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Diabetic Ketoacidosis and Hyperosmolar Coma
Published in Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu, Medical Management of Diabetes Mellitus, 2000
It is usually not difficult to differentiate among the different causes of diabetic coma. Whereas acidosis causes a negative inotropic effect and peripheral vasodilation, such that patients in DKA have warm skin, those in NKH have normal skin temperature, higher blood glucose levels, and more profound dehydration, with no or trace ketones found in the blood. Alternatively hypoglycemic coma can be distinguished by the lower blood glucose level (usually less than 50 mg/dL) and the presence of cold and clammy extremities. If there is any doubt about the cause of coma, low or high glucose levels, 20 mL of 50% glucose can be given intravenously. Other causes of acidosis with an increased anion gap include lactic acidosis, uremia, and ingestion of salicylates or methanol. Plasma ketones may be mildly positive in severe lactic acidosis, but in these other causes of acidosis including lactic acidosis, the blood glucose is not as elevated as those values found in DKA.
Diabetes
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
Ketones form when the body cannot utilize glucose to supply energy. Although the presence of low levels of ketones is not dangerous when glucose levels are normal, when fewer calories are consumed the body breaks down excess stored fat. The production of ketones (ketosis) alters the acid base (pH) chemistry when the body cannot eliminate these by-products rapidly enough or when too many are produced, resulting in a high-acid state called ketoacidosis. Ketosis is the accumulation of ketones in the body from the incomplete metabolism of fatty acids. It is generally caused by carbohydrate deficiency or inadequate utilization and an abnormal state of acidity due to rapid and incomplete breakdown of fat (Campaigne & Lampman, 1994). The presence of ketones is a sign that diabetes is poorly controlled, requiring prompt attention. This is a life-threatening situation that calls for immediate medical attention and the administration of insulin to restore proper chemistry, regulating the amount of glucose and insulin in the blood. When the chemistry of the body is affected by the production of ketones, the blood sugar level is dangerously high and dehydration occurs. A medical emergency called hyperglycemia occurs, which may lead to diabetic coma. Hyperglycemia, excess sugar in the blood, usually develops gradually over a longer period of time. A diabetic coma will occur when too much sugar remains in the blood because there is insufficient insulin to use it properly (NIH, 2016). The detection of hyperglycemia is quite difficult but is usually characterized by fatigue and lethargy. The most prevalent sign may be the “fruity” odor of the diabetic’s breath. Individuals with diabetes are especially prone to hyperglycemia when insulin is omitted, during infections, in periods of stress, and when there is a minimal compliance to diet.
Interference of altered plasma trace elements profile with hyperhomocysteinemia and oxidative stress damage to insulin secretion dysfunction in Psammomys obesus: focus on the selenium
Published in Archives of Physiology and Biochemistry, 2023
Asma Bouazza, Eric Fontaine, Xavier Leverve, Elhadj-Ahmed Koceir
As shown in Table 1, when the P. obesus is fed to a synthetic-chow diet, it develops insulin resistance (elevated HOMA-IR index), glucose intolerance (increased HbA1c levels), dyslipidemia, and progressively insulinopenic and hyperglycaemic in end-stage. Bodyweight (BW) and visceral adipose tissue (VAT) mass are significantly increased, reflecting the increasing body mass index (BMI) in groups II and III compared to the control group (p < .001). Over 9 months, approximately 15% of diabetic’s P. obesus (group IV) develops insulin-deficiency with ketoacidosis. BW and BMI are significantly drastic decreased (p < .001). Fat storage (VAT) has completely disappeared in group IV and plasma insulin levels declined gradually. Dyslipidemia was especially due to triglycerides and NEFA increase becomes paroxystic levels. In addition, the hepatic mass increase together with triglycerides accumulation was obviously indicative of severe liver deterioration in diabetic P. obesus groups IV versus the control group. This fact was supported by a drastic increase of transaminases activity in ALT and AST (Table 1). Most P. obesus of group IV required insulin treatment for survival (10 to 20 units) and without insulin treatment, the gerbils died in ketosis diabetic coma. In contrast, on a halophilic plant diet; P. obesus does not reveal impaired glucose tolerance, hyperinsulinemia or plasma lipid impairments.
Fifty years of experience with loxapine for the rapid non-coercive tranquilization of acute behavioral disturbances in schizophrenia patients, and beyond
Published in Expert Review of Neurotherapeutics, 2022
Philippe Nuss, Emmanuelle Corruble, Emmanuelle Baloche, Ricardo P. Garay, Pierre-Michel Llorca
Cousin et al. [19] conducted an observational, prospective study in France, evaluating the safety of loxapine in 645 adult patients with schizophrenia. The patients had been treated with loxapine daily for at least 4 months regardless of the dosage or the galenic form used; they were followed on an outpatient basis or during hospitalization. During the inclusion in the study, 84 non-serious side effects were declared by 69 participants (mainly EPS and sedation). During a 6-month follow-up, 92 participants presented non-serious side effects (Table 6), and two participants presented serious side effects (abnormal weight gain and hyperosmolar diabetic coma). Psychoneurological disorders (EPS and sedation) were seen in 9% of the participants. The second more frequent side-effect observed was metabolic and nutritional disorder (2.3%) with weight gain under treatment. Other side effects of FGAPs were less frequent (dry mouth, visual disturbances). In almost all cases, the two main groups of side effects (psychoneurological disturbances and metabolic disturbances) were correlated with treatments combining several antipsychotics [19].
The efficacy and safety of luseogliflozin and sitagliptin depending on the sequence of administration in patients with type 2 diabetes mellitus: a randomized controlled pilot study
Published in Expert Opinion on Pharmacotherapy, 2019
Masahiro Takihata, Yasuo Terauchi
The inclusion criteria included men and women with T2DM aged >20 years whose diabetes had been inadequately controlled (HbA1c ≥6.5%) with conventional therapy. Patients were excluded if they had type 1 diabetes mellitus; had severe ketosis, diabetic coma, or precoma within 6 months; had severe infection, were perioperative, or with severe trauma; were hypersensitive to ingredients of the drug used or its excipient; had severe renal dysfunction (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2), terminal renal failure, or were undergoing dialysis; had severe hepatic dysfunction; were pregnant or breast-feeding; or were considered inappropriate to participate in the study by the principal investigator or sub-investigator. All the patients received an explanation of the study by using an informed consent form and gave written consent on study participation. The study protocol was compliant with the ethical principles of the Declaration of Helsinki and was approved by the ethics committee of the Miura Central Clinic.