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How Does Ketoacidosis Affect The Kidneys

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 >>

Diabetes And Kidney Failure (stage 5)

Diabetes And Kidney Failure (stage 5)

What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause damage to the very small blood vessels in your kidneys. Over time, this can lead to kidney disease and kidney failure. What is kidney failure? Healthy kidneys do many important jobs. They filter your blood, keep fluids in balance, and make hormones that help your body control blood pressure, have healthy bones, and make red blood cells. If you have kidney failure, it means your kidneys have stopped working well enough to do these important jobs and keep you alive. As a result: Harmful wastes build up in your body Your blood pressure may rise Your body may hold too much fluid Your body cannot make enough red blood cells When this happens, you need treatment to replace the work of your failed kidneys. There is no cure for kidney failure. A person with kidney failure needs treatment to live. Three types of treatment can be used if your kidneys have failed: Hemodialysis Peritoneal dialysis Kidney transplantation Your healthcare team will discuss these different treatments with you and answer all your questions. They will help you choose the best treatment for you, based on your general health, lifestyle, and treatment preference. Your decision does not need to be final. Many people have used each one of these treatments at different times in their lifetime. If I have kidney failure and diabetes, what will my treatment involve? A kidney doctor (called a nephrologist) will plan your treatment with you, your family, and your dietitian. In addition to dialysis or a transplant, you will need to: Keep your blood sugar under control. This is usually done with d Continue reading >>

The Impact Of Hyperglycemic Emergencies On The Kidney And Liver

The Impact Of Hyperglycemic Emergencies On The Kidney And Liver

Copyright © 2013 Feng Bai et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Studies on the alterations of liver and kidney function parameters in patients with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) were limited. Participants with DKA, DK, non-DK, and healthy controls were enrolled in the current study. Parameters of liver and kidney function were measured and evaluated. The patients with DKA had higher levels of plasma glucose, hemoglobin A1c (HbA1c), uric acid, and creatinine but lower levels of transferases and protein compared with the other three groups ( for all). The patients with DK had higher levels of plasma glucose and HbA1c but lower levels of glutamyl transpeptidase and protein compared with the non-DK and control groups (). Prealbumin levels were significantly reduced in the severe DKA patients compared with the mild/moderate DKA patients. Serum prealbumin levels were correlated with albumin levels (, ), HCO3 (, ), and arterial pH (, ) in the DKA patients. A diagnostic analysis showed that lower prealbumin levels significantly reflected the presence of hyperglycemic emergencies (). Liver and kidney function parameters deteriorated, especially in DKA. Prealbumin levels can be of value in detecting the presence of hyperglycemic crisis. This clinical trial is registered with ChiCTR-OCH-12003077. 1. Introduction Diabetic ketoacidosis (DKA) and diabetic ketosis (DK) are common and serious complications of diabetes mellitus. DKA most often occurs in patients with type 1 diabetes (T1D). However, increasing evidence indicates that DKA and DK are also common features of ketosis-pr Continue reading >>

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Robin George Manappallil Department of Medicine, Mar Baselios Medical Mission Hospital, Kothamangalam, Ernakulam, Kerala, India. Abstract Diabetic ketoacidosis (DKA) is a life threatening acute complication of type 1 diabetes. Since diabetic patients may have hypertriglyceridemia, they are at risk of developing acute pancreatitis (AP). Hyperamylasemia may suggest a diagnosis of AP, but levels may be elevated in DKA. Hence, serum lipase levels correlate better with the diagnosis of AP. However, pancreatic enzymes are excreted by the kidneys and their levels are elevated in patients with chronic kidney disease (CKD). This report describes a patient with type 1 diabetes and CKD stage 4, not on hemodialysis, who presented with DKA and had very high levels of pancreatic enzymes in the absence of pancreatitis. Keywords : Diabetes Ketoacidosis, Kidney, Renal Insufficiency, Pancreatitis, Hypertriglyceridemia. Introduction Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas. In 10-15% cases, the condition is life threatening. Epigastric pain is the predominant symptom, which may radiate to the back, chest, flanks or lower abdomen. Serum amylase and lipase levels are elevated in AP. Abdominal contrast enhanced computed tomography (CT), abdominal ultrasound, magnetic resonance imaging (MRI) are radiological methods which aid in diagnosis of AP [1]. However, elevated pancreatic enzyme levels have been noted in CKD patients [2,3]. Features like epigastric pain and elevated pancreatic enzymes are also seen in DKA [4]. Moreover, AP can present or coexist with DKA [5,6]. This case report aims to highlight the importance of elevated pancreatic enzymes in DKA and CKD, and the diagnostic dilemma posed by such elevations in patients with these two illnesses. Case Repo Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were Continue reading >>

