Ketoacidosis Accompanied By Epileptic Seizures In A Patient With Diabetes Mellitus And Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis And Stroke-like Episodes (melas).
Abstract We herein report a rare case of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) and diabetes mellitus with ketoacidosis. An 18-year-old female patient was diagnosed to have diabetes mellitus and insulin therapy was thereafter initiated. At 26 years of age, she was hospitalized for diabetic ketoacidosis, soon followed by a loss of consciousness, left-sided dysmetria, and ataxic speech. MELAS was diagnosed because of the presence of ragged red fibers in a muscle biopsy. At 33 years of age, she was admitted to our hospital because of ketoacidosis and partial status epilepticus. A blood gas examination revealed as follows; arterial pH, 6.88; bicarbonate, 2.1 mmol/l; base excess - 29.8 mmol/l. The serum level of glucose had also increased to 30 mmol/l. The serum levels of lactate and B-hydroxybutyrate were elevated to 11.4 mmol/l and 1,990 micromol/l, respectively. Ketoacidosis improved by fluid replacement and continuous intravenous insulin infusion. A brain MRI demonstrated hyperintensity areas on FLAIR images in the bilateral temporal lobes and the cerebellum. A proton MRS demonstrated the abnormal lactate accumulation in the bilateral temporal and occipital lobes. Since epileptic seizures are rare in patients with diabetic ketoacidosis, such seizures may indicate the existence of MELAS syndrome. Continue reading >>
Diabetes In Dogs
Diabetes-Related Emergencies Diabetes in dogs is treated with insulin, much the same way as it is in humans. But if too much or too little insulin is administered, it can be very dangerous for the animal. What To Watch For Diabetes causes high blood sugar levels and is signaled primarily by excessive urination, excessive drinking, increased appetite and weight loss. In cases where the diabetes is not treated promptly and allowed to progress to the point of a crisis, symptoms may include a loss of appetite, weakness, seizures, twitching, and intestinal problems (diarrhea or constipation). Primary Cause Diabetic emergencies can be caused by either injecting too much or too little insulin, or not treating the diabetes in the first place. Both cases are equally dangerous for the dog and can cause coma or death. In cases where the diabetes is not treated, it can progress to diabetic ketoacidosis, a very serious condition that can cause death of your pet. Diabetic ketoacidosis can also be seen in dogs where the diabetes had been regulated and yet in which another condition has developed affecting the body's ability to regulate the diabetes. Immediate Care If signs of an insulin dosage problem are noticed, it should be treated as an extreme emergency. The following steps may provide aid to your dog until you are able to bring her to a veterinarian (which should be as quickly as possible): Syringe liquid glucose into the dog’s mouth. This can be in the form of corn syrup, maple syrup, honey, etc. If the dog is having a seizure, lift its lips and rub glucose syrup on the gums. Be careful not to get bit. Veterinary Care Depending on the cause of the crisis, dogs suffering from diabetic emergencies may need to be given glucose or insulin intravenously. In cases of diabetic ketoa Continue reading >>
WHAT YOU NEED TO KNOW: What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your blood sugar levels become high because your body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. What increases my risk for DKA? Not enough insulin Poorly controlled diabetes Infection or other illness Heart attack, stroke, trauma, or surgery Certain medicines such as steroids or blood pressure medicines Illegal drugs such as cocaine Emotional stress Pregnancy What are the signs and symptoms of DKA? More thirst and more frequent urination than usual Abdominal pain, nausea, and vomiting Blurry vision Dry mouth, eyes, and skin, or your face is red and warm Fast, deep breathing, and a faster heartbeat than normal for you Weak, tired, and confused Fruity, sweet breath Mood changes and irritability How is DKA treated? DKA can be life-threatening. You must get immediate medical attention. The goal of treatment is to replace lost body fluids, and to bring your blood sugar level back to normal. How can I help prevent DKA? The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following may help decrease your risk for DKA: Monitor your blood sugar levels closely if you have an infection, are stressed, sick, or experience trauma. Check your blood sugar levels often. You may need to check at least 3 times each day. If your blood sugar level is too high, give yourself insulin as Continue reading >>
