1/33. An unusual complication of subclavian vein catheterization for total parenteral nutrition.A 25-year-old woman with diabetic ketoacidosis and esophagitis was given total parenteral nutrition to improve her nutritional status. A central venous catheter inserted in the right subclavian vein was well tolerated for three weeks, when infection developed. The line was replaced by a left subclavian line. Within an hour the patient complained of back pain. A chest x-ray film showed that the tip of the catheter was to the left of the mediastinum and that left pleural effusion was present. The line was removed and 1,500 cc of fluid was removed from the left pleural space. The pleural fluid cleared gradually over several days and the patient became asymptomatic.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
2/33. Brachial plexopathy in diabetic ketoacidosis.We report the clinical and electrodiagnostic findings of a 39-year-old patient who presented with severe, bilateral and asymmetrical, axon-loss brachial plexopathies occurring in the midst of diabetic ketoacidosis. This patient's unusual presentation is not consistent with the rare diabetic polyradiculopathy of the upper extremities usually occurring in association with diabetic amyotrophy.- - - - - - - - - - ranking = 5keywords = ketoacidosis (Clic here for more details about this article) |
3/33. The antiphospholipid symdrome in a teenage with miscarriages, thromboses, and diabetes mellitus.The antiphospholipid syndrome has been associated with many clinical conditions since its description by GRV Hughes in 1983. The linkage to Type 1 diabetes mellitus has not been established. There have been no reports of deep venous thrombosis in association with antiphospholipid syndrome and diabetes mellitus. We present the case of an African-American teenager with multiple miscarriages, diabetic ketoacidosis, deep venous thromboses, and elevated immunoglobulin m and G anticardiolipin antibodies. We urge that clinicians consider testing for antiphospholipid antibodies when diabetic patients present with multiple miscarriages or deep venous thrombosis.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
4/33. Pulmonary mucormycosis in a diabetic patient.We present the case of a 54 year-old male from Moldavia with diabetes mellitus (type II diabetic), admitted to hospital in January 1999, with ketoacidosis and consolidation of the lower left lobe. The diagnosis of mucormycosis was confirmed by identification of large, nonseptate hyphae of the order mucorales. A strain of rhizopus oryzae (rhizopus arrhizus) was isolated from culture on sabouraud medium. The patient was treated by systemic amphotericin b, associated with surgical debridement (lobectomy).The treatment with amphotericin b was stopped after ten days and the patient was completely asymptomatic and returned to Moldavia. Mucormycoses are rare, and tend to be encountered in individuals with predisposing factors such as malignant blood disorders (immunocompromised patients) or diabetes mellitus. prognosis is poor, resembling infection with aspergillus, despite aggressive treatment as in the present case. The gravity of the condition can be accounted for by the thrombotic and necrosing nature of the fungal invasion of lung vessels.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
5/33. diabetes mellitus associated with atypical antipsychotic medications: new case report and review of the literature.BACKGROUND: Since the introduction of atypical antipsychotic medications, beginning with clozapine in 1990, several case reports in the psychiatric literature have suggested that they might be associated with new onset of diabetes mellitus as well as with diabetic ketoacidosis. methods: We report the case of a 38-year-old patient with schizophrenia who suddenly developed diabetes mellitus and ketoacidosis 12 months after starting olanzapine. Similar cases in the literature were found through a medline-assisted search using the key words "schizophrenia," "diabetes mellitus," "ketoacidosis," and "adverse drug reaction." RESULTS: Including this case, 30 patients have been reported in the literature to have developed diabetes or have lost diabetic control after starting clozapine, olanzapine, or quetiapine. Twelve of these 30 developed diabetic ketoacidosis. Two limited quantitative studies have added evidence toward this association. CONCLUSION: Although a causal relation has not been definitively proved, the number of cases reported in the literature suggests there might be an association between atypical antipsychotic medications and diabetes mellitus. Primary care physicians who care for patients with schizophrenia should be aware of this possible association.- - - - - - - - - - ranking = 4keywords = ketoacidosis (Clic here for more details about this article) |
6/33. Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin b and incomplete surgery: a case report.BACKGROUND: mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. mucormycosis was diagnosed based on these findings. amphotericin b (AmBisome(R); 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin b therapy was approximately 6 months and the total dose of liposomal amphotericin b used was 32 grams. Liposomal amphotericin b therapy was stopped six months later and oral fluconazole was started. CONCLUSIONS: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
7/33. Clonic focal seizure of the foot secondary to nonketotic hyperglycemia.Focal epileptic seizures can be the first manifestation of a diabetic disorder. Metabolic disturbances, including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of partial focal seizures. A review of the medical literature for partial focal seizures is presented, followed by a case study of a patient who developed clonic seizures of the right foot secondary to hyperglycemia, hyponatremia, and hyperosmolality.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
8/33. Fatality from olanzapine induced hyperglycemia.A case history of a 31-year-old male schizophrenic patient is presented. The man was treated with olanzapine for three weeks before he died. After one week on a 10 mg daily dose of olanzapine, his fasting blood glucose was elevated to 11.3 mmol/L (203 mg/dL). In order to treat more aggressively his psychosis, the olanzapine dose was raised to 20 mg daily resulting in his fasting blood glucose climbing to 15.8 mmol/l (284 mg/dL). On the days preceding his death, he became progressively weaker, and developed polydipsia with polyuria. He had no personal or family history of diabetes mellitus and he was on no other medication at the time of his death. Postmortem blood, vitreous humor, and urine glucose concentrations were 53 mmol/L (954 mg/dL), 49 mmol/L (882 mg/dL), and 329 mmol/L (5922 mg/dL), respectively. Drug screen on urine and blood indicated only a small amount or olanzapine and no alcohols. Peripheral blood olanzapine concentration was within therapeutic limits, 45 ng/mL. Analysis of vitreous humor and urine revealed severe dehydration with small amounts of ketones. death was attributed to hyperosmolar nonketotic diabetic coma, and olanzapine was felt most likely to be the cause. Another atypical neuroleptic, clozapine, has also been associated with the development and exacerbation of diabetes mellitus or diabetic ketoacidosis. We recommend including vitreous glucose and beta-hydroxybutyrate analysis as part of postmortem toxicology work up when the drug screen reveals the presence of either olanzapine or clozapine.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
9/33. death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes.Seven obese African American youth were considered to have died from diabetic ketoacidosis (DKA) due to type 1 diabetes, despite meeting the criteria for hyperglycemic hyperosmolar state and not for DKA. All had previously unrecognized type 2 diabetes, and death may have been prevented with earlier diagnosis or treatment.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
10/33. diabetes mellitus and autonomic dysfunction after vacor rodenticide ingestion.A case of N-3 pyridylmethyl-N' 4 nitrophenyl urea (Vacor) rodenticide poisoning in a 52-year-old man is presented. Vacor is structurally related to alloxan and streptozotocin, agents that have been used extensively to produce diabetes mellitus in laboratory animals. Seven days after ingestion of Vacor, the patient presented in diabetic ketoacidosis complicated by postural hypotension and adynamic ileus. The patient recovered from ketoacidosis but has continued to require insulin. With infusion of arginine, glucagon rose from 185 to 650 pg./ml. and c-peptide from 0.5 to 3.4 ng./ml. Six weeks after onset of diabetes, no anti-islet-cell antibodies were detected. Muscle capillary basement membrane thickness on electron microscopy was found to be 1,918 /- 194 A. The absence of hyperglycemia after Vacor ingestion should not lead to complacency on the part of the attending physician. The patient must be observed closely for development of ketoacidosis and treated prophylactically with nicotinamide, the suggested antidote.- - - - - - - - - - ranking = 3keywords = ketoacidosis (Clic here for more details about this article) |
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