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1.
Säo Paulo med. j ; 139(1): 10-17, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156965

ABSTRACT

ABSTRACT BACKGROUND: Diabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design. OBJECTIVE: To describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years. DESIGN AND SETTING: Prospective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil. METHODS: All patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate. RESULTS: The incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission. CONCLUSIONS: Diabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.


Subject(s)
Humans , Child , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Prognosis , Brazil/epidemiology , Incidence , Prospective Studies , Retrospective Studies , Cohort Studies , Emergency Service, Hospital
2.
In. Manzanares Castro, William; Aramendi Epstein, Ignacio; Pico, José Luis do. Disionías en el paciente grave: historias clínicas comentadas. Montevideo, Cuadrado, 2021. p.255-275.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1344740
4.
Arch. argent. pediatr ; 118(5): 332-336, oct 2020. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1122029

ABSTRACT

Introducción. El edema cerebral (EC) es la complicación más grave de la cetoacidosis diabética (CAD) en niños. La patogénesis del EC no se conoce con exactitud y su aparición ha sido relacionada con la terapia de rehidratación endovenosa en el tratamiento inicial.Objetivos. Estimar la prevalencia de EC en pacientes con CAD tratados en el Hospital General de Niños Pedro de Elizalde mediante rehidratación endovenosa y analizar potenciales factores de riesgo para el desarrollo de EC.Materiales y método. Estudio de diseño transversal para prevalencia y un análisis exploratorio para comparar las características clínicas y de laboratorio entre los pacientes con y sin EC. Se incluyeron pacientes de 1 a 18 años hospitalizados con diagnóstico de CAD desde el 1 de enero de 2005 hasta el 31 de diciembre de 2014.Resultados. Se analizaron 693 episodios de CAD en 561 historias clínicas. En 10 pacientes, se evidenció EC (el 1,44 %; intervalo de confianza del 95 %: 0,8-2,6). Los pacientes con EC presentaron mayor uremia (p < 0,001), menor presión de dióxido de carbono (p < 0,001) y menor natremia (p < 0,001) que aquellos pacientes sin EC.Conclusión. La prevalencia de EC en pacientes con CAD fue del 1,44 %, menor que la reportada en nuestro país (del 1,8 %). Los factores de riesgo al ingresar asociados a su desarrollo fueron la presencia de uremia elevada, hiponatremia e hipocapnia.


Introduction. Cerebral edema (CE) is the most severe complication of diabetic ketoacidosis (DKA) in children. There is no accurate knowledge of CE pathogenesis and its onset has been related to intravenous rehydration therapy during the initial treatment.Objectives. To estimate the prevalence of CE among DKA patients treated at Hospital General de Niños Pedro de Elizalde with intravenous rehydration and analyze potential risk factors for the development of CE.Materials and methods. Cross-sectional prevalence study and exploratory analysis to compare clinical and laboratory characteristics between patients with and without CE. Patients aged 1-18 years hospitalized with the diagnosis of DKA between January 1st, 2005 and December 31st, 2014 were included.Results. A total of 693 DKA events from 561 medical records were analyzed. Ten patients had evidence of CE (1.44 %; 95 % confidence interval: 0.8-2.6). Patients with CE had higher serum urea levels (p < 0.001), lower carbon dioxide pressure (p < 0.001), and lower serum sodium levels (p < 0.001) than those without CE.Conclusion. The prevalence of CE among DKA patients was 1.44 %, smaller than that reported in our country (1.8 %). The risk factors at admission associated with CE development were high serum urea levels, hyponatremia, and hypocapnia.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Brain Edema , Diabetic Ketoacidosis/complications , Prevalence , Cross-Sectional Studies , Risk Factors , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/therapy
5.
Autops. Case Rep ; 9(1): e2018072, Jan.-Mar. 2019. ilus
Article in English | LILACS | ID: biblio-987500

ABSTRACT

Endotracheal intubation injuries are rare, but may be devastating­mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication.


