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Can Ketoacidosis Cause Chest Pains?

Case Of Diabetic Ketoacidosis As An Initial Presentation Of Cushing’s Syndrome

Case Of Diabetic Ketoacidosis As An Initial Presentation Of Cushing’s Syndrome

Background Diabetic ketoacidosis (DKA) is an acute metabolic disorder characterized by markedly increased circulating ketone bodies e.g. beta-hydroxybutyrate, aceto-acetate and acetone in the presence of hyperglycemia. DKA is a serious and potentially life-threatening metabolic complication of diabetes mellitus. Some well-known precipitants of DKA include new-onset T1DM, insulin withdrawal and acute illness. In this report, we present a subject who presented with DKA as an initial manifestation of Cushing’s disease secondary to ACTH-producing pituitary adenoma. Case presentation A 48-year-old Caucasian woman was admitted with fever, cough, left-sided chest pain, shortness of breath and hemoptysis. She reported amenorrhea of one-year duration. She was a chronic smoker for over 20 years. Patient was unable to provide a detailed history at the time of admission due to acuteness of her illness and respiratory distress. On physical examination, patient was alert, oriented and in moderate respiratory distress with Kussmaul breathing, temperature: 102 F; respiratory rate: 20/min; pulse: 110/min and blood pressure: 148/98 mmHg; body weight: 158 lbs as well as round flushed face with acne, hirsutism and dark purple striae of the abdominal wall (Fig. 1). Lung examination revealed bronchial breath sounds with crackles in the lower left field. Heart evaluation showed normal heart sounds with tachycardia without a murmur, and neurological assessment was unremarkable. Investigation Complete blood count was significant for WBC 21.600/mL with segmented neutrophils 69%. Serum chemistries showed sodium: 134 mM/L (normal: 135–146); potassium: 3.5 mM/L (normal: 3.5–5.3); chloride: 78 mM/L (normal: 98–110); HCO3−: <10 mM/L (normal: 20–31); anion gap: 50 mM/L (normal: 8–16); se Continue reading >>

Ketoacidosis: A Complication Of Diabetes

Ketoacidosis: A Complication Of Diabetes

Diabetic ketoacidosis is a serious condition that can occur as a complication of diabetes. People with diabetic ketoacidosis (DKA) have high blood sugar levels and a build-up of chemicals called ketones in the body that makes the blood more acidic than usual. Diabetic ketoacidosis can develop when there isn’t enough insulin in the body for it to use sugars for energy, so it starts to use fat as a fuel instead. When fat is broken down to make energy, ketones are made in the body as a by-product. Ketones are harmful to the body, and diabetic ketoacidosis can be life-threatening. Fortunately, treatment is available and is usually successful. Symptoms Ketoacidosis usually develops gradually over hours or days. Symptoms of diabetic ketoacidosis may include: excessive thirst; increased urination; tiredness or weakness; a flushed appearance, with hot dry skin; nausea and vomiting; dehydration; restlessness, discomfort and agitation; fruity or acetone smelling breath (like nail polish remover); abdominal pain; deep or rapid breathing; low blood pressure (hypotension) due to dehydration; and confusion and coma. See your doctor as soon as possible or seek emergency treatment if you develop symptoms of ketoacidosis. Who is at risk of diabetic ketoacidosis? Diabetic ketoacidosis usually occurs in people with type 1 diabetes. It rarely affects people with type 2 diabetes. DKA may be the first indication that a person has type 1 diabetes. It can also affect people with known diabetes who are not getting enough insulin to meet their needs, either due to insufficient insulin or increased needs. Ketoacidosis most often happens when people with diabetes: do not get enough insulin due to missed or incorrect doses of insulin or problems with their insulin pump; have an infection or illne Continue reading >>

