Dieta cetogénica como factor desencadenante de cetoacidosis diabética euglucémica en un paciente en tratamiento con iSGLT2 / Ketogenic diet as a trigger for diabetic euglycaemic ketoacidosis in a patient under treatment with iSGLT2

La cetoacidosis diabética euglucémica es un posible efecto adverso de los inhibidores selectivos del cotransportador sodio-glucosa 2 (isGLT2) en pacientes con diabetes. Por otro lado, recientemente, las principales sociedades científicas han recomendado para el tratamiento de la diabetes dietas bajas o muy bajas en hidratos de carbono, que se han relacionado con la aparición de cetosis. La combinación del tratamiento con estos fármacos y el seguimiento de este tipo de dieta puede ser peligrosa. Presentamos el caso de un paciente de 64 años afecto de diabetes de tipo LADA, en tratamiento habitual con insulinoterapia intensiva en 4 dosis, quien, tras iniciar empagliflocina y una dieta muy baja en hidratos de carbono, en pocos días presentó una descompensación cetoacidótica euglucémica severa

Euglycaemic diabetic ketoacidosis is a possible adverse effect of selective sodium-glucose cotransporter inhibitors 2 (isGLT2) in patients with diabetes. However, the main scientific societies have recently recommended low or very low carbohydrate diets for the treatment of diabetes, relating the latter with the onset of ketosis. The combination of treatment with these drugs and following this type of diet can be dangerous. We present the case of a 64-year-old patient, suffering from LADA type diabetes, under usual treatment with intensive insulin therapy in 4 doses, who a few days after starting empagliflocin and a very low carbohydrate diet presented severe euglycaemic ketoacidotic decompensation

[Ketogenic diet as a trigger for diabetic euglycaemic ketoacidosis in a patient under treatment with iSGLT2]. / Dieta cetogénica como factor desencadenante de cetoacidosis diabética euglucémica en un paciente en tratamiento con iSGLT2.

Euglycaemic diabetic ketoacidosis is a possible adverse effect of selective sodium-glucose cotransporter inhibitors 2 (isGLT2) in patients with diabetes. However, the main scientific societies have recently recommended low or very low carbohydrate diets for the treatment of diabetes, relating the latter with the onset of ketosis. The combination of treatment with these drugs and following this type of diet can be dangerous. We present the case of a 64-year-old patient, suffering from LADA type diabetes, under usual treatment with intensive insulin therapy in 4 doses, who a few days after starting empagliflocin and a very low carbohydrate diet presented severe euglycaemic ketoacidotic decompensation.

Terapia nutricional en el paciente obeso con insulinorresistencia y riesgo cardiovascular / Nutritional therapy in the obese patient with insulin resistance and cardiovascular risk

En la actualidad cada una de las diferentes sociedades científicas aboga por un tipo u otro de recomendaciones nutricionales para el paciente con riesgo vascular. Esta gran variedad de dietas por un lado enriquecen las posibilidades terapéuticas nutricionales, pero por otro pueden conducir a cierta confusión, tanto para el paciente como para el profesional que las aconseja. Por otro lado, la mayoría de estudios que valoran riesgo vascular hacen mención a «la dieta», sin definir ni concretar a qué tipo de dieta se está haciendo referencia, introduciendo, por tanto, un importante sesgo en los resultados de dichos estudios. De hecho algunas de ellas guardan cierta contradicción. Esta revisión pretende aportar algo de luz en un tema tan controvertido

Currently, each of the different scientific societies advocate one kind or another nutritional recommendations for patients with vascular risk. This variety of diets on the one hand enrich the nutritional therapeutic possibilities, but on the other can lead to some confusion, both for the patient and for the professional that advises. Furthermore, most studies assessing vascular risk mention a "diet" without defining or specifying to which kind of diet they refer, thereby introducing an important bias in the results of those studies. In fact, some of them bear a degree of contradiction. This review aims to shed some light on such a controversial topic

[Nutritional therapy in the obese patient with insulin resistance and cardiovascular risk]. / Terapia nutricional en el paciente obeso con insulinorresistencia y riesgo cardiovascular.