Understanding And Treating Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>
Severe Diabetic Ketoacidosis Complicated By Hypocapnic Seizure
Summary In clinical practice, seizures independent of hypoglycemia are observed in patients with type 1 diabetes mellitus (T1DM) more frequently than expected by chance, suggesting a link. However, seizures during management of diabetic ketoacidosis (DKA) have generally been considered a bad prognostic factor, and usually associated with well-known biochemical or neurological complications. We present the case of a 17-year-old girl with known T1DM managed for severe DKA complicated by hypocapnic seizure. We review the literature on this rare occurrence as well as outline other possible differentials to consider when faced with the alarming combination of DKA and seizure. Learning points: Seizures during DKA treatment require immediate management as well as evaluation to determine their underlying cause. Their etiology is varied, but a lowered seizure threshold, electrolyte disturbances and serious neurological complications of DKA such as cerebral edema must all be considered. Sudden severe hypocapnia may represent a rare contributor to seizure during the treatment of DKA. Background Diabetic ketoacidosis (DKA) is an endocrine emergency occurring in patients with both new-onset and established type 1 diabetes (T1DM). In brief, the diagnosis is based on clinical suspicion followed by fulfillment of biochemical criteria: Hyperglycemia (blood glucose level (BGL) >11 mmol/L); ketonuria and/or ketonemia and metabolic acidosis (pH <7.3, bicarbonate <15 mmol/L). It is a leading acute cause of diabetes-related morbidity and mortality, particularly in children (1), often due to well-described complications of treatment. The most common of these include cerebral edema, and electrolyte disturbances such as hypoglycemia and hypokalemia. Seizure activity occurring during treatment o Continue reading >>
Complications caused by diabetes People with diabetes must routinely monitor and regulate their blood sugar. No matter how careful you may be, there’s still a possibility that a problem might arise. There are two types of complications you may experience: acute and chronic. Acute complications require emergency care. Examples include hypoglycemia and ketoacidosis. If left untreated, these conditions can cause: seizures loss of consciousness death Chronic complications occur when diabetes isn’t managed properly. Diabetes causes high blood sugar levels. If not controlled well over time, high blood sugar levels can damage various organs, including the: eyes kidneys heart skin Unmanaged diabetes can also cause nerve damage. People with diabetes can experience sudden drops in their blood sugar. Skipping a meal or taking too much insulin or other medications that increase insulin levels in the body are common causes. People who are on other diabetes medications that do not increase insulin levels are not at risk for hypoglycemia. Symptoms can include: blurry vision rapid heartbeat headache shaking dizziness If your blood sugar gets too low, you can experience fainting, seizures, or coma. This is a complication of diabetes that occurs when your body cannot use sugar, or glucose, as a fuel source because your body has no insulin or not enough insulin. If your cells are starved for energy, your body begins to break down fat. Potentially toxic acids called ketone bodies, which are byproducts of fat breakdown, build up in the body. This can lead to: dehydration abdominal pain breathing problems Diabetes can damage blood vessels in the eyes and cause various problems. Possible eye conditions may include: Cataracts Cataracts are two to five times more likely to develop in people Continue reading >>
Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>
Diabetic Coma Recovery: What You Need To Know
In people with diabetes, a diabetic coma occurs when severe levels of either high or low uncontrolled blood sugar are not corrected. If treated quickly, a person will make a rapid recovery from a diabetic coma. However, diabetic coma can be fatal or result in brain damage. It is important for people with diabetes to control their blood sugars and know what to do when their blood sugar levels are not within their target range. The severe symptoms of uncontrolled blood sugar that can come before a diabetic coma include vomiting, difficulty breathing, confusion, weakness, and dizziness. Recovery from diabetic coma If a diabetic coma is not treated within a couple of hours of it developing, it can cause irreversible brain damage. If no treatment is received, a diabetic coma will be fatal. In addition, having blood sugar levels that continue to be too low or too high can be bad for long-term health. This