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1.
Rev. chil. pediatr ; 89(4): 491-498, ago. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959551

ABSTRACT

INTRODUCCIÓN: La cetoacidosis (CAD) es la principal causa de morbimortalidad en niños con diabetes mellitus tipo 1 (DM1) debido a las alteraciones bioquímicas asociadas, siendo el más temido el edema cerebral, con altas tasas de mortalidad y secuelas neurológicas a largo plazo. OBJETIVO: caracterizar el perfil clínico y las complicaciones de pacientes con CAD ingresados en una unidad de paciente crítico pediátrico. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con CAD atendidos en el Hospital Clínico de la Pontificia Universidad Católica de Chile (UPCPUC) entre los años 2000 y 2015. Se evaluaron características demográficas, manifestaciones clínicas, alteraciones bioquímicas, tratamiento, complicaciones y pronóstico. Se compararon pacientes con debut de DM1 versus diabéticos conocidos, analizándose variables según distribución. RESULTADOS: Se identificaron 46 episodios de CAD. El 67% de éstos correspondió a un debut de DM1. El 66% de los diabéticos conocidos ingresaron por mala adherencia al tratamiento. Los principales síntomas de presentación fueron: 63% polidipsia, 56% poliuria, 48% vómitos, 39% pérdida de peso y 35% dolor abdominal, con medias de Glicemia 522 mg/dL, pH 7,17 y osmolaridad plasmática 305 mOsm/L. El 89% recibió insulina en infusión. El 37% presentó hipokalemia. No se registraron episodios de edema cerebral ni muertes. CONCLUSIONES: La mayoría de los ingresos por CAD correspondió a debut de DM1. En el grupo de diabéticos conocidos, la mala adherencia al tratamiento fue la principal causa de descompensación. No se presentaron complicaciones graves ni muertes asociadas al manejo de la CAD durante el período estudiado. El diagnóstico precoz y el tratamiento adecuado y estandarizado pudieran contribuir a reducir la morbilidad y mortalidad en niños con CAD.


INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/diagnosis , Prognosis , Retrospective Studies , Treatment Outcome , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetes Mellitus, Type 1/complications , Intensive Care Units
2.
Arch. argent. pediatr ; 116(3): 365-370, jun. 2018. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950013

ABSTRACT

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.


Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Acid-Base Equilibrium/physiology , Acidosis/therapy , Chlorides/blood , Diabetic Ketoacidosis/therapy , Acidosis/physiopathology , Water-Electrolyte Imbalance , Prevalence , Cross-Sectional Studies , Diabetic Ketoacidosis/physiopathology , Organism Hydration Status/physiology
3.
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
4.
Rev. Soc. Bras. Clín. Méd ; 8(3)maio-jun. 2010.
Article in Portuguese | LILACS | ID: lil-549759

ABSTRACT

JUSTIFICATIVA E OBJETIVOS: A cetoacidose diabética (CAD) e o estado hiperglicêmico hiperosmolar (EHH) são as duas complicações agudas mais graves que se observa durante a evolução do diabetes mellitus. O objetivo deste estudo foi rever a fisiopatologia destas complicações com ênfase no tratamento da CAD e EHH. CONTEÚDO: A fisiopatologia da descompensação metabólica da CAD é mais entendida do que a do EHH. Fundamentalmente, na CAD o que ocorre é a redução da concentração efetiva de insulina circulante associada à liberação excessiva de hormônios contra-reguladores, entre eles, o glucagon, as catecolaminas, o cortisol e o hormônio de crescimento Esta combinação libera grandes quantidades de ácidos graxos livres na circulação. No fígado, estes ácidos graxos livres são oxidados em corpos cetônicos, resultando assim em cetonemia e acidose metabólica. Os principais critérios diagnósticos utilizados para a CAD são, a glicemia ≥ 250 mg/dL, o pH arterial ≤ 7,3, o bicarbonato sérico ≤ 15 mEq/L e graus variáveis de cetonemia e cetonúria. Para o EHH a glicemia em geral > 600 mg/dL, a osmolalidade sérica > 320 mOsm/kg e o bicarbonato sérico ≥ 15 mEq/L, com discreta cetonemia. As metas terapêuticas para as crises hiperglicêmicas agudas são: a liberação das vias aéreas superiores, a correção da desidratação com solução fisiológica, a correção dos distúrbios eletrolíticos e da acidose, a redução da hiperglicemia com insulina em baixas doses e a identificação e o tratamento dos fatores precipitantes. CONCLUSÃO: O rápido diagnóstico e o tratamento da CAD e do EHH são procedimentos essenciais para diminuir a morbimortalidade com estas doenças.