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic Ketoacidosis Causes, Symptoms, Treatment, And Complications

Diabetic ketoacidosis definition and facts Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes (though rare, it can occur in people with type 2 diabetes) that occurs when the body produces high levels of ketones due to lack of insulin. Diabetic ketoacidosis occurs when the body cannot produce enough insulin. The signs and symptoms of diabetic ketoacidosis include Risk factors for diabetic ketoacidosis are type 1 diabetes, and missing insulin doses frequently, or being exposed to a stressor requiring higher insulin doses (infection, etc). Diabetic ketoacidosis is diagnosed by an elevated blood sugar (glucose) level, elevated blood ketones and acidity of the blood (acidosis). The treatment for diabetic ketoacidosis is insulin, fluids and electrolyte therapy. Diabetic ketoacidosis can be prevented by taking insulin as prescribed and monitoring glucose and ketone levels. The prognosis for a person with diabetic ketoacidosis depends on the severity of the disease and the other underlying medical conditions. Diabetic ketoacidosis (DKA) is a severe and life-threatening complication of diabetes. Diabetic ketoacidosis occurs when the cells in our body do not receive the sugar (glucose) they need for energy. This happens while there is plenty of glucose in the bloodstream, but not enough insulin to help convert glucose for use in the cells. The body recognizes this and starts breaking down muscle and fat for energy. This breakdown produces ketones (also called fatty acids), which cause an imbalance in our electrolyte system leading to the ketoacidosis (a metabolic acidosis). The sugar that cannot be used because of the lack of insulin stays in the bloodstream (rather than going into the cell and provide energy). The kidneys filter some of the glucose (suga Continue reading >>

Does Ketosis Cause Kidney Damage?

Does Ketosis Cause Kidney Damage?

The ‘Lean for Life’ program is mildly ketotic, and only for a brief portion of the program. It has not been associated with kidney damage or disease in individuals who have normally functioning kidneys. Concerns regarding undue stress on the kidneys are often aimed at very low carbohydrate, very high protein ketogenic diets. Few studies have shown any actual damage, however. (Note: Although the Weight Loss portion of the ‘Lean for Life’ program is mildly ketogenic, it is not considered to be exceptionally “high protein” for most individuals.) Dietary ketosis is among the most maligned and misunderstood concepts in nutrition medicine. Particularly among researchers who don’t actually treat patients, ketosis (the presence of ketone bodies in the urine) is often confused with ketoacidosis, which is a life-threatening build-up of ketone bodies due to muscle wasting and dehydration as in states of shock or uncontrolled Type 1 diabetes. In the Type 1 diabetic, the absence of insulin leads to a toxic build-up of blood glucose and an extreme break-down of fat and muscle tissue. This condition doesn’t occur in individuals who have even a small amount of insulin, whether from natural production or artificially administered. Whereas patients in ketoacidosis are closely monitored in Intensive Care Units, individuals in ketosis are amongst the healthy, active population. Dietary ketosis is a natural adjustment to the body’s reduced intake of carbohydrates as the body shifts its primary source of energy from carbohydrates to stored fat. The presence of insulin keeps ketone production in check so that a mild, beneficial ketosis is achieved. Blood glucose levels are stabilized within a normal range and there is no break-down of healthy muscle tissue. It would be diffi Continue reading >>

