Nontraumatic rhabdomyolysis during diabetic ketoacidosis.

The frequency of nontraumatic rhabdomyolysis in diabetic ketoacidosis was investigated by serial measurements of the serum levels of myoglobin and the serum activity of creatine kinase isoenzyme MM in 12 consecutively admitted ketoacidotic patients. In 5 patients (Group 1) we found hypermyoglobinaemia and elevated activity of creatine kinase isoenzyme MM on admission to hospital, whereas these two variables were normal in 7 patients (Group 2). On admission significantly higher median blood glucose levels and higher median serum osmolality were found in Group 1 than in Group 2 (for blood glucose: 49.6 mmol/l versus 19.0 mmol/l, p less than 0.02; for serum osmolality: 360 mosm/kg H2O versus 315 mosm/kg H2O, p less than 0.05). Decreased renal function was found in Group 1 as reflected by significantly higher beta 2-microglobulin serum concentrations in Group 1 compared with Group 2 on admission (median values 4.1 mg/l versus 1.7 mg/l, p less than 0.01) and during the first 3 days of therapy. The serum concentration of hypoxanthine (an indicator of the cellular energy state) was elevated in all patients on admission, with no difference between patients with or without hypermyoglobinaemia. In conclusion, our findings suggest that nontraumatic rhabdomyolysis with hypermyoglobinaemia and elevated serum activity of creatine kinase isoenzyme MM may be a hitherto unrecognized common feature of diabetic ketoacidosis.

Lipid pattern of plasma in the presence of episcleral lipid deposits.

Examination of 40 subjects aged under 70 with episcleral lipid deposits revealed an abnormal serum lipid pattern in 48% of all. No correlation was noticed between the number of lipid deposits and the raised plasma lipid concentration or the distribution of fatty acids (saturated, unsaturated).

Hyperamylasemia, specific pancreatic enzymes, and hypoxanthine during recovery from diabetic ketoacidosis.

The contribution of the exocrine pancreas to hyperamylasemia in diabetic ketoacidosis was investigated by measuring total amylase, salivary and pancreatic isoamylases, cathodic trypsin-like immunoreactivity, and pancreatic lipase in 12 consecutive patients recovering from diabetic ketoacidosis. Hyperamylasemia was present in six of the patients [50%; expected incidence: 21.1-78.9% (95% confidence limits)]--in five with simultaneously increased activities of all three specific pancreatic enzymes, and in one with only increased salivary isoamylase. The serum concentration of hypoxanthine--an indicator of the cellular energy state--was above normal in all patients at admission. We found no differences in concentrations of hypoxanthine in serum of patients with or without hyperamylasemia or in patients with or without increases in the specific pancreatic enzymes. In none of the patients was the clinical course or the time--concentration curves of the pancreatic enzymes consistent with acute pancreatitis. The pathogenic mechanism leading to hyperamylasemia in diabetic ketoacidosis remains uncertain.

Plasma lipids and lipoproteins in young patients with brain infarction.

Thirty-two patients aged 60 or less with brain infarction were examined with regard to possible changes in lipoprotein pattern as compared with a reference group. Except for a lower concentration of total lipids, cholesterol and high-density lipoproteins in the female patients, no difference was demonstrated in the two groups. In all patients a significant reduction in total lipids, cholesterol, triglyceride and all lipoproteins was demonstrated after the acute cerebrovascular accident presumedly due to the stress situation.

Profile analysis of blood proteins with a centrifugal analyzer.

We describe a procedure for routine analysis of a profile composed of eight blood proteins with a GEMSAEC centrifugal analyzer. The end-point technique is used and four standards are included in each run in the immunochemical analysis of the individual proteins. Additional computer programs fit the absorbance readings from the samples to the (nonlinear) standard curve and store the results in a patient's file for a final printout, which also presents the patient's data and reference values. The proteins are analyzed in a given order, which allows common blank runs to be used. Antisera are used in suitably high concentrations, so that the "antigen in excess" problem only appears for analysis of IgA and IgM when sera contain high amounts of the M-components of these two classes. The capacity, accuracy, and precision of the method are satisfactory.

Fatty acid composition of the plasma lipids in Greenland Eskimos.

Gas-liquid chromatography analyses have been carried out to investigate the composition of esterified fatty acids in the plasma lipids in 130 Greenland Eskimos, compared with those of 32 Greenland Eskimos living in Denmark and of 31 Caucasian Danes in Denmark. While the Eskimos living in Denmark did not differ substantially from other persons living in Denmark and, from what is found in other studies in Western communities, the Greenland Eskimos showed a completely different pattern. They demonstrated a much higher proportion of palmitic, palmitoleic, and timnodonic acids, while they had a markedly lower concentration of linoleic acid. The total concentration of polyunsaturated fatty acids was lower in Greenland Eskimos than in the other groups. These findings are discussed in the light of the generally accepted opinion of the beneficial effect on plasma lipid levels and on the morbidity of coronary atherosclerosis of a high dietary intake of polyunsaturated fatty acids. As plasma lipid and lipoprotein levels in Greenland Eskimos in a previous study were found markedly lower than those found in Western populations, and as coronary atherosclerosis seems to occur far less commonly among Eskimos in Greenland than among peoples in industrialized countries, it was found difficult to combine these observations with the results from the present study. If dietary differences are the main reason for the differences in plasma lipid concentrations, the results from the present study point more toward qualitative than toward quantitative differences in respect of fatty acid composition of the food.

Immunochemical determination of serum albumin with a centrifugal analyzer.

The turbidity resulting from the reaction between albumin and specific anti-human serum was measured with a good precision by using a GEMSAEC centrifugal analyzer. The reaction was enhanced by polyethylene glycol to shorten the reaction time (5 min) and to displace the point of equivalence between antigen and antibody to an albumin concentration unlikely to occur in human sera (about 100 g/liter). An additional program for the computer was necessary to fit the absorbance readings of individual sera to the nonlinear standard curve. Serum albumin values obtained by the described method correlated well with values obtained by the electro-immuno-technique. About 100 samples could be analyzed per hour, 500 mul of 100-fold diluted antiserum being used per specimen.