remains true even if they do not develop into diabetic coma. Recognizing the early signs of low or high blood sugar levels and regular monitoring can help people with diabetes keep their blood sugar levels within the healthy range. Doing so will also reduce the risk of associated complications and diabetic coma. What is diabetes? Diabetes is a long-term condition in which the body is unable to control the level of a sugar called glucose in the blood. Diabetes is caused by either a lack of insulin, the body's inability to use insulin correctly, or both. In people who don't have diabetes, insulin usually ensures that excess glucose is removed from the bloodstream. It does this by stimulating cells to absorb the glucose they need for energy from the blood. Insulin also causes any remaining glucose to be stored in the liver as a substance called glycogen. The production of insul Continue reading >>
Diabetic encephalopathy is damage to the brain caused by diabetes. A relatively unknown complication, encephalopathy is becoming more widely recognized as more people are diagnosed with type 1 and type 2 diabetes. Diabetic encephalopathy presents itself both mentally and physically. It can induce an altered mental state, cognitive decline, changes in personality, memory lapses, or severe impairment like dementia. The complication can also cause tremors, lack of coordination, and even seizures. Diabetic encephalopathy is largely due to acute hypoglycemia (blood sugar levels are too low) or severe hyperglycemia (blood sugar levels are too high). The condition manifests itself differently between the two major types of diabetes. Type 2 diabetes Encephalopathy in those with type 2 diabetes increases the risk of developing Alzheimer’s disease or other forms of dementia. According to a 2011 study, those with type 2 diabetes were twice as likely to develop Alzheimer’s and 1.75 times more likely to develop other forms of dementia than healthy participants. This increased risk could be due to many different factors brought about from type 2 diabetes. It could be caused by the body’s resistance to insulin, which makes it difficult for the brain to break down amyloid, a protein that forms brain plaques. Brain plaques are abnormal clusters of this protein that block cell-to-cell signaling at the synapses—a symptom infamous for contributing to the development of Alzheimer’s disease. Type 2 diabetic encephalopathy can also be generated from hyperglycemia or the conditions that commonly accompany type 2 diabetes like high blood pressure, obesity, or high cholesterol. Oxidative stress is another provoker of the complication. This stems from an imbalance between reactive oxyge Continue reading >>
Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome
In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>
Can People Die From Bulimia?
Yes! It can go unnoticed for a long period of time because you don’t see the binging or purging part ,at least most of the time. The article from Death From Bulimia - 9 Terrifying Conditions To Look Out For sums it up perfectly, so I’m just going to copy and paste it here. 1. Ketoacidosis: This is when high acid levels build up in your blood. An extremely dangerous condition that can lead to sudden coma and death. 2. Seizures or Fits: People with bulimia have a higher chance of suffering from seizures or fits which can cause brain damage and death. 3. Pancreatitis: This potentially life threatening illness is when digestive enzymes attack your pancreas. It can be caused by the excessive use of laxatives or diet pills. 4. Electrolyte Imbalance: Dehydration, the loss of potassium and the loss of sodium can cause electrolyte imbalances. Abnormal electrolyte levels are common in bulimics and can cause sudden cardiac arrest - which is what happened to Terri Schiavo. 5. Suicide and Depression: Being bulimic can feel like a living hell. Every day is hard. It's an exhausting and depressing way to live. Suicide is a real risk for those deeply lost in bulimia. 6. Cardiac Arrest: Cardiac arrest is when the heart simply stops beating. It is one of the most common causes of death from bulimia. 7. Gastric Rupture: A gastric rupture can occur when you eat huge amounts during a binge and it bursts your stomach. Although it is not very common, a gastric rupture is often fatal. 8. Hypo and Hyperglycemia: These can be caused when your blood sugar levels are too high or too low. This is usually the result of binging and purging/fasting. Hypo and hyperglycemia can cause many different life threatening complications. 9. Barrett's Esophagus: Bulimia can cause Gastroesophageal Reflux Disea Continue reading >>
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 >>
Which Foods Increase Blood Acidity?
