Endocrinology and gonads
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
11.17. A 4-year-old boy presents with drowsiness, hyperpnoea and vomiting. He has been unwell for several days. Acetone can be smelt on his breath and the urine contains sugar in large quantities. Other clinical signs and symptoms associated with this disorder includeantecedent increase in thirst.antecedent weight loss.moderate to severe dehydration.constipation.Kussmaul breathing (deep sighing respiration).
Clinical features of malaria in children
David A Warrell, Herbert M Gilles in Essential Malariology, 2017
Metabolic acidosis carries a 24 per cent case fatality rate when it occurs alone, 35 per cent when associated with cerebral malaria and/or anaemia (Marsh et al., 1995). The most common clinical sign, deep (Kussmaul) breathing, occurs in nearly two-thirds of patients with acidosis. Acidaemia and hyperlactataemia may also be present, separately or together (Taylor et al., 1993; Krishna et al., 1994). Respiratory distress is not associated with abnormal pulmonary auscultatory or chest radiography findings, or with oxygen desaturation, and probably represents a compensatory response to the metabolic acidosis. Acidosis may be the sole presenting feature in a child with malaria; deep breathing (alar flaring, chest recession, indrawing of the bony structure of the lower chest wall on inspiration, the use of accessory muscles of respiration – see Plate 11) in this situation is a manifestation of falciparum malaria and not an indication of pulmonary pathology.
Methylmalonic acidemia
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
During episodes of ketosis, acidosis may be extreme. Arterial pH values as low as 6.9 have been recorded, and the serum bicarbonate is often 5 mEq/L or less. Ketosis is massive. Hypoglycemia has been observed and has led to seizures during acute episodes. Elevated concentrations of glycine in the blood and urine may be striking, and this may be an early clue to the diagnosis. Concentrations of glycine as high as 1500 μmol/L have been observed in the plasma. However, concentrations of glycine may also be normal, even in the same patient. Hyperammonemia may complicate the initial episode in which levels may be as high as in urea cycle defects and lead to deep coma and apnea [24, 25]. With development, this propensity to hyperammonemia is lost, and acute episodes after the first year are seldom complicated by hyperammonemia [24]. The typical acute episode of disease with massive ketosis has led us to examine the urine for ketones in any acidotic infant. In addition, in management we provide ketostix to parents and instruct them to test for ketones at any sign of illness, especially infections; on the other hand, this too can be misleading. We are currently following an adult with mut0 methylmalonic acidemia who develops acute episodes of acidosis with no ketonuria. Kussmaul breathing is still an alerting feature.
COVID-19 and hyperglycaemic emergencies: perspectives from a developing country
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2022
Raisa Bhikoo, Marli Conradie-Smit, Gerhard Van Wyk, Sa’ad Lahri, Elizabeth Du Plessis, Jaco Cilliers, Susan Hugo, Ankia Coetzee
Clinical examination revealed an acutely unwell patient, with Kussmaul breathing and tachypnoea. The oxygen saturation was 83% in ambient air with a BP of 153/100 mmHg and a sinus tachycardia (HR 127 bpm). Fingerpick glucose was 27 mmol/l. She had marked central obesity but did not have an accurate BMI available. Fine bi-basal inspiratory crackles were audible on chest auscultation with no signs indicative of left ventricular dysfunction. Her GCS fluctuated between 12 and 14 with no lateralising signs.
Severe methanol intoxication with atypical symptoms and imaging changes: a fatal case report
Published in British Journal of Neurosurgery, 2023
Jiaqi Chen
A 51-year-old male was admitted with sudden onset of dizziness for two days. He denied recurrent postural dizziness and any headache, nausea, vomiting, abdominal pain, blurred vision, slurred speech, fever, or chills. Neurological examination and computed tomography of brain showed no obvious abnormalities. The diagnosis of posterior circulation ischemia was considered. Two hours later, the patient suddenly developed delirium progressing to coma. Meanwhile, he experienced frequent twitching of the limbs and facial cyanosis. He developed bilateral unreactive pupil dilation. As the condition rapidly progressed, a diagnosis of aneurysm rupture was considered but CT angiography (CTA) indicated no significant abnormalities. At this point the patient developed Kussmaul breathing and hypothermia and a further history of long-term drinking became available. Fundus examination revealed oedematous optic disks with dilated peripapillary vessels and arterial blood gas analysis showed a high anion-gap metabolic acidosis (pH 6.71, PCO2 34.2 mmHg, HCO3– 4.2 mmol/l, Cl– 103mmol/l, K+ 6.5mmol/l). Therefore acute methanol intoxication was suspected and a blood sample was sent for Centers for Disease Control (CDC) measuring the serum methanol level, which was high (450 mg/L, reference level<2.9 mg/L). He was transferred to intensive care unit and intubated. Hemodialysis was initiated to help correct the severe acidosis and eliminate both methanol and its metabolites (formic acid or formate). After hemodialysis, the methanol level fell to 17mg/L. But his conscious level deteriorated to a Glasgow Coma Scale of 3 with pupils dilated and fixed. CT brain demonstrated extensive subarachnoid hemorrhage, diffuse cerebral edema, lateral ventricular compression and ambient cistern effacement (Figure 1). Hemodialysis was continued until methanol was undetectable. Unfortunately, the patient’s condition did not improve and he died on the ninth day due to cardiopulmonary arrest.
Related Knowledge Centers
- Metabolic Acidosis
- Diabetic Ketoacidosis
- Kidney Failure
- Hyperventilation
- Physician
- Diabetes
- Kussmaul'S Sign
- Respiration
- Carbon Dioxide
- Bicarbonate