1/6. Lipaemia retinalis in a case of juvenile diabetic ketoacidosis.A rare case of diabetic retinal lipaemia is described in a 5-year-old child.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
2/6. Plasma lipids and apolipoproteins in a 13-year-old boy with diabetic ketoacidosis and extreme hyperlipidemia.A 13-year-old boy with untreated diabetes presented in severe ketoacidosis (DKA) for the first time with an initial triglyceride (TG) level of 14,461 mg/dl. Serial blood samples were drawn to determine the interrelationships of changes in lipids and apolipoproteins during treatment with insulin and intravenous fluids. The TG level declined to 122 mg/dl in 7 days concomitant with a lowering of apolipoproteins c-II, C-III, E, D, and F. Further observations suggested that the TG-rich lipoproteins underwent degradation associated with a decline in the levels of apolipoproteins associated with very low density lipoprotein (VLDL) in contrast to an increase in high density lipoprotein-cholesterol (HDL-C), ApoA-I and ApoA-II. ApoB and low density lipoprotein cholesterol (LDL-C) were increased transiently. Subsequent therapy with continuous subcutaneous insulin infusion (CSII) were effective in maintaining glucose homeostasis and normolipidemia for 6 months.- - - - - - - - - - ranking = 1.25keywords = ketoacidosis (Clic here for more details about this article) |
3/6. The urine anion gap: the critical clue to resolve a diagnostic dilemma in a patient with ketoacidosis.Usually, ketoacidosis presents few if any diagnostic or therapeutic problems; in this article, we report a case where ketoacidosis was clinically occult and biochemically obscure. The patient presented with acute pancreatitis associated with a modest antecedent alcohol intake. Metabolic acidosis with a normal anion gap (10 meq/L) was observed together with moderate hyperglycemia and a 2 (but not 4 ) test for serum ketones. None of the usual causes of metabolic acidosis with a normal anion gap was identified nor was there an obvious explanation for a reduction in unmeasured anion gap (e.g., hypoalbuminemia, dysproteinemia, or the presence of abnormal halides). Despite the initial normal anion gap, ketoacidosis was suspected clinically and this was confirmed by the elevated serum B-hydroxybutyrate of 8 mmol/L. We deduced that the serum unmeasured anions, which should have been increased by at least 8 meq/L, were being underestimated because of the effect of hypertriglyceridemia on the serum chloride determination. When the serum chloride was reestimated by a method not influenced by hyperlipidemia, the value was 102 mmol/L not 112 mmol/L and, when reevaluated, the anion gap was indeed appropriately elevated. In addition, the urine anion gap (Na K - Cl) was 103 meq/L in the absence of renal disease. This indicated that the expected large quantity of urinary ammonium must have been masked by an even greater quantity of unmeasured anion; in this case proven by direct measurement to be B-hydroxybutyrate. Finally, metabolism of the alcohol ingested, which yields hepatic NADH, could explain, in part, the modest hyperglycemia and the absence of a 4 test for serum ketones.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1.75keywords = ketoacidosis (Clic here for more details about this article) |
4/6. Factitious methemoglobinemia caused by hyperlipemia.Hyperlipemia in an acyanotic patient with diabetic ketoacidosis, alcoholism, and pancreatitis produced a falsely elevated concentration of methemoglobin (19 percent) and a lower-than-expected oxygen saturation measured with an automated spectrophotometer (IL-282 CO-Oximeter). In addition, there was a "normal" hemoglobin level despite a low hematocrit reading. in vitro studies showed that hyperlipemia corresponding to triglyceride levels of 500 mg/100 ml and greater produced erroneously high values for methemoglobin and total hemoglobin and "negative" values for carboxyhemoglobin. These abnormalities disappeared when the excessive lipids were removed by washing the erythrocytes in physiologic saline solution.- - - - - - - - - - ranking = 0.25keywords = ketoacidosis (Clic here for more details about this article) |
5/6. Treatment by plasma exchange of a patient with hyperlipidemia and diabetic ketoacidosis with lesional pulmonary edema and acute pancreatitis.The authors report a case of severe hypertriglyceridemia (148.5 mmol/l) in a 27-year-old woman admitted for coma of unknown origin. Initial investigations revealed ketoacidosis, pancreatitis and noncardiogenic pulmonary edema. The diabetes was unknown. Ketoacidosis was rapidly controlled. The hypertriglyceridemia was corrected by one course of plasma exchange (4,400 ml) during which the patient returned to consciousness. The patient recovered without any sequelae. Only 2 similar cases, treated by plasma exchange, have been reported in the literature until now.- - - - - - - - - - ranking = 1.25keywords = ketoacidosis (Clic here for more details about this article) |
6/6. A difficult case. Childhood onset insulin dependent diabetes presenting with severe hyperlipidaemia.Confronted with a child deteriorating during treatment of diabetic ketoacidosis, Godfrey Nyamugunduru and Helen Roper describe how the child's management was complicated by gross hyperlipidaemia. At the point where the child's condition was deteriorating despite conventional management we invited two experts-Gilbert R Thompson and J I Mann-to suggest a course of action. The original authors then describe how they did manage the case, and our experts comment again.- - - - - - - - - - ranking = 0.25keywords = ketoacidosis (Clic here for more details about this article) |