Prime Pubmed | Chest Pain Pleuritic Journal Articles From Pubmed

Prime Pubmed | Chest Pain Pleuritic Journal Articles From Pubmed

Reverse Takotsubo Pattern in the Setting of Undiagnosed Pheochromocytoma and Pulmonary Embolism: A Rare Presentation. [Journal Article] Am J Case Rep 2020; 21:e920231Sakul NFN, Balabbigari NR, Roberti R AJ CONCLUSIONS: Reverse Takotsubo variant pattern can be seen in non-Takotsubo cardiomyopathies, and in our patient was noted in the presence of pheochromocytoma and pulmonary embolism. In this scenario, the presence of both would have significantly affected management, if she had not decompensated so quickly. Postpericardiotomy Syndrome after Cardiac Operations. [Systematic Review] J Coll Physicians Surg Pak 2020; 30(1):62-66Yuan SM JC The postpericardiotomy syndrome (PPS) is an important cause of morbidity and mortality following heart operation. This systematic review reviewed the literature regarding PPS. It was found to occur on day 18.3 15.9 after cardiac operations, most often after coronary artery bypass grafting, and mitral valve replacement. The most common symptoms were new/worsening pericardial effusions, pleuritic The postpericardiotomy syndrome (PPS) is an important cause of morbidity and mortality following heart operation. This systematic review reviewed the literature regarding PPS. It was found to occur on day 18.3 15.9 after cardiac operations, most often after coronary artery bypass grafting, and mitral valve replacement. The most common symptoms were new/worsening pericardial effusions, pleuritic chest pain, and fever. The inflammation markers, such as C-reactive protein and erythrocyte sedimentation rate, were found to increase significantly in each patient who had these parameters examined. The subjects were managed conservatively in 472 (83.5%) patients, by surgical pericardial drainage in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 ( Continue reading >>

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>

Diabetic Ketoacidosis (causing Abdominal Pain)

Diabetic Ketoacidosis (causing Abdominal Pain)

Tricky when occurring in undiagnosed, occult Type-1 Diabetics Accompanied by nausea / vomiting; may be severe enough to mimic acute abdomen Polydypsia & Polyuria usually present, but you have to ask about them Urine dipstick for large ketones (and glucose) strongly suggestive Continue reading >>

Diabetic Ketoacidosis - Symptoms

Diabetic Ketoacidosis - Symptoms

A A A Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones. Diabetic ketoacidosis is associated with significant disturbances of the body's chemistry, which resolve with proper therapy. Diabetic ketoacidosis usually occurs in people with type 1 (juvenile) diabetes mellitus (T1DM), but diabetic ketoacidosis can develop in any person with diabetes. Since type 1 diabetes typically starts before age 25 years, diabetic ketoacidosis is most common in this age group, but it may occur at any age. Males and females are equally affected. Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation. The body consumes its own muscle, fat, and liver cells for fuel. In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis. Significant loss of potassium and other salts in the excessive urination is also common. The most common Continue reading >>

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic Ketoacidosis (dka) - Topic Overview

Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>

Can Diabetes Cause Fatigue, Body Ache?

Can Diabetes Cause Fatigue, Body Ache?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society. Asked by Mike from Tennessee Can diabetes be a (possible) cause of fatigue, leg and lower back aches? I have had bursts of energy for 10 to 15 minutes, but then need to sit for about 10 minutes, and I'm ready to go full steam again. PLEASE, Thank You, Mike Expert answer Dear Mike: Thanks for an important question, as a lot of people with diabetes complain of these symptoms. The answer is that diabetes itself probably is not the cause of your fatigue, lower back and leg aches. The things that cause type 2 diabetes (also called adult onset diabetes), such as a weight problem and lack of exercise, are commonly the cause these symptoms. Fatigue incorporates three components: 1. The inability to initiate activity. 2. Reduced ability to maintain activity. 3. Difficulty with concentration and memory. Fatigue should be distinguished from sleepiness, shortness of breath on exertion and muscle weakness, although these can also be associated with fatigue. Fatigue lasting six months or more is referred to as chronic fatigue. Chronic fatigue is not necessarily the entity known as chronic fatigue syndrome, which is a diagnosis after exclusion of all other causes. Fatigue in anyone should be evaluated by a health care provider to exclude all possible causes and to get counseling on how to treat it. Other medical causes of fatigue are the side effect of drugs, thyroid dysfunction, high calcium levels, rheumatologic illnesses, adrenal, kidney or liver problems. Some infections such as tuberculosis or hepatitis can cause fatigue, and indeed, fatigue can be their only symptom. Depression is also a major cause of fatigue. While unus Continue reading >>

Diabetic Ketoacidosis Symptoms

Diabetic Ketoacidosis Symptoms

What is diabetic ketoacidosis? Diabetic ketoacidosis, also referred to as simply ketoacidosis or DKA, is a serious and even life-threatening complication of type 1 diabetes. DKA is rare in people with type 2 diabetes. DKA is caused when insulin levels are low and not enough glucose can get into the body's cells. Without glucose for energy, the body starts to burn fat for energy. Ketones are products that are created when the body burns fat. The buildup of ketones causes the blood to become more acidic. The high levels of blood glucose in DKA cause the kidneys to excrete glucose and water, leading to dehydration and imbalances in body electrolyte levels. Diabetic ketoacidosis most commonly develops either due to an interruption in insulin treatment or a severe illness, including the flu. What are the symptoms and signs of diabetic ketoacidosis? The development of DKA is usually a slow process. However, if vomiting develops, the symptoms can progress more rapidly due to the more rapid loss of body fluid. Excessive urination, which occurs because the kidneys try to rid the body of excess glucose, and water is excreted along with the glucose High blood glucose (sugar) levels The presence of ketones in the urine Other signs and symptoms of ketoacidosis occur as the condition progresses: These include: Fatigue, which can be severe Flushing of the skin Fruity odor to the breath, caused by ketones Difficulty breathing Type 2 Diabetes Diagnosis, Treatment, Medication What should I do if I think I may have, or someone I know may diabetic ketoacidosis? You should test your urine for ketones if you suspect you have early symptoms or warning signs of ketoacidosis. Call your health-care professional if your urine shows high levels of ketones. High levels of ketones and high blood sug Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