Subject(s)
Humans , Female , Adolescent , Tracheal Stenosis/prevention & control , Intubation, Intratracheal/adverse effects , Diabetic Ketoacidosis/complications
6.
Rev. med. Rosario ; 83(2): 79-82, mayo-ago. 2017. tab
Article in Spanish | LILACS | ID: biblio-973302

ABSTRACT

Los inhibidores del cotransportador sodio-glucosa tipo 2 son un grupo de fármacos que se utilizan en tratamiento de la diabetes tipo 2. Un efecto adverso que pueden producir es la cetoacidosis diabética euglucémica, una entidad clínica que se debe conocer para realizar el adecuado diagnóstico y tratamiento, suspendiendo la administración de dichos fármacos.


Inhibitors of sodium-glucose cotransporter type 2 are a group of drugs used in treatment of type 2 diabetes. Euglycemic diabetic ketoacidosis is an adverse effect that may occur and a clinical entity that should be known for proper diagnosis and treatment, suspending the administration of this medication.


Subject(s)
Humans , Female , /complications , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , /adverse effects , Pharmaceutical Preparations
7.
J. bras. med ; 101(02): 41-45, mar.-abr. 2013.
Article in Portuguese | LILACS | ID: lil-686293

ABSTRACT

Os estados hiperglicêmicos e hipoglicêmicos agudos são exemplos das mais comuns emergências médicas com que nos deparamos no campo das alterações do metabolismo. Os estados hiperglicêmicos agudos compreendem a cetoacidose diabética e o coma hiperosmolar hiperglicêmico não cetótico. Neste artigo, analisamos essas condições hiperglicêmicas, que representam um desafio para o clínico e o médico generalista que trabalham no terreno nas emergências médicas


The acute hypoglycemic and hyperglycemic situations are examples of the most common medical emergencies that we face in the field of metabolic disorders. The acute hyperglycemic situations include diabetic ketoacidosis and hyperosmolar hyperglycemic coma hyperosmolar nonketotic. In this article, we analyze these two hyperglycemic conditions that represent a challenge to the clinician and general practitioner working in the field in medical emergencies


Subject(s)
Humans , Male , Female , Diabetes Complications/metabolism , Diabetes Mellitus/metabolism , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetic Coma/complications , Blood Glucose/analysis , Fluid Therapy , Hyperglycemia/therapy , Hypoglycemia/therapy , Insulinoma/complications
8.
Bahrain Medical Bulletin. 2013; 35 (4): 215-217
in English | IMEMR | ID: emr-143111

ABSTRACT

We present a case of cerebral venous thrombosis and cerebral infarction associated with diabetic ketoacidosis. The patient presented with vomiting, headache, lethargy and altered sensorium. CT venography provided the final diagnosis; therefore, anticoagulant was used, which resulted in the improvement of neurological outcome. Neurological deterioration during an episode of diabetic ketoacidosis is usually assumed to be caused by cerebral edema. Neuroimaging should always be performed in suspected cerebral edema associated with diabetic ketoacidosis in order to exclude other pathologies.


Subject(s)
Humans , Female , Diabetic Ketoacidosis/complications , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/etiology , Intracranial Thrombosis/complications , Cerebral Infarction/diagnosis , Magnetic Resonance Spectroscopy , Awareness , Cerebral Angiography , Neuroimaging , Cerebral Veins/diagnostic imaging , Rare Diseases
9.
Article in English | WPRIM | ID: wpr-148456

ABSTRACT

A 21-year-old man with diabetic ketoacidosis (DKA) displayed short and clubbed fingers and marked eyebrow, which are typical of Hajdu-Cheney Syndrome (HCS). Laboratory findings confirmed type 1 diabetes mellitus (DM). After conservative care with hydration and insulin supply, metabolic impairment was improved. Examinations of bone and metabolism revealed osteoporosis and craniofacial abnormalities. The mutation (c.6443T>G) of the NOTCH2 gene was found. The patient was diagnosed with HCS and DM. There may be a relationship between HCS and DM, with development of pancreatic symptoms related to the NOTCH2 gene mutation.