Currently, each of the different scientific societies advocate one kind or another nutritional recommendations for patients with vascular risk. This variety of diets on the one hand enrich the nutritional therapeutic possibilities, but on the other can lead to some confusion, both for the patient and for the professional that advises. Furthermore, most studies assessing vascular risk mention a "diet" without defining or specifying to which kind of diet they refer, thereby introducing an important bias in the results of those studies. In fact, some of them bear a degree of contradiction. This review aims to shed some light on such a controversial topic.

[Intravenous cannulae: complications arising from their use and analysis of their predisposing factors]. / Cánulas intravenosas: complicaciones derivadas de su utilización y análisis de los factores predisponentes.

BACKGROUND: The aim of this study was to analyze the complications derived from the use of intravenous cannulae with particular attention being paid to the possible predisposing factors. METHODS: A prospective follow up of 569 intravenous cannulae placed in the emergency department or the medical ward of a county hospital was carried out. 492 of these cannulae were peripheral (PC) and 77 central inserted through peripheral veins (CPVC). RESULTS: Fifty-one percent of the catheters were withdrawn due to complications with the most frequent being phlebitis (35%), followed by extravasation (11.5%). The mean time in situ was 3.61 +/- 3.2 days. The daily risk of complications ranged from 2 to 9% for the CPVC (non significant differences) and between 15% (day 1) and 30% (6 or more days) for the PC. In the latter case there were no differences in the daily specific rate of complications after the first 24 hours. The probability of a catheter remaining in place more than three and six days without complications was 51% and 31%, respectively for the CP and 91% and 87% for the CPVC (p < 0.0001). Of the variables analyzed, age > 65 years, female sex, insertion of the cannula into the back of the hand, the fact of the route being peripheral without the administration of heparin were significantly associated to the development of complications, while the intravenous administration of aminophillin was associated with the appearance of phlebitis. Thirteen percent of the catheters withdrawn due to phlebitis were infected. CONCLUSIONS: The complication most frequent observed in intravenous cannulation was phlebitis, an entity which is generally not of an infectious nature. The risk of unspecific complications every day during catheterization is constant in the case of central peripheral vein cannulae as well as in peripheral cannulae which do show problems during the first 24 hours after placement. Insertion of the cannulae into the veins of the back of the hand, female sex, advanced age and intravenous administration of certain drugs influence in the development of phlebitis.

[Familial microepidemics of tuberculosis]. / Microepidemia familiar de tuberculosis.

We report a microepidemic of tuberculosis (TBC) in a family of 12 members, 4 of which were parenteral drug abusers and 3 had anti-human immunodeficiency virus (HIV) antibodies. Four new cases were simultaneously diagnosed in the investigation of the contacts of a patient with extrapulmonary tuberculosis and acquired immunodeficiency syndrome. We review the requirements for the development of these epidemic outbreaks, both in noninfected communities and in the family contacts, where positive anti-HIV antibodies may increase the risk. We emphasize the importance of a systematic study of contacts in these families and the indication of chemoprophylaxis in all those sharing the same household, without age limit.

Late-onset hypocalcemia appearing years after thyroid surgery.

We revised four cases of hypocalcemia diagnosed yr after thyroid surgery, including 1 man and 3 women, operated 5-23 yr before the onset of symptoms, which ranged from mild paresthesia to convulsive seizures. Total serum calcium levels ranged from 1.1 to 2.05 mmol/l, and PTH levels were low in the 3 cases in which they were measured. Hypoparathyroidism appearing as late-onset hypocalcemia after extense thyroid surgery is a poorly understood condition, perhaps not as unfrequent as it is considered.

A case with persistent nephrogenic diabetes insipidus following parathyroidectomy for hyperparathyroidism.

A 25-year-old woman with persistent nephrogenic diabetes insipidus (NDI) following parathyroidectomy for primary hyperparathyroidism is described. NDI is a well recognized complication of primary hyperparathyroidism, generally imputed to hypercalcemia, and promptly reversible after correcting it. In our case, the impaired concentrating ability of the renal tubule was irreversible after the removal of the parathyroid adenoma and the correction of the hypercalcemia, presumptively due to the morphological irreversible changes in the kidney. In addition, hypercalciuria persisted and was the cause of a compensatory hyperparathyroidism. Treatment with thiazide diuretic was effective to decrease relative hypercalciuria, thus reversing the compensatory hyperparathyroidism.