What Is It? Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when you have much less insulin than your body needs. This problem causes the blood to become acidic and the body to become dangerously dehydrated. Diabetic ketoacidosis can occur when diabetes is not treated adequately, or it can occur during times of serious sickness. To understand this illness, you need to understand the way your body powers itself with sugar and other fuels. Foods we eat are broken down by the body, and much of what we eat becomes glucose (a type of sugar), which enters the bloodstream. Insulin helps glucose to pass from the bloodstream into body cells, where it is used for energy. Insulin normally is made by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce enough insulin and must inject it daily. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

Is It Really A Health Emergency Or Is There A Much Simpler Explanation?

Is It Really A Health Emergency Or Is There A Much Simpler Explanation?

Is it really a health emergency or is there a much simpler explanation? Use our traffic light guide to assess whether youre actually seriously ill - or just need an early night Discomfort: But stomach pain can have many causes (Image: Getty Images) Sign up to FREE daily email alerts from Mirror - daily news We will use your email address only for sending you newsletters. Please see our Privacy Notice for details of your data protection rights Thank you for subscribingWe have more newsletters Show me See our privacy notice Is it really an emergency.. or do you just need an early night? This month figures have revealed that more than half of A&E visits were for non-emergencies so how do you know when you really need medical attention or if its something a lot less serious? How do you know if youre a hypochondriac or just health-aware? How do you tell if your stomach pain is life-threatening or down to that huge take-away? How can you tell if that throbbing is just a headache and not a brain tumour? We asked the experts for a traffic-light guide to assessing your health risk. A 'green' signal means theres probably nothing to be concerned about and an early night could help; an 'amber' signal suggests you should get checked out by your GP. And a 'red' signal indicates medical attention should be sought immediately. Phone 111 for advice; book an emergency GP appointment or, if necessary, go straight to A&E or dial 999 for an ambulance. Green : IBS (Irritable Bowel Syndrome) is the commonest cause of abdominal pain, explains Dr Adam Harris, Consultant Gastroenterologist at The Tunbridge Wells Hospital. Pain tends to be gradual and moves around, or comes and goes and varies in intensity, but doesnt usually disturb sleep. Try keeping a food diary to eliminate triggers, drink p Continue reading >>

Diabetes

Diabetes

Diabetes is a chronic (long-term) condition that occurs when your body doesn’t make enough insulin, or when your body has trouble using the insulin that it does make. About 1 in 400 young people have this condition. What is insulin? Why is it important? Insulin is a hormone made by a gland called the pancreas. The pancreas is located behind the stomach. Whenever you eat food, your body digests the food (breaks it down) into smaller parts: vitamins, minerals, sugar (called “glucose”), fat, and protein. Your body then uses glucose for energy. Glucose is the body’s major source of energy. Insulin is the hormone that helps glucose enter the cells of your body so it can be used as energy. If your body doesn’t make enough insulin, or if your body has difficulty using the insulin that it makes, the glucose from your food does not get changed into energy. Instead, the glucose stays in your blood, causing your blood glucose (also called “blood sugar”) to rise. Why is high blood sugar a problem? High blood sugar is a problem because it can cause serious damage to the body. Some of the most serious, long term problems are loss of vision, kidney problems, heart problems, damage to circulation and stroke. This kind of damage happens slowly over many years and can be delayed or prevented if you take good care of your diabetes. There are also short-term problems that come from high blood sugar. Some common short term-problems (caused from high blood sugar) are: Being thirsty Having to urinate (pee) more often Feeling irritable or exhausted Weight loss If your blood sugar gets too high due to not having enough insulin, you can experience a very serious condition called diabetic ketoacidosis. Signs of ketoacidosis are: Rapid deep breathing Stomach pain or chest pain and/or Continue reading >>