Subject(s)
Adult , Bone Density , Craniofacial Abnormalities/complications , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Glycosuria , Hajdu-Cheney Syndrome/complications , Humans , Ketone Bodies/urine , Male , Mutation , Osteoporosis/complications , Receptor, Notch2/genetics , Young Adult
10.
Arq. bras. endocrinol. metab ; 55(4): 288-290, June 2011. ilus, tab
Article in English | LILACS | ID: lil-593123

ABSTRACT

Neurological deterioration in children with diabetic ketoacidosis (DKA) is commonly caused by cerebral edema. However, subtle cerebral injuries including strokes should also be suspected, since children with hyperglycemia and DKA are prone to thrombosis. In this paper, a case involving a 2 month-old patient that presented cerebral edema and stroke as complications of DKA is reported. In the discussion, the literature on neurological complications of DKA in children is briefly reviewed, emphasizing the prothrombotic tendency of these patients.


Alterações neurológicas em crianças com cetoacidose diabética (CAD) são comuns, sobretudo em decorrência de edema cerebral. Contudo, lesões cerebrais agudas, como acidente vascular cerebral (AVC), também devem ser investigadas, já que as crianças com hiperglicemia e cetoacidose têm maior chance de apresentar essa complicação. Neste relato, descreve-se a história de um paciente de 2 meses de idade que apresentou edema cerebral e AVC como complicações de um quadro de cetoacidose diabética. Durante a discussão, será feita uma breve revisão da literatura sobre as complicações neurológicas da CAD nos pacientes pediátricos enfatizando sua tendência pró-trombótica.


Subject(s)
Humans , Infant , Male , Brain Edema/etiology , Diabetic Ketoacidosis/complications , Stroke/etiology
11.
Rev. méd. hondur ; 79(2): 85-93, abr.-jun. 2011. tab, graf
Article in Spanish | LILACS | ID: lil-644958

ABSTRACT

Introducción: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son las complicaciones agudas de la diabetes mellitus y constituyen causas frecuentes de ingreso en los hospitales. La patogenia de estas dos patologías difiere en cuanto a la disponibilidad de insulina, el estado de hidratación e incrementos de las hormonas contra reguladoras y por lo tanto la terapia es diferente. Fuentes: Artículos publicados a nivel internacional en relación al tratamiento de dichas patologías en los últimos 10 años. Desarrollo: El tratamiento de la cetoacidosis diabética requiere la administración de insulina, mientras que el estado hiperosmolar hiperglucémico requiere primordialmente de la adecuada terapia hídrica sustitutiva. Sin embargo en ambas situaciones es importante realizar al ingreso una minuciosa valoración clínicay laboratorial a los pacientes para establecer el manejo específico e individualizado en cada caso. Ya que la administración de insulina sin cuantificar previamente los niveles de potasio, selección inadecuada de soluciones isotónicas o hipotónicas para restitución hídrica, descenso acelerado de la osmolaridad plasmática entre otros, pueden poner en peligro la vida del paciente. Conclusión: El éxito de la terapia depende de la estrecha vigilancia clínico laboratorial periódica del paciente y de la capacidad del médico para identificar, tratar y prevenir las complicaciones tales como la hipoglucemia, hipocalemia, edema cerebral, síndrome de distres respiratorio agudo, tromboembolismo y coagulación intravascular diseminada entre otras con un alto grado de mortalidad; en los últimos años se han adoptado nuevas guías de manejo para estas condiciones, las cuales son recopiladas en esta revisión...


Subject(s)
Humans , Diabetic Ketoacidosis/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/diagnosis , Diabetes Mellitus/classification , Pulmonary Edema/complications , Insulin/therapeutic use
12.
Rev. bras. cardiol. (Impr.) ; 24(2): 119-121, mar.-abr. 2011. ilus
Article in Portuguese | LILACS | ID: lil-594184

ABSTRACT

Paciente idoso, portador de cardiomiopatia isquêmica, hipertenso, com leve disfunção renal e diabético insulinodependente, por suspensão do uso da insulina desenvolveu cetoacidose com grave desidratação e severa hiperpotassemia, que reverteu com o uso de medicações. Analisam-se interessantes aspectos eletrocardiográficos inerentes ao caso.


An elderly patient with ischemic cardiomyopathy, hypertension, slight renal dysfunction and insulindependentdiabetes developed ketoacidosis aftersuspending insulin use, with severe dehydration and severe hyperpotassemia, both reverted throughmedications. This paper analyzes interesting eletrocardiographic aspects of this case.


Subject(s)
Humans , Male , Aged , Diabetic Ketoacidosis/complications , Dehydration/complications , Hyperkalemia/complications , Hypertension/complications , Hypertension/diagnosis , Renal Insufficiency/complications , Electrocardiography/methods , Electrocardiography
13.
Salud(i)ciencia (Impresa) ; 18(2): 127-132, mar. 2011. graf
Article in Spanish | LILACS | ID: lil-610110

ABSTRACT

La cetoacidosis diabética (CAD) es la complicación más importante de la diabetes mellitus. La piedra angular para el diagnóstico de la CAD son la historia clínica y la exploración física, en ellas generalmente encontramos los factores precipitantes y podemos clasificar el estado de hidratación del paciente. Los estudios de laboratorio son de gran utilidad para monitorizar la hiperglucemia, el estado ácido-base y el desequilibrio electrolítico inicial. La terapia inicial durante la primera hora es administración de líquidos intravenosos, generalmente cristaloides, con revaloraciones del estado de hidratación y de los niveles séricos de potasio antes de comenzar el tratamiento con insulina, que debe hacerse en la segunda hora. El monitoreo de la glucemia y de los electrolitos séricos es la base para un tratamiento exitoso en la CAD, sobre todo para evitar el edema cerebral, que es la complicación más seria. Afortunadamente, dicha complicación es rara y uno de los factores de riesgo asociados es el tratamiento inadecuado; si bien se han propuesto otros factores de riesgo, no están totalmente identificados.


Subject(s)
Humans , Male , Female , Child , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/prevention & control , Diabetic Ketoacidosis/therapy , Brain Edema/prevention & control , Brain Edema/therapy , Pediatrics/instrumentation
14.
West Indian med. j ; 60(2): 214-216, Mar. 2011. tab
Article in English | LILACS | ID: lil-672753

ABSTRACT

This is a patient with septicaemia and diabetic ketoacidosis who developed an acute ischaemic lower limb from an arterial thrombus. The patient had decreased protein S function.


Se trata de un paciente con septicemia y cetoacidosis diabética que desarrolló una isquemia aguda en un miembro inferior a partir de un trombo arterial. El paciente presentaba función disminuida de la proteína S.


Subject(s)
Adult , Female , Humans , Diabetic Ketoacidosis/complications , Ischemia/etiology , Leg/blood supply , Sepsis/complications , Thrombosis/diagnosis , Acute Disease , Thrombosis/complications
16.
Med. interna (Caracas) ; 26(2): 133-136, 2010. ilus
Article in Spanish | LILACS | ID: lil-772205

ABSTRACT

La Trombosis Venosa de Miembros Superiores (TVP – Ms Ss) profunda es una enfermedad poco frecuente y de difícil diagnóstico. Sin historia de esfuerzo físico de miembros superiores, las trombofilias suelen ser la condición más frecuentemente relacionada. La cetoacidosis diabética puede tener relación con la TVP por varias razones. Se presenta un caso de un hombre de 26 años con cetoacidosis diabética e infección respiratoria baja; tenía instalado un catéter venoso central y presentó una TVP en miembro superior derecho


Deep Vein Thrombosis of upper limbs is not common and sometimes, of difficult diagnosis. Risk factors, in absence of physical strain include thrombophylia, as is found in diabetic ketoacidosis . We present a 26 year-old man who was admitted with diabetic acidosis and a lower respiratory infection. A central vein catheter was installed and TVP of right upper limb was diagnosed and treated


Subject(s)
Humans , Male , Adult , Diabetic Ketoacidosis/complications , Respiratory Tract Infections/complications , Respiratory Tract Infections/pathology , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/pathology , Internal Medicine
17.
Rev. chil. dermatol ; 26(2): 148-153, 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-569960

ABSTRACT

Presentamos un caso de Mucormicosis Rinoorbitaria en una mujer de 48 años, diabética, en cetoacidosis, a quien se hizo el diagnóstico por histopatología. Tratada con anfotericina B intravenosa y un agresivo debridamiento quirúrgico para eliminar tejidos infartados y necróticos de gran parte de la hemicara y ojo derecho, logra sobrevivir a esta catastrófica infección. La mucormicosis es una infección aguda y extremadamente grave causada por hongos oportunistas y ubicuos del orden Mucoroles pertenecientes a la clase Phycomycetes, que afecta principalmente a un grupo de pacientes cuyas condiciones inmunológicas y metabólicas favorecen el desarrollo del hongo. Hacemos una definición del grupo de "pacientes en riesgo", lo que es extremadamente importante, ya que de la sospecha clínica se puede abordar un diagnóstico precoz para evitar la alta mortalidad y morbilidad que esta enfermedad provoca. Analizamos la patogenia de la enfermedad, así como una revisión de la literatura sobre modalidades de diagnóstico y terapéutica. El diagnóstico de urgencia sigue siendo de responsabilidad del patólogo, y el tratamiento de mayor éxito es la anfotericina B.


We present a case of rhinoorbital mucormycosis in a diabetic, developing ketoacidose, 48-year old woman. Diagnosis was established through histopathology. The patient was successfully treated and survives with a combination of anphotericin B and an aggressive surgery in order to eliminate all the ischemic and necrotic tissues affecting almost the entire right side of the face and intraorbital structures surviving to this catastrophic infection. Mucormycosis is an acute and often fatal infection caused by opportunistic fungus of the class Zygomycetes, order Mucoroles that affects a select group of patients associated with underlying metabolic and immunological disorders. A definition of "risk-group" is proposed. This definition is of extreme importance for a prompt diagnosis avoiding the high rate of morbidity and mortality associated with this condition. We review both pathogenic mechanism and literature related to diagnostic modalities and new therapeutical approaches. Emergency diagnosis is still in hands of pathologists and the most successful treatment is with anphotericin B.


Subject(s)
Humans , Female , Middle Aged , Nose Diseases/diagnosis , Nose Diseases/therapy , Orbital Diseases/diagnosis , Orbital Diseases/therapy , Mucormycosis/diagnosis , Mucormycosis/therapy , Antifungal Agents/therapeutic use , Amphotericin B/therapeutic use , Causality , Diabetic Ketoacidosis/complications , Nose Diseases/classification , Nose Diseases/etiology , Orbital Diseases/classification , Orbital Diseases/etiology , Mucormycosis/classification , Mucormycosis/etiology , Necrosis , Opportunistic Infections
18.
Article in English | WPRIM | ID: wpr-187901

ABSTRACT

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.


Subject(s)
Acute Disease , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Female , Humans , Hypertriglyceridemia/complications , Insulin/therapeutic use , Pancreatitis/complications , Tomography, X-Ray Computed , Young Adult
19.
Rev. méd. Minas Gerais ; 19(4,supl.3): S10-S15, out.-dez. 2009. tab
Article in Portuguese | LILACS | ID: lil-568861

ABSTRACT

A cetoacidose diabética (CAD) constitui um distúrbio endócrino caracterizado por acidose metabólica, cetose (pH arterial < 7,3 ou venoso < 7,25 e/ou HCO3- < 15mEq/L), hiperglicemia (> 200 mg/dL) e graus variados de desidratação em portadores de diabetes mellitus (DM). É motivo habitual de admissão em emergência ou Unidade de Terapia Intensiva pediátrica. É a causa mais frequente de morte em crianças e adolescentes com DM tipo 1. Resulta da deficiência de insulina e aumento dos níveis circulantes de hormônios contrarreguladores. A abordagem da CAD em pediatria não deve prescindir das particularidades existentes nessa população quando comparada à de adultos. Os principais fatores desencadeantes são as infecções e a omissão de insulina. A terapêutica na emergência visa a: corrigir a desidratação e os distúrbios eletrolíticos; reverter a cetose e a acidose; restabelecer a glicemia normal; evitar complicações; identificar e tratar a causa precipitante; e prevenir novos episódios. Este artigo atualiza sobre a CAD, tratando, em especial, sobre seus aspectos da fisiopatologia, diagnóstico, classificação, manifestações clínicas, abordagem terapêutica, complicações e profilaxia.


The diabetic ketoacidosis (DK) is an endocrine disorder characterized by metabolic acidosis and ketosis (arterial pH < 7,3 or venous pH < 7,25 and HCO3- < 15 mEq/L), hyperglycemia (higher than 200 mg/dL) and different degrees of dehydration in patients with Diabetes Mellitus (DM). It is a usual reason for admission in emergency services or pediatric ICU, as well as the most frequent cause of death in children and teenagers with type 1 DM. This pathology results from lack of insulin and elevation of counter-regulatory hormone levels. The DK’s approach in pediatric patients must consider the singular characteristics of this age group. The main trigger factors are infections and omission of insulin. The therapeutic at the emergency aims to: correct the dehydration and electrolyte disturbances, ketosis, acidosis and hyperglycemia; avoid complications; identify and treat the trigger factors; and prevent new events. The aim of this review is to present updates on DK, dealing in particular with aspects of physiopathology, diagnosis, classification, clinical findings, therapeutic approach, complications and prophylaxis.


Subject(s)
Humans , Child , Adolescent , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/physiopathology , Diabetes Mellitus , Risk Factors , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy
20.
Arq. bras. endocrinol. metab ; 53(7): 880-883, out. 2009. ilus, graf
Article in Portuguese | LILACS | ID: lil-531703

ABSTRACT

OBJETIVOS: A cetoacidose diabética é uma entidade frequente nos serviços de emergência que requer tratamento rápido e eficaz. Algumas vezes pode estar associada ao aumento do nível de triglicérides, expondo o paciente ao risco de pancreatite. MÉTODOS: Foi relatado o caso de uma paciente de 38 anos com cetoacidose diabética associada à hipertrigliceridemia grave (triglicérides: 11.758 mg/dL). RESULTADOS: Paciente foi admitida em Unidade de Terapia Intensiva, realizando-se hidratação e insulinoterapia endovenosa com resolução do quadro. Durante toda a internação, a paciente não apresentou elevação de amilase e lipase que pudessem sugerir pancreatite, e houve redução importante no nível de triglicérides. Não foram encontrados outros relatos de casos nacionais com esses valores de triglicérides. CONCLUSÃO: Concluiu-se que, em casos de cetoacidose diabética, deve-se pedir o perfil lipídico dos pacientes, incluindo a contagem de triglicérides, tendo em vista a prevalência não desprezível de complicações relacionadas à hipertrigliceridemia e à pancreatite.


OBJECTIVES: Diabetic ketoacidosis is a recurrent problem in the emergency room that requires prompt and effective treatment. Usually, it may be associated with an increase in triglyceride levels, exposing the patient to the risk of pancreatitis. METHODS: We report the case of a 38-year-old female patient with diabetic ketoacidosis and severe hypertriglyceridemia (triglycerides: 11.758 mg/dL). RESULTS: The patient was admitted to the Intensive Care Unit. Hydration and intravenous insulin were performed with success. During hospitalization, the levels of triglycerides decreased significantly and the levels of amylase and lipase remained at normal ranges, not suggesting pancreatitis. No other Brazilian cases with these levels of triglycerides were found. CONCLUSION: We conclude that, in diabetic ketoacidosis, lipid profile, including triglycerides, should be requested, due to a not negligible prevalence of complications such as hypertriglycerides and pancreatitis.


Subject(s)
Adult , Female , Humans , Diabetic Ketoacidosis/blood , Hypertriglyceridemia/blood , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Hypertriglyceridemia/complications , Triglycerides/blood
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