A case of diabetic ketoacidosis and hyperosmolar hyperglycemic state complicated with iatrogenic left femoral arterial thrombosis in a 14-year-old girl with newly diagnosed type 2 diabetes mellitus

Although diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality of type 1 diabetes mellitus, DKA also occurs in ketosis-prone type 2 diabetes. Recently, cases of DKA associated with hyperosmolar hyperglycemic state (HHS) have been reported in adolescents. We reported a 14-year-old girl with newly diagnosed type 2 diabetes mellitus-associated DKA and HHS complicated with iatrogenic left femoral arterial thrombosis, requiring a below-knee amputation. In DKA and HHS, risk factors for thrombosis, vascular access predisposes patients to thrombosis. Consequently, occurrence of thrombosis should be monitored in patients with DKA or HHS.

A case of diabetic ketoacidosis and hyperosmolar hyperglycemic state complicated with iatrogenic left femoral arterial thrombosis in a 14-year-old girl with newly diagnosed type 2 diabetes mellitus

Although diabetic ketoacidosis (DKA) is a major cause of morbidity and mortality of type 1 diabetes mellitus, DKA also occurs in ketosis-prone type 2 diabetes. Recently, cases of DKA associated with hyperosmolar hyperglycemic state (HHS) have been reported in adolescents. We reported a 14-year-old girl with newly diagnosed type 2 diabetes mellitus-associated DKA and HHS complicated with iatrogenic left femoral arterial thrombosis, requiring a below-knee amputation. In DKA and HHS, risk factors for thrombosis, vascular access predisposes patients to thrombosis. Consequently, occurrence of thrombosis should be monitored in patients with DKA or HHS.

Erratum: Correction of Title. Longitudinal Standards for Height and Height Velocity in Korean Children and Adolescents: the Kangwha Cohort Study

We found an title error in our published article.

Longitudinal Standards for Height and Height Velocity in Korean Children and Adolescents: the Kangwha Cohort Study

Longitudinal standards for height and height velocity are essential to monitor for appropriate linear growth. We aimed to construct standards in Korean children and adolescents through the population-based longitudinal Kangwha study. Our study was a part of a community-based prospective cohort study from 1986 to 1999 with 800 school children. Height and height velocity were recorded annually from age 6 until final height. Results were compared with cross-sectional data from the 2007 Korean National Growth Charts. Final height was 173.5 cm in boys and 160.5 cm in girls. Although final height was similar between longitudinal and cross-sectional standards, the mean height for age was higher in the longitudinal standard by 1-4 cm from age 6 until the completion of puberty. Using the longitudinal standard, age at peak height velocity (PHV) was 12 in boys and 10 in girls; height velocity at PHV was 8.62 cm/yr in boys and 7.07 cm/yr in girls. The mean height velocity was less than 1 cm/yr at age 17 in boys and 15 in girls. Thus, we have presented the first report of longitudinal standards for height and height velocity in Korean children and adolescents by analyzing longitudinal data from the Kangwha cohort.

Hemoglobin A1c in the Screening of Obesity-Related Diseases in Children and Adolescents

PURPOSE: The aim of this study is to investigate differences in hemoglobin A1c (HbA1c) levels according to degree of obesity, clinical findings on HbA1c 5.7% and factors affecting HbA1c in growing children and adolescents. METHODS: 168 children and adolescents (M/F, 93/75; age, 10.2+/-2.6 years) who visited an obesity clinic were included in the study. Participant's body mass index (BMI), percent weight for height (PWH), height z score (HTZ), weight z score (WTZ), and BMI z score (BMIZ) were calculated. Their blood glucose, insulin, total cholesterol, triglyceride, HDL-cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3) levels were checked. Confirmed cases of diabetes and endocrine disease were excluded. Participants were divided into two groups based on whether their HbA1c levels were higher or lower than 5.7%. The difference in HbA1c between the groups based on the BMIZ 2 and PWH 20 were analyzed. A correlation analysis involving HbA1c and metabolic parameters was conducted, and factors contributing to HbA1c were evaluated through a regression analysis. RESULTS: HbA1c was higher in subjects with impaired fasting glucose (5.3+/-0.3, 5.4+/-0.2; P = 0.018). HbA1c and the homeostasis model assessment of insulin resistance (HOMA-IR) were not significantly different in the groups based on BMIZ 2.0. Based on PWH 20, HOMA-IR was significantly different (1.8+/-0.7, 2.3+/-1.1; P < 0.05), although HbA1c was not. Levels of TG (107.4+/-69.4, 154.1+/-77.7; P = 0.006), HDL-C (53.6+/-11.9, 47.4+/-6.6; P = 0.024), AST (29.7+/-11.4, 39.2+/-24.6; P = 0.004), and ALT (32.4+/-32.0, 53.9+/-58.8; P = 0.014) indicated significant differences between the groups. There were positive correlations between HbA1c and height, weight, BMI, gender, AST, ALT, glucose, and HOMA-IR, but no significant correlation with HTZ, WTZ, and BMIZ. The contributing factors for HbA1c were gender, ALT, BMI, and IGFBP-3. CONCLUSIONS: HbA1c level is associated with metabolic syndrome parameters, but is not correlated with degree of obesity. Along with HbA1c, other factors should be considered in evaluating the risk of complications related to obesity in children and adolescents.

Hemoglobin A1c in the Screening of Obesity-Related Diseases in Children and Adolescents

PURPOSE: The aim of this study is to investigate differences in hemoglobin A1c (HbA1c) levels according to degree of obesity, clinical findings on HbA1c 5.7% and factors affecting HbA1c in growing children and adolescents. METHODS: 168 children and adolescents (M/F, 93/75; age, 10.2+/-2.6 years) who visited an obesity clinic were included in the study. Participant's body mass index (BMI), percent weight for height (PWH), height z score (HTZ), weight z score (WTZ), and BMI z score (BMIZ) were calculated. Their blood glucose, insulin, total cholesterol, triglyceride, HDL-cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3) levels were checked. Confirmed cases of diabetes and endocrine disease were excluded. Participants were divided into two groups based on whether their HbA1c levels were higher or lower than 5.7%. The difference in HbA1c between the groups based on the BMIZ 2 and PWH 20 were analyzed. A correlation analysis involving HbA1c and metabolic parameters was conducted, and factors contributing to HbA1c were evaluated through a regression analysis. RESULTS: HbA1c was higher in subjects with impaired fasting glucose (5.3+/-0.3, 5.4+/-0.2; P = 0.018). HbA1c and the homeostasis model assessment of insulin resistance (HOMA-IR) were not significantly different in the groups based on BMIZ 2.0. Based on PWH 20, HOMA-IR was significantly different (1.8+/-0.7, 2.3+/-1.1; P < 0.05), although HbA1c was not. Levels of TG (107.4+/-69.4, 154.1+/-77.7; P = 0.006), HDL-C (53.6+/-11.9, 47.4+/-6.6; P = 0.024), AST (29.7+/-11.4, 39.2+/-24.6; P = 0.004), and ALT (32.4+/-32.0, 53.9+/-58.8; P = 0.014) indicated significant differences between the groups. There were positive correlations between HbA1c and height, weight, BMI, gender, AST, ALT, glucose, and HOMA-IR, but no significant correlation with HTZ, WTZ, and BMIZ. The contributing factors for HbA1c were gender, ALT, BMI, and IGFBP-3. CONCLUSIONS: HbA1c level is associated with metabolic syndrome parameters, but is not correlated with degree of obesity. Along with HbA1c, other factors should be considered in evaluating the risk of complications related to obesity in children and adolescents.