Alcoholic Ketoacidosis

Alcoholic Ketoacidosis

Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. Treatment is IV saline solution and dextrose infusion. Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism. Alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion, increased lipolysis, impaired fatty acid oxidation, and subsequent ketogenesis, causing an elevated anion gap metabolic acidosis. Counter-regulatory hormones are increased and may further inhibit insulin secretion. Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. Diagnosis requires a high index of suspicion; similar symptoms in an alcoholic patient may result from acute pancreatitis, methanol or ethylene glycol poisoning, or diabetic ketoacidosis (DKA). In patients suspected of having alcoholic ketoacidosis, serum electrolytes (including magnesium), BUN and creatinine, glucose, ketones, amylase, lipase, and plasma osmolality should be measured. Urine should be tested for ketones. Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurement. The absence of hyperglycemia makes DKA improbable. Those with mild hyperglycemia may have underlying diabetes mellitus, which may be recognized by elevated levels of glycosylated Hb (HbA1c). Typical laboratory findings include a high anion gap metabolic acidosis, ketonemia, and low levels of potassium, magnesium, and phosphorus. Detection of acidosis may be com Continue reading >>

Chest Pain In Emergency Department: A Diagnosis Of Diabetic Ketoacidosis Must Be Ruled Out

Chest Pain In Emergency Department: A Diagnosis Of Diabetic Ketoacidosis Must Be Ruled Out

CASE REPORT Chest pain in emergency department: A diagnosis of diabetic ketoacidosis must be ruled out Nasir Mohamad1, Rashidi Ahmad2, PK Cheah2 1Senior Lecturer/ Consultant Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, 16150 Kubang Kerian, Kelantan, Malaysia. 2Senior Lecture/ Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, Health Campus USM, 16150 Kubang Kerian, Kelantan, Malaysia. 3Emergency Physician, Department of Emergency Medicine, School of Medical Sciences, Health Campus USM, 16150 Kubang Kerian, Kelantan, Malaysia. doi:10.5348/ijcri-2010-11-5-CR-2 Address correspondence to: Nasir Mohamad Department of Emergency Medicine School of Medical Sciences 16150 Kubang Kerian, Kelantan Malaysia Phone: +6097676978 Fax: +6097673219 Email: [email protected] [HTML Abstract] [PDF Full Text] How to cite this article: Mohamad N, Ahmad R, Cheah PK. Chest pain in emergency department: A diagnosis of diabetic ketoacidosis must be ruled out. International Journal of Case Reports and Images 2010;1(3):6-9. Introduction: Diabetic ketoacidosis (DKA) is a common diabetic complication presenting to the Emergency Department (ED). Early recognition and initial aggressive treatment of DKA decreases morbidity and mortality. Clinical presentations of DKA are non specific such as nausea, vomiting, dehydration and abdominal pain. Chest pain is unusual presentation of DKA, however, acute coronary syndrome and pericarditis that manifest with chest pain are known precipitating factors of DKA. Case Report: We report a case of a middle aged diabetic patient who was presented with severe chest pain and elevated creatine kinase that might have thrown us off the correct diagnosis of DKA. Conclusion: A description of his pr Continue reading >>

Ask The Diabetes Team

Ask The Diabetes Team

Question: From West Chester, Pennsylvania, USA: My eight-year-old son was diagnosed with type 1 diabetes last fall. His sugars have been running high off and on for the past two weeks. I spoke with his diabetes nurse last week and she recommended he be given an extra unit of NPH insulin in the morning since his late morning and lunchtime numbers have been high (his highest was 498 mg/dl [27.7 mmol/L]). He was okay for a few days after his changed dose but now is running high once again. Just last night, he started complaining of chest pain. He has never complained of this before. I got him calmed down and got him to sleep, but the pain woke him up a few hours later. I thought may be it was indigestion so, at first, I wasn't to worried. But, today, he has been complaining of this pain as well. I am concerned because he also has been having these high blood sugars. Do you have any idea what might be causing this? Answer: There are many, many, many causes of chest pain in children and almost all have nothing to do with diabetes. To get a better sense of the potential seriousness of this discomfort, your doctor will want to know the quality of the pain (e.g., "stabbing like a knife" or "pressure" or "pinprick," etc.), the duration of the pain ("how long it lasts before it goes away"), what brings it on, what gives relief, if there is a change in breathing pattern or development of cough, whether it interferes with eating, etc. Strictly from a diabetes perspective, the presence of ketones can certainly lead to chest pain. As you should know, higher glucoses can lead to the development of ketones and can progress to the serious "diabetic ketoacidosis" (DKA). This is why blood or urine ketones should be checked when the blood glucose is over 240 mg/dl [13.3 mmol/L] or so (alth Continue reading >>

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