Diabetic Nephropathy - Kidney Disease

Diabetic Nephropathy - Kidney Disease

Tweet Kidney disease amongst diabetics is commonly called diabetic nephropathy. Statistically, around 40% of people with diabetes develop nephropathy but it is possible to prevent or delay through control of both blood glucose and blood pressure levels. Diabetes affects the arteries of the body and as the kidneys filter blood from many arteries, kidney problems are a particular risk for people with diabetes. What is diabetic nephropathy? Nephropathy is a general term for the deterioration of proper functioning in the kidneys. At an advanced level, this is called end-stage renal disease or ESRD. ESRD often stems from diabetes, with diabetes causing just under half of all cases. Diabetic nephropathy can affect people with both type 1 and type 2 diabetes. Diabetic nephropathy is divided into five stages of deterioration, with the final one being ESRD. It commonly takes over 20 years for patients to reach stage 5. Symptoms of kidney disease The symptoms of diabetic nephropathy tend to become apparent once the condition has reached the later stages. Typically the following symptoms may start to be noticed around stage four of its progression: Swelling of the ankles, feet, lower legs or hands caused by retention of water Darker urine, caused by blood in the urine Becoming short of breath, when climbing the stairs for instance Tiredness as a result of a lack of oxygen in the blood Nausea or vomiting To help catch nephropathy before the later stages develop, people with diabetes should be screened for kidney complications once a year. The screening test involves a simple urine sample which is tested to detect whether protein is present in the urine. Read more on kidney disease screening What are the causes of diabetic nephropathy? Statistics show that development of kidney dise Continue reading >>

Feline Chronic Kidney Disease

Feline Chronic Kidney Disease

ON THIS PAGE: Risk Factors Home > Related Diseases > Diabetes It is not uncommon for a CKD cat to also have or develop diabetes. The dietary needs of a diabetic cat may seem incompatible with the needs of a CKD cat but the diabetes must take precedence. What is Diabetes Mellitus? Insulin is a hormone which enables the body to process food and to produce energy from it. Diabetes mellitus is a disease in which: not enough insulin is produced by the pancreas; or the cat’s body cells do not properly process insulin which the pancreas has produced. As a result, the cat develops high blood sugar levels (hyperglycaemia), which eventually lead to high sugar levels in the urine (glucosuria). Diabetes may present as: uncomplicated; or diabetes with ketoacidosis (DKA) Cats with the former may only have mild symptoms, at least in the early stages, but cats with ketoacidosis are usually very ill, and may die if not treated promptly. There is another, much rarer form of diabetes called diabetes insipidus which is beyond the scope of this website. Cornell University College of Veterinary Medicine has a good general overview of diabetes in cats. Feline diabetes mellitus: from diagnosis to therapy (2009) is a helpful article by Dr DL Zoran. Feline Diabetes provides detailed answers to frequently asked questions. Risk Factors Increasing age is a factor (as it is for CKD cats). Steroid-induced diabetes in cats (2013) Peterson ME Veterinary Endocrinology says "The average age at diagnosis for feline diabetes is 10 years, with a peak incidence between 9 and 13 years." Obesity in cats, as in humans, is a strong predisposing factor for diabetes. For some reason, male cats and neutered cats are more at risk of diabetes. Burmese cats in the UK and Australasia (but not the USA) appear to be mo Continue reading >>

I’ll See Your Ketoacidosis And Raise You A Renal Failure

I’ll See Your Ketoacidosis And Raise You A Renal Failure

A while back I posted on a paper that appeared in The Lancet about an obese woman who came to the emergency room with gastroenteritis and was misdiagnosed as being in diabetic ketoacidosis (a life-threatening disorder). She was misdiagnosed because the pinheads covering the ER couldn’t get past the fact that she had been on a low-carb diet. At the time I posted on this travesty I noted that this Lancet paper would from here on out be