Before Having Your Tonsils Removed Tonsillectomies are performed under general anesthesia. You will be completely asleep and will not be able to feel pain during the procedure. You will not be able to eat before surgery. This is because there is a risk of vomiting with anesthesia. Your physician or nurse will give you exact instructions about when to stop eating and drinking. In addition to not eating or drinking, you should not smoke, chew gum, or suck on mints or candy. Tonsillectomies are mostly performed in same day surgery settings. This means that you will go home the same day that you have your tonsils removed. You should wear loose comfortable clothing to the surgical center. Arrive on time. In some cases a medication called Versed can be given prior to the procedure to reduce anxiety, especially in small children. If you have other health problems, your doctor may order blood work or other tests before the surgery. If you are a woman of childbearing age (usually age 12 to 55 unless you have had a hysterectomy), it is mandatory that you have a pregnancy test before the surgery. This requires a small amount of urine. If the patient is a child and has a comfort item, such as a blanket or a favorite toy, bring it with you. Also, if your child drinks from a bottle or special cup, bring it along so your child can drink after the surgery. Make sure you bring comfortable clothing and extra diapers or underwear. Prior to having your tonsils removed, you will need to remove any metal from your body, including jewelry, retainers or body piercings. You will also need to remove contact lenses, dentures, and hearing aids. You will also need to refrain from medications that have the ability to thin your blood for one to two weeks before surgery. These medications include aspi Continue reading >>
Do Humans Or Animals Hang Like Computers, Ever? If Not, Why? If Yes, When And Under What Circumstances?
Yes, they do. Meet the myotonic goat aka “fainting goat”. “A myotonic goat, otherwise known as the fainting goat, is a domestic goat whose muscles freeze for roughly 3 seconds when the goat feels panic. Though painless, this generally results in the animal collapsing on its side. The characteristic is caused by a hereditary genetic disorder called myotonia congenita. When startled, younger goats will stiffen and fall over. Older goats learn to spread their legs or lean against something when startled, and often they continue to run about in an awkward, stiff-legged shuffle.” For more in-depth explanation visit these links Anand Muglikar asks in the comment “A hang also happens because the CPU (processor) is processing info at 100% capacity or the RAM (memory) is fully occupied by some process. Is there an analogy to this in biology?” This I think was added in the question later. Anyways, the closest example of a healthy mind going through this is in case of Fight or Flight response. It basically means that when you face a threat, your body goes into fight or flight mode which means that it either readies itself to fight the threat or to flee, if it can’t. But the problem arises when the threat level is so significant or life threatening that it overwhelms your brain which in turn overwhelms your body. In such a case you body freezes (or hangs) as your brain can’t decide as to how to respond in such a situation. For more in-depth explanation visit this link Continue reading >>
The Dangers In Bulimia Are Real - This Illness Can Kill!
People often overlook the dangers in bulimia. They think that because bulimics are often within a healthy weight range, that it's a 'safe' eating disorder. The truth could not be more different... I was bulimic for over 10 years. The illness ravaged my body and I knew that it was close to killing me. But thankfully, I got help and I recovered... Too many people don't seek help for their bulimia and suffer from it for years on end, sometimes for many decades. Too often, bulimia kills. To help you realize the dangers in bulimia, I've listed the 10 most worrying ones below. TOP 10 Terrifying Dangers in Bulimia Please click on the links below to jump to that part of the 'dangers in bulimia' page, or just scroll down. Suicide Ketoacidosis Malnutrition and then see... Seizures or Fits If you suffer from bulimia you have an increased risk of having seizures or fits. The seizures may be caused by dehydration, hyperglycemia or ketoacidosis. Seizures are one of the serious dangers in bulimia because they can cause brain damage. Electrolyte Imbalance Electrolytes are important chemicals in your body. Having the right balance of electrolytes is essential for your nerves, muscles and organs to work properly. Electrolyte imbalances are caused by a mix of dehydration and the loss of potassium and sodium. This can be caused by excessive vomiting or laxative abuse. Bulimics often develop electrolyte abnormalities... Which can lead to sudden cardiac arrest and death. Because of the stress that electrolyte imbalances place on the organs - this is one of the most deadly dangers in bulimia. When I was bulimic, my electrolyte balance was so messed up that my heartbeat became very irregular. I am lucky that bulimia didn't kill me. Terri Schiavo had a heart attack, which was caused by a massiv Continue reading >>