BACKGROUND AND OBJECTIVES: Diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) are the two most severe acute complications that are observed in diabetes mellitus. The objective of this study is to review the pathophysiology with emphasis in treatment of DKA and HHS. CONTENTS: The pathophysiology of DKA is better understood than that of the HHS. Fundamentally, in DKA the basic underlying mechanism is a reduction in the net effective action of circulating insulin associate with a concomitant elevation of counter-regulatory hormones, such as glucagon, catecholamines, cortisol and growth hormone. This combination releases great amounts of free fatty acids into the circulation from adipose tissues (lipolysis) that are transformed by oxidation to ketones bodies, causing ketonemia ad metabolic acidosis. The main criteria used to diagnoses DKA are plasma glucose ≥ 250 mg/dL, pH ≤ 7.3 and serum bicarbonate ≤ 15 mEq/L and variable degrees of ketonemia and ketonuria. To diagnose HHS, the criteria are plasma glucose greater than 600 mg/dL, serum osmolality > 320 mOsm/kg and serum bicarbonate ≥ 15 mEq/L with mild ketonemia. The main therapeutical purpose of treating acute hyperglycemic crises require care of the upper airways, correction of dehydration with fluid therapy (saline solution), correction of electrolyte imbalance and acidosis, reduction of hyperglycemia with low-dose insulin therapy, and identification as well as the treatment of comorbidity precipitating events. CONCLUSION: The rapid diagnosis and treatment of DKA and HHS are essential procedures to reduce morbimortality of these diseases.


Subject(s)
Humans , Diabetic Ketoacidosis/physiopathology , Diabetes Mellitus
6.
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
7.
J. bras. med ; 97(3): 40-43, nov.-dez. 2009.
Article in Portuguese | LILACS | ID: lil-539050

ABSTRACT

A cetoacidose diabética e o estado hiperosmolar hiperglicêmico não cetótico são complicações hiperglicêmicas agudas do diabetes mellitus e representam um desafio para o clínico que trabalha no terreno das emergências médicas. A cetoacidose diabética pode ser a manifestação inicial ou resultar de intercorrências havidas em pacientes com diabetes tipo 1. Além disso, pode se instalar em pacientes diabéticos tipo 2 submeticos a situações de extrema gravidade, tais como sepse. O coma hiperosmolar hiperglicêmico não cetótico costuma acometer portadores de diabetes tipo 2. Tais complicações trazem risco à vida do paciente diabético, com elevada taxa de mortalidade. Estas e outras emergências diabéticas são abordadas no presente artigo, com ênfase em diagnóstico e tratamento.


Diabetic ketoacidosis and nonketotic hyperosmolar hyperglycemic syndrome are challenging metabolic complications of diabetes mellitus, especially in the setting of the emergency department. Diabetic ketoacidosis can be the first clinical manifestation of type 1 diabetes or result of intercurrent events in someone already diagnosed with type 1 diabetes. Nonketotic hyperosmolar hyperglycemic coma is more frequently associated with type 2 diabetes. Both complications are lefe-threatening and the mortality rate is high. Management of this and other acute complications of diabetes are discussed, emphasizing diagnosis and treatment.


Subject(s)
Male , Female , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetes Complications , Diabetes Mellitus/physiopathology , Diabetic Coma/etiology , Diabetic Coma/physiopathology , Diabetic Coma/prevention & control
8.
Arq. bras. endocrinol. metab ; 52(2): 367-374, mar. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-481006

ABSTRACT

A principal complicação hiperglicêmica no diabetes melito tipo 1 (DM1) é a cetoacidose diabética (CAD). Embora variações nos protocolos possam ocorrer, os princípios básicos que norteiam o tratamento devem ser os mesmos. A recuperação inicial da capacidade circulatória, com a infusão rápida de solução salina na dose de 20 mL/kg, que pode ser repetida, é o ponto de partida para o tratamento. A partir daí, a reposição de volume é relativamente lenta, e o objetivo principal é corrigir gradualmente os distúrbios metabólicos instalados, sem ocasionar variações muito intensas e muito rápidas na osmolalidade, fator de risco para complicações. Atenção ao desenvolvimento de edema cerebral que, uma vez suspeitado, deve ser imediatamente corrigido, sob pena de óbito ou seqüelas neurológicas. A administração de insulina ultra-rápida, por via subcutânea, mostra-se eficaz e simplifica o atendimento do paciente. A CAD é uma situação grave, ainda com alta mortalidade, e seu tratamento deve ser dirigido aos pontos principais que levaram ao quadro clínico, com correções graduais, sob risco de se agravar o quadro.


Diabetic ketoacidosis (DKA) is the main hyperglycemic complication in type 1 Diabetes Mellitus (DM1). The basic principles in treatment have to be followed carefully. The patient with DKA has a very deep volume depletion. To restore the circulatory capacity is the first step. From this point on, the restoration of the lost fluids is slow, around 1 percent per hour, aiming at the correction of the metabolic disturbance already on and avoiding great fluctuations in osmolality, which increases the risk of having complications. Attention to the development of cerebral edema, which, once suspected, deserves an urgent treatment plan, trying to avoid neurologic sequelae or even death. Subcutaneous ultra-rapid insulin has been demonstrated to be efficient and easier to use. As the perfusion gets improved and the levels of insulin increase, the lipolysis is blocked, as well as the generation of ketones and so the acidemia tends to be solved. DKA is still a high-mortality condition. And to be in a hurry frequently leads to neurologic sequelae and even to a fatal outcome.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Diabetes Mellitus, Type 1/physiopathology , Diabetic Ketoacidosis/physiopathology , Acute Disease , Brain Edema/etiology , Brain Edema/physiopathology , Diagnosis, Differential , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , /complications , /drug therapy , /physiopathology , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/drug therapy , Hyperglycemia/complications , Hyperglycemia/physiopathology , Hyperglycemic Hyperosmolar Nonketotic Coma/complications , Hyperglycemic Hyperosmolar Nonketotic Coma/drug therapy , Hyperglycemic Hyperosmolar Nonketotic Coma/physiopathology , Hypoglycemic Agents/therapeutic use , Infusions, Intravenous , Insulin/analogs & derivatives , Insulin/therapeutic use
9.
Arq. bras. endocrinol. metab ; 51(9): 1434-1447, dez. 2007. ilus, tab
Article in Portuguese | LILACS | ID: lil-471763

ABSTRACT

A cetoacidose diabética é uma complicação aguda do Diabetes Mellitus (DM) caracterizada por hiperglicemia, acidose metabólica, desidratação e cetose, na vigência de deficiência profunda de insulina. Acomete principalmente pacientes com DM tipo 1 e geralmente é precipitada por condições infecciosas, uso inadequado de insulina ou desconhecimento do diagnóstico de diabetes. Os autores revisam mecanismos fisiopatológicos, critérios diagnósticos e opções terapêuticas do distúrbio em adultos, bem como suas possíveis complicações.


Diabetic ketoacidosis is an acute complication of Diabetes Mellitus characterized by hyperglycemia, metabolic acidosis, dehydration, and ketosis, in patients with profound insulin deficiency. It occurs predominantly in patients with type 1 diabetes and is frequently precipitated by infections, insulin withdrawal or undiagnosed type 1 diabetes. The authors review its pathophysiology, diagnostic criteria and treatment options in adults, as well as its complications.


Subject(s)
Adult , Humans , Diabetic Ketoacidosis/physiopathology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/physiopathology , /complications , /diagnosis , /physiopathology , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/therapy
10.
Med. lab ; 13(9/10): 437-450, oct. 2007. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-477910

ABSTRACT

La cetoacidosis diabética y el estado hiperglicémico hiperosmolar son las dos complicaciones metabólicas más graves de la diabetes. Estas enfermedades aparecen tantoen los pacientes con diabetes tipo 1 como en la tipo 2 y ocurren durante estrés catabólico o enfermedades agudas severas. La tasa de mortalidad en pacientes con cetoacidosis diabética es del 5 por ciento mientras que la tasa de mortalidad del estado hiperglicémico hiperosmolar es de aproximadamente el 11 por ciento. como prioridad en todo paciente que ingresa al servicio de urgencias se tendrá en cuenta el ABC en la evaluación inicial con medidas de soporte, monitorización y acceso venoso. Las metas terapéuticas en la cetoacidosis diabética se dirigen hacia la corrección de la deshidratación para mejorar el volumen circulante, la administración adecuada de insulina y el reemplazo de potasio. La administración de bicarbonato, fosfato, magnesio u otras terapias puede ser ventajosa en algunos pacientes, pero no se deben considerar como la primera línea de manejo. Luego de la estabilización del paciente es muy importante el tratamiento basado en la educación para reconocer oportunamente una descompensación,tratando de llevar siempre al paciente a una prevención de eventos posteriores.


Subject(s)
Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy
11.
Al-Azhar Medical Journal. 2006; 35 (2): 155-162
in English | IMEMR | ID: emr-75597

ABSTRACT

Diabetic Ketoacidosis [DKA], resulting from severe insulin deficiency, accounts for most hospitalization in type 1 DM. However, the frequency, distinguishing features and pathogenesis of this syndrome in type 2 DM remain to be defined. The study was performed to evaluate the role of some endogenous factors and hormones contributing in the vulnerability of some type 2 DM that developed DKA easily than other. The study was conducted on 80 known type 2 diabetic patients [45 males and 35 females], 48 of them were obese body mass index [BMI] > 30 kg/m[2], admitted to Al-Azhar University Hospitals [emergency department] with manifestations of DKA [group I] from July 2003 to January 2005, and 20 type 2 diabetic patients of the same duration of DM, without history of DKA, [group II] with age and sex matched [12 males and 8 females], 10 of them were obese, as controls. After complete clinical examination and routine laboratory investigations, which confirm the diagnosis of DKA, the following investigations were studied; serum glucagon, C-peptide, glutamic acid decarboxylase antibody [GAD-ab], and C-peptide / glucagon ratio, random blood sugar [RBS], renal and liver function tests, arterial blood gases [bicarbonate and pH], serum electrolyte [sodium, potassium and chloride], lipid profile, CBC, complete urine analysis with special attention to level of ketone bodies Serum levels of glucagon, RBS and urine ketone were significantly higher in-group I than group II, while serum levels of C-peptide, C-peptide / glucagon ratio, sodium, potassium, and bicarbonate were significantly lower in-group I than group II. On the other hand no significant differences in the age, sex, disease duration, GAD abs, lipid profile, blood pH and serum chloride between group I and II. In patients with DKA, the age, disease duration, C-peptide, glucagon and C-peptide / glucagon ratio were significantly lower in lean than obese parents [p<0.05] for all. While serum levels of GAD-abs were significantly higher in lean than obese patients [p<0.05]. Interestingly in patients without DKA, serum levels of C-peptide were significantly lower [p<0.05], while serum levels of GAD-abs were significantly higher in lean than obese patients [p<0.05] and no significant changes in other parameters between them. On the other hand C-peptide correlated negatively with glucagon [r=-650] and GAD abs [r=-684], while serum glucagon correlated positively with GAD-abs [r=644]. It could be concluded that the pathogenesis of ketosis in type 2 diabetes is triggered mainly by deficient endogenous insulin in lean patients [had a criteria of type 1 diabetes such as; younger age of onset of DKA short duration of disease, elevated GAD-abs and low C-peptide / glucagon ratio but still classified as type 2diabetes] and relative increase glucagon level activity in obese patietrts. However, the C-peptide / glucagon ratio is the main denominator or determinant factor for ketosis in type 2 diabetes mellitus


Subject(s)
Humans , Male , Female , Diabetic Ketoacidosis/physiopathology , Obesity , Body Mass Index , Insulin/deficiency , C-Peptide , Glucagon , Glutamate Decarboxylase , Blood Glucose , Blood Gas Analysis , Liver Function Tests , Electrolytes , Kidney Function Tests , Ketone Bodies
13.
Univ. med ; 44(2): 52-61, 2003. tab, graf
Article in Spanish | LILACS | ID: lil-395571

ABSTRACT

La cetoacidosis diabética usualmente se presenta por un estado de hiperglucemia crónico o mal manejado en pacientes con una diabetes incipiente o en pacientes diabéticos mal controlados. Dado que la morbimortalidad está relacionada no solamente con la gravedad de las alteraciones acido-base y de electrolitos sino con el manejo adecuado que de ello se haga, el tener unos parámetros claros para las diferentes intervenciones es fundamental para el éxito del tratamiento.


Subject(s)
Adolescent , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Child , Fluid Therapy , Insulin , Osmolar Concentration , Colombia
14.
J. bras. med ; 78(3): 37-40, mar. 2000. tab
Article in Portuguese | LILACS | ID: lil-289082

ABSTRACT

O autor faz uma revisão bibliográfica sobre conceitos atuais relativos ao tratamento da cetoacidose diabética, destacando as condutas atuais referentes à hidratação, uso de insulina e respectivas doses empregadas, vias de administração, emprego ou não de bicarbonato, colóides e cristalóides. Também alerta para as complicações do tratamento e como evitá-las


Subject(s)
Humans , Male , Female , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetes Mellitus/complications
17.
Med. interna Méx ; 13(1): 10-6, ene.-feb. 1997. tab, ilus
Article in Spanish | LILACS | ID: lil-226992

ABSTRACT

Es una revisión retrospectiva de los egresos y defunciones que ocurrieron en las unidades hospitalarias del Instituto Mexicano del Seguro Social de 1980 a 1993. Los diagnósticos de egreso y defunción fueron codificados de acuerdo con la lista tabular de la Clasificación Internacional de Enfermedades. Se consideraron el número de casos, egresos y defunciones por grupo de edad y sexo. Se calcularon tasas específicas por 1,000 egresos y por 100 defunciones hospitalarias. La tendencia fue calculada a través del análisis de regresión por mínimos cuadrados. Los resultados del análisis mostraron que la cetoacidosis representó el 3.02 y 6.47 por ciento del total de egresos y defunciones por diabetes y el 1.07 y 5.60 por ciento respectivamente en coma diabético. La tendencia de ambas afecciones mostró una reducción no significativa durante el periodo analizado. Los pacientes menores de 24 años de edad fueron el grupo predominante en los egresos por cetoacidosis y coma, pero en mortalidad los grupos de 25 a 34 años, y menores de 1 año y de 35 a 44 años en cetoacidosis y coma fueron los más representativos. En ambos grupos hubo un predominio en el sexo femenino (56 por ciento). El análisis del promedio de días de estancia hospitalaria no mostró cambios significativos durante este tiempo, aunque los casos de muerte en ambas enfermedades mostraron los promedios más bajos. Estos hallazgos indican que las complicaciones agudas no representan un problema mayor en la casuística de la diabetes mellitus, aunque un mejor control podría disminuir su frecuencia. Finalmente se hacen algunas consideraciones sobre los resultados del estudio y se toman en cuenta algunos puntos importantes en la fisiopatología, complicaciones y posibles causas de muerte


Subject(s)
Humans , Male , Female , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/mortality , Diabetic Coma/epidemiology , Diabetic Coma/physiopathology , Diabetic Coma/mortality , Diabetes Mellitus/complications , Diabetes Mellitus/epidemiology , Diabetes Mellitus/mortality , Hospital Mortality , Mortality
18.
Arch. med. res ; 27(2): 177-81, 1996. tab
Article in English | LILACS | ID: lil-200311

ABSTRACT

In this retrospective study, we report the clinical and biochemical features of diabetic ketoacidosis (DKA) in adult patients who were managed at the Instituto Nacional de la Nutricion during a 6.5 year period. There were 98 episodes in 46 patients: 22 females (48 per cent) and 24 males (52 per cent). Six patients (13 per cent) had four or more episodes of DKA were the initial manifestation of diabetes. We compared our results with those from other reported series, finding no differences among them. The mean anion gap in our series was 30.4. Main complications identified were hypokalemia in five cases, hypoglycemia in four cases hypernatremia in four cases, and acute pulmonary edema, ventricular fibrillation, neurological deficit and coma in one case each. There were three death (6.5 per cent) in the whole group. To our knowledge, this is the largest series on adult patients with DKA reported in our country in the last decade. The obtained results may help evaluate prospectively the impact of different diagnostic and therapeutic strategies in the management of DKA


Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Alcoholism/complications , Diabetic Ketoacidosis/physiopathology , Clinical Laboratory Techniques , Diabetes Mellitus/diagnosis , Insulin Resistance/immunology , Myocardial Ischemia/etiology , Pancreatitis/etiology
19.
Rev. méd. IMSS ; 33(3): 321-5, mayo-jun. 1995.
Article in Spanish | LILACS | ID: lil-174152

ABSTRACT

Es bien conocido el hecho de que en la diabetes mellitus totalmente desarrollada se produce una serie de alteraciones metabólicas que se traducen en complicaciones vasculares en el ojo y en el riñon y aumento en la frecuencia de enfermedad coronaria y vascular periférica entre otras. Aquí se describen algunos cambios que ocurren en distintos sitios corporales al inicio de la diabetes y que se asocian con alteraciones en la circulación, donde destacan los cambios en los eritrocitos, leucocitos y plaquetas, así como la viscosidad plasmática y sanguínea, además de cambios en las concentraciones de proteínas, lipoproteínas y lípidos


Subject(s)
Humans , Diabetic Ketoacidosis/physiopathology , Coronary Disease/etiology , Diabetes Mellitus/complications , Diabetes Mellitus/metabolism , Diabetic Neuropathies , Diabetic Nephropathies/etiology , Diabetic Retinopathy/etiology
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