Proton-Pump Inhibitor-Induced Hypocalcemia and Hypomagnesemia

A 7-day-old female neonate who visited emergency depar tment due to generalized tonic seizure. Laboratory test results showed hypocalcemia (5.7 mg/dL), hypomagnesemia (0.55 mmol/L), low parathyroid hormone (7.5 pg/mL), and normal 25(OH) vitamin D3. Symptom and metabolic abnormalities were normalized with intravenous calcium gluconate and magnesium sulfate. Discharged with supplement of oral calcium, vitamin D, phenobarbital, and lansoprazol, she was re-admitted with hypocalcemia (4.8 mg/dL) with normal level of parathyroid hormone (12.3 pg/mL). Hypocalcemia was resolved with discontinuation of proton pump inhibitor. We report a case of recurrent hypocalcemia and hypomagnesemia due to proton-pump inhibitor.

Adolescent Build Plotting on Body Composition Chart and the Type of Diabetes Mellitus

Although the prevalence of type 2 diabetes is increasing, there are cases difficult to categorize into certain type in pediatric diabetic patients. The aims of this study were to detect and choose a proper treatment modality for atypical cases of diabetes mellitus, using the body composition chart. We conducted a retrospective study from August 2005 to 2012 with patients who visited Konkuk University Medical Center, and were diagnosed with diabetes mellitus. The medical records were reviewed for the anthropometric data and indices of body composition. The subjects were grouped by the type of diabetes and gender. We constructed a body composition chart plotting fat free mass index and fat mass index (FMI). Body mass index and all body composition indices were higher in type 2 diabetes, in each gender in analysis with Mann-Whitney test. Significant determinant of diabetes type was revealed as FMI and contributing factors on FMI were analyzed with regression analysis. Six atypical cases were identified by a body composition chart including non-obese type 2 diabetes showing suboptimal growth with lower BMI related to relatively lower insulin secretion and type 1 diabetes with insulin resistance resulted from obesity. Body composition chart analysis might be useful in characterization of diabetes type and detection of atypical cases and early adjustment of diabetes management strategy.

Adolescent Build Plotting on Body Composition Chart and the Type of Diabetes Mellitus

Although the prevalence of type 2 diabetes is increasing, there are cases difficult to categorize into certain type in pediatric diabetic patients. The aims of this study were to detect and choose a proper treatment modality for atypical cases of diabetes mellitus, using the body composition chart. We conducted a retrospective study from August 2005 to 2012 with patients who visited Konkuk University Medical Center, and were diagnosed with diabetes mellitus. The medical records were reviewed for the anthropometric data and indices of body composition. The subjects were grouped by the type of diabetes and gender. We constructed a body composition chart plotting fat free mass index and fat mass index (FMI). Body mass index and all body composition indices were higher in type 2 diabetes, in each gender in analysis with Mann-Whitney test. Significant determinant of diabetes type was revealed as FMI and contributing factors on FMI were analyzed with regression analysis. Six atypical cases were identified by a body composition chart including non-obese type 2 diabetes showing suboptimal growth with lower BMI related to relatively lower insulin secretion and type 1 diabetes with insulin resistance resulted from obesity. Body composition chart analysis might be useful in characterization of diabetes type and detection of atypical cases and early adjustment of diabetes management strategy.

Growth Status and Body Composition in Children with Central Precocious Puberty and Early Puberty

PURPOSE: The aim of this study was to analyze the growth status and body composition in children with central precocious puberty (CPP ) and early puberty (EP). METHODS: One hundred and five girls (mean age, 7.7 +/- 0.8 years) with early thelarche were included, and a gonadotropin-releasing hormone (GnRH) stimulation test was performed. We divided the subjects into two groups based on peak leuteinizing hormone (LH) levels; peak LH level > or = 5 mIU/L was diagnosed as CPP (n = 49), and peak LH level < 5 mIU/L was diagnosed as EP (n = 56). Patients' height, weight, and body composition were measured, and their body mass index (BMI) and Z-score were calculated. Fat mass (FF), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), and percent of body fat (PBF) were compared. RESULTS: Height, weight, and height Z-score were not significantly different between the CPP and EP groups. Weight Z-score (P = 0.045), BMI (P = 0.015), BMI Z-score (P = 0.006), PBF (P = 0.018), FM (P = 0.047), and FMI (P = 0.017) in the EP group were significantly greater than in the CPP group. CONCLUSION: In EP girls, increased BMI was attributed to increased FMI. Body-composition analysis might be a useful tool in monitoring life style modification during pubertal growth.

Growth Status and Body Composition in Children with Central Precocious Puberty and Early Puberty

PURPOSE: The aim of this study was to analyze the growth status and body composition in children with central precocious puberty (CPP ) and early puberty (EP). METHODS: One hundred and five girls (mean age, 7.7 +/- 0.8 years) with early thelarche were included, and a gonadotropin-releasing hormone (GnRH) stimulation test was performed. We divided the subjects into two groups based on peak leuteinizing hormone (LH) levels; peak LH level > or = 5 mIU/L was diagnosed as CPP (n = 49), and peak LH level < 5 mIU/L was diagnosed as EP (n = 56). Patients' height, weight, and body composition were measured, and their body mass index (BMI) and Z-score were calculated. Fat mass (FF), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), and percent of body fat (PBF) were compared. RESULTS: Height, weight, and height Z-score were not significantly different between the CPP and EP groups. Weight Z-score (P = 0.045), BMI (P = 0.015), BMI Z-score (P = 0.006), PBF (P = 0.018), FM (P = 0.047), and FMI (P = 0.017) in the EP group were significantly greater than in the CPP group. CONCLUSION: In EP girls, increased BMI was attributed to increased FMI. Body-composition analysis might be a useful tool in monitoring life style modification during pubertal growth.

Identification of a Novel Mutation in the ATP7A Gene in a Korean Patient with Menkes Disease

Menkes disease is an infantile-onset X-linked recessive neurodegenerative disorder caused by diverse mutations in a copper-transport gene, ATP7A. Affected patients are characterized by progressive hypotonia, seizures, failure to thrive and death in early childhood. Here, we report a case of Menkes disease presented by intractable seizures and infantile spasms. A 3-month-old male infant had visited our pediatric clinic for lethargy, floppy muscle tone, poor oral intake and partial seizures. His hair was kinky, brown colored and fragile. Partial seizures became more frequent, generalized and intractable to antiseizure medications. An EEG showed frequent posteriorly dominant generalized spikes that were consistent with a generalized seizure. From a genetic analysis, a c.2743C>T (p.Gln915X) mutation was detected and diagnosed as Menkes disease. The mutation is a novel one that has not been previously reported as a cause of Menkes disease.

Body Composition Analysis in Newly Diagnosed Diabetic Adolescent Girls / 대한소아내분비학회지

PURPOSE: The objective of this study was to determine the type differences of diabetes by analyzing the growth status and body composition of newly diagnosed diabetic adolescent girls. METHODS: The study included 6 type 1 diabetic adolescent girls (age 11.7 +/- 1.9 years) and 6 type 2 diabetic adolescent girls (age 14.4 +/- 2.6 years). The height, weight and body composition of fat mass and fat-free mass were measured in each patient. Body mass index (BMI), fat mass index (FMI), fat free mass index (FFMI) and percent body fat (PBF) were calculated and each component was plotted on a body composition chart. RESULTS: Type 2 diabetic adolescent girls seemed to be taller and heavier compared to type 1 diabetic girls, but the differences in height and weight z-score were not significant. BMI, FFMI, FMI, PBF were also higher in type 2 diabetic girls. The body composition chart revealed that type 2 diabetic girls had significantly higher FMI and PBF. In type 1 diabetic girls, FFMI was lower compared to type 2 diabetic girls. The BMI difference between diabetes types was explained with the difference in FFMI as well as FMI. CONCLUSION: The components of body composition differ according to diabetes type in adolescent girls. Measuring the body composition of diabetic girls might help to promote growth and adequate FFM gain during childhood. In diabetes control, diet and exercise should be emphasized along with insulin treatment.