Accident and Emergency
Nagi Giumma Barakat in Get Through, 2006
27-29. For the following scenarios regarding epilepsy associated with metabolic disorders, choose the most appropriate investigations from the list below: A 2-week-old baby presents with a history of altered consciousness, hypertonia and opisthotonos with seizures. Blood amino acid chromatography shows an increase in branched amino acids, leucine, isoleucine and valine.A 4-day-old baby presents with hypothermia, is acidotic and dehydrated, exhibits loss of consciousness and starts to have generalized tonic clonic seizures. The EEG shows burst suppression. There is a characteristic odour of sweaty feet. There is ketonuria. There is a suspected diagnosis of iso-valeric acidaemia.A 2-week-old baby presents with vomiting, anorexia, somnolence and convulsions followed by coma. There is no acidosis or ketosis. The blood sugar is normal, and there is no organomegaly.
Features of Lipid Metabolism in Diabetes Mellitus and Ischemic Heart Disease
E.I. Sokolov in Obesity and Diabetes Mellitus, 2020
Since the glucose pool cannot be utilized completely in either the adipose or the muscle tissue, a diabetic situation arises proceeding with glycosuria. With pronounced hyperlipacidemia, insufficient burning up of fats occurs at the periphery, and next their input to the liver grows. The synthesis of triglycerides in the liver increases, which leads to metabolically caused fat dysfunction of the liver. A part of the fats synthesized in an excessive amount is excreted from the liver, so that hyperlipacidemia is followed by hyperlipoproteinemia. The peripheral utilization of glucose lowers, and clearing of the blood serum is slowed down because of the lack of lipoproteinlipase. Hyperlipacidemia results in the appearance of ketonemia and ketonuria. Fig. 13 shows various models of the reactions of glucose and fatty acids, namely, in healthy persons and with compensated and decompensated obesity.
Diabetes in Children
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Even a relatively minor illness in a child with diabetes can cause rapid deterioration in metabolic control. The stress of infection, surgery, injury, or severe emotional disturbance increases secretion of the stress or counterregulatory hormones: glucagon, epinephrine, growth hormone, and Cortisol. These hormones cause insulin resistance and tend to raise the blood glucose level. Despite reduced intake of carbohydrate associated with the underlying illness, blood glucose levels typically increase, and enhanced ketoacid production results in ketonuria. Unchecked, these metabolic disturbances can rapidly progress to DKA. The aim of sick day management, therefore, is to minimize deterioration of metabolic control and prevent DKA from developing. In addition to managing the diabetes, the underlying illness should be treated appropriately.
Advances in pharmacological treatment of type 1 diabetes during pregnancy
Published in Expert Opinion on Pharmacotherapy, 2019
Angelo Maria Patti, Rosaria Vincenza Giglio, Kalliopi Pafili, Manfredi Rizzo, Nikolaos Papanas
Recent NICE guidelines underscore the importance of providing ketonaemia dosing to women with type 1 diabetes in both planning and pregnancy [40,41]. Glycated haemoglobin as a guide to the management of gestational diabetes is often not enough and it is necessary to resort to the evaluation of ketone bodies (for potential damage on the newborn) on capillary blood. Frequent and prolonged ketosis can have adverse effects on the foetus and should be avoided during pregnancy; for this purpose, frequent controls of ketonuria and/or ketonaemia upon awakening should be performed. Patient plasma ketones may be underestimated by measurement of ketonuria alone. Therefore, plasma ketone dosage should be preferred to urinary ketone [42]. In this context, moreover, the recent NICE guidelines underline the importance of offering the ketonaemia assay to women with type 1 diabetes in both planning and pregnancy [40,41].
The incidence of biliary sludge in first trimester pregnancies with hyperemesis gravidarum and its effect on the course of hyperemesis gravidarum
Published in Journal of Obstetrics and Gynaecology, 2022
Aylin Saglam, Iris Derwig, Mekin Sezik, Sibel Cigdem Tuncer, Mustafa D. Ozcil, Burcu Kasap, Mesut Misirlioglu, Ender Alkan, Namık Ozkan
Serum levels of sodium, potassium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglyceride and cholesterol were tested in the first trimester in both groups. Serum triglyceride and cholesterol level measurements were carried out after 12 hours of overnight fasting. The presence of ketones in the urine was also tested in the study group, and ketonuria was graded as 1+, 2+ and 3+ by dipstick urine testing. Gestational age at delivery and neonatal birthweight were recorded. Low birthweight was defined as birthweight <2500 g, and small for gestational age (SGA) was considered when birthweight was <10th centile, using the Foetal Medicine Foundation online Birth Weight Assessment Calculator (https://fetalmedicine.org/research/assess/bw). Preterm delivery (PTD) was defined as all deliveries before 37 + 0 weeks of gestation.
The role of the clinical laboratory in diagnosing acid–base disorders
Published in Critical Reviews in Clinical Laboratory Sciences, 2019
In diabetic ketoacidosis, the AG plays an essential role in establishing the diagnosis, and normalization of the AG is used to confirm resolution of ketosis [106–108]. However, if available, the preferred test is to determine serum β-hydroxybutyrate (β-OHB) in all diabetic patients when ketoacidosis is suspected. A urine dipstick for ketones can be used to diagnose diabetic ketoacidosis, but it does not measure the concentration of β-OHB, the ketone body that plays an important role in the pathogenesis of diabetic ketoacidosis. In one study involving 265 diabetic patients, capillary ketone levels were high in 13% of the patients who had no ketonuria. Severe ketonemia was identified in 10% of these patients [109]. Urine ketones may also be detected in more than half of patients after the ketoacidosis is eliminated, giving the false impression that one should continue ketoacidosis treatment [110]. If capillary blood ketone bodies exceed 0.5 mmol/L, therapeutic management with insulin is indicated; for values greater than 3 mmol/L, hospitalization is indicated [111].
Related Knowledge Centers
- Acetoacetic Acid
- Fatty Acid
- Glucose
- Ketone Bodies
- Type 1 Diabetes
- Urine
- Liver
- Carbohydrate
- Fat
- Β-Hydroxybutyric Acid