1/4. Extreme gestational starvation ketoacidosis: case report and review of pathophysiology.A case of severe starvation ketoacidosis developing during pregnancy is presented. The insulinopenic/insulin-resistant state found during fasting in late gestation predisposes to ketosis. Superimposition of stress hormones, which further augment lipolysis, exacerbates the degree of ketoacidosis. In our patient, gestational diabetes, twin pregnancies, preterm labor, and occult infection were factors that contributed to severe starvation ketoacidosis. diagnosis was delayed because starvation ketosis is not generally considered to be a cause of severe acidosis, and because the anion gap was not elevated. Improved understanding of the complex fuel metabolism during pregnancy should aid in prevention, early recognition, and appropriate therapy of this condition.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
2/4. Self-starvation in a diabetic adolescent.The case of a 14-year-old girl who began food refusal shortly after the development of diabetes mellitus is presented. Her dieting eliminated the need for insulin and urine testing and, as a result, allowed the patient to deny that she had diabetes. Although her course resembled that seen in primary anorexia nervosa, this patient was felt to have atypical anorexia nervosa, in this case an extreme form of illness denial probably associated with psychosis.- - - - - - - - - - ranking = 4.1994799028763keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/4. starvation diet and very-low-calorie diets may induce insulin resistance and overt diabetes mellitus.We have observed seven initially obese individuals who, during the course of a strenuous weight-reduction program, developed diabetes mellitus: non-insulin-dependent diabetes mellitus in five cases and insulin-dependent diabetes mellitus in two cases. None had any sign of prior diabetic symptoms. Although weight reduction is encouraged in obesity, crash diets without proper medical surveillance may have deleterious effects. This sequence of induction of diabetes has not previously been reported in the medical literature. The metabolic situation in extremely low-calorie diets may be comparable to that in starvation. An attempt is made to explain our observation concerning the induction of a diabetic state during such diets, on the basis of increased insulin resistance in states of starvation and anorexia nervosa, with a concomitant role in stress hormones.- - - - - - - - - - ranking = 23.396359320134keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
4/4. hypoglycemia presenting as acute respiratory failure in an infant.hypoglycemia, a common metabolic abnormality seen in the pediatric population, is most often easily diagnosed and rapidly treated with satisfactory outcome. If not recognized and treated in prompt fashion, however, hypoglycemia may cause irreversible central nervous system injury or expose the patient to unnecessary procedures; it rarely results in death. The classic emergency department (ED) presentation of hypoglycemia, the diabetes mellitus patient using hypoglycemic therapy, is frequently encountered and adequately managed with excellent outcome. Alternatively, the patient may present to the ED in a fashion suggestive of a situation other than hypoglycemia. For example, the patient with an altered sensorium following a traumatic event, with a focal neurologic finding, or with bradycardia--all situations in which hypoglycemia is the causative issue--may not be immediately recognized as such a metabolic problem. This report presents a case of a 9-month-old boy who presented with acute respiratory failure and mental status change; the initial ED impression was one of pneumonia with sepsis. Further evaluation uncovered the actual reason for the mental status change and respiratory insufficiency: hypoglycemia was noted on laboratory analysis; no clinical evidence of pneumonia was found after thorough ED evaluation and a prolonged hospital stay. His mental status improved and his respiratory insufficiency resolved after glucose therapy. No other explanation for the respiratory failure was found during the hospital admission. It is imperative that the emergency physician consider hypoglycemia in all patients with any degree of mental status abnormality, even when the findings seem to be explained initially by other etiologies.- - - - - - - - - - ranking = 3.1994799028763keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |