and the diabetes course was about 3 years, the patient was admitted to Children′s Hospital of Soochow University on November 10, 2021(4 th hospitalization at the hospital), in the course of diabetes, the children repeatedly suffered from diabetes ketoacidosis, and lipid metabolism complications gradually emerged.The gene sequencing showed that the proband and his mother carried dual gene mutations of PLIN1 c. 1325delG(p.G442Afs*99) and SPINK1 c. 194+ 2T>C(p.? ). The PLIN1 gene was the causal gene of FPLD4.The mutations of c. 1325delG in the PLIN1 gene had not been previously reported.Based on the clinical phenotype, family history and genetic testing findings, the patient was diagnosed as FPLD4.In addition, the mutation of SPINK1 c. 194+ 2T>C(p.? ) might increase the risk of chronic pancreatitis.This case report enriched the clinical characteristics and genotype data of FPLD4.Gene sequencing assisted the accurate diagnosis of the type of diabetes.The effects of dual gene mutations on disease progression should be concerned, which were of great significance to develop treatment regimen and disease management.

Analysis of clinical characteristics of diabetic ketoacidosis complicated with coronavirus disease 2019 / 天津医药

Objective To explore the clinical features of diabetic ketoacidosis(DKA)complicated with COVID-19.Methods DKA patients were divided into two groups,with 29 cases in the DKA group and 36 cases in the DKA+COVID-19 group.The general data of patients were collected.The serum uric acid,creatinine,white blood cell count,lymphocyte count,hemoglobin,blood glucose at first diagnosis,glycosylated hemoglobin A1c(HbA1c),β-hydroxybutyrate,bicarbonate(HCO3-),arterial blood pH,fasting blood glucose(FBG),2 h postprandial blood glucose(PBG2 h),fasting C-peptide,2 h postprandial C-peptide and other laboratory indexes were detected in two groups.The insulin dosage was calculated when blood glucose reached the standard during hospitalization.Results There were no significant differences in blood pressure,gender,body mass index(BMI),uric acid,creatinine,hemoglobin,FBG and PBG2 h between two groups(P>0.05).Compared with the DKA group,patients in the DKA+COVID-19 group were older and had longer course of disease(P＜0.05).The white blood cell count,blood glucose at first diagnosis,β-hydroxybutyrate,CK,CK-MB,HbA1c and insulin use were increased,fasting C-peptide,2 h postprandial C-peptide,PH and lymphocyte count were decreased in the DKA+COVID-19 group(P＜0.05).Conclusion Patients with DKA combined with COVID-19 have more severe metabolic disorder and infection at onset,worse immunity,worse islet cell function and higher insulin use.

Diabetic ketoacidosis in pregnancy: a retrospective analysis of ten cases / 中华围产医学杂志

Objective:To analyze the clinical features, prevention, and treatment of diabetic ketoacidosis (DKA) in pregnancy.Methods:Clinical features, treatment, and pregnancy outcomes of ten pregnant patients diagnosed with DKA and treated at Peking University First Hospital from January 2004 to December 2021 were analyzed retrospectively using descriptive statistical analysis.Results:DKA was found in two cases in the first trimester, three in the second trimester, and five in the third trimester, respectively. Six had type 1 diabetes (including two patients with fulminant type 1 diabetes) and four patients had type 2 diabetes. Only two cases received regular pregnancy examinations, and two began prenatal care in the second trimester. The other six cases neither had prenatal examination nor regular examination. Infection, pancreatitis, and preeclampsia occurred in six, two, and one case, respectively, and among them, four had urinary system infection. Laboratory examination showed that the average pH, blood glucose, and glycated hemoglobin A1c (HbA1c) at onset were 7.06±0.16, (23.7±2.6) mmol/L and (9.2±0.8)%. All patients had different degrees of electrolyte disorder and tested positive for urine ketone bodies. After rehydration, glucose-lowering, and correction of electrolyte disorder, the acidosis was relieved, and the ketone bodies turned negative in all patients. There was no maternal death. The fetal loss occurred in five cases, including one with intrauterine fetal death in late pregnancy, one with embryo arrest in early pregnancy, one with unavoidable abortion, and two terminated on maternal request. The remaining three were term labor and two were preterm labor.Conclusions:The leading cause of DKA in pregnancy is poor control of diabetic blood glucose, followed by infection. Once DKA is complicated during pregnancy, the outcome of the mother and her baby is poor. Its occurrence should be actively prevented. For women with fulminant type 1 diabetes, DKA is easier to occur, and the prognosis is poorer, so strict management and follow-up should be warranted.

Cetoacidosis diabética como debut de diabetes mellitus inmunomediada en paciente en tratamiento con inhibidores de checkpoint / Diabetic ketoacidosis as debut of immune-mediated diabetes mellitus in a patient in treatment with immune checkpoint inhibitors

Los inhibidores de checkpoint (ICP) son anticuerpos usados en inmunoterapia contra el cáncer. Uno de sus blancos de acción es el receptor de muerte celular programada-1 (PD-1), el cual es importante para mantener la tolerancia inmunitaria. Sin embargo, este mecanismo se asocia a riesgo de eventos adversos relacionados a la inmunidad que pueden afectar a múltiples órganos incluyendo el sistema endocrino. Se describe el caso inhabitual de un paciente que a los 18 meses de terapia con ICP debutó con cetoacidosis diabética (CAD).

Immune checkpoint inhibitors consist in antibodies used in immunotherapy against cancer. One of their targets is the programmed cell death-1 (PD-1) receptor, which is important in maintaining self-tolerance. However, this mechanism is associated with a risk for immune-related adverse events potentially affecting multiple organs, including the endocrine system. We describe the unusual case of a patient who, after 18 months of treatment with an immune checkpoint inhibitor, debuted with diabetic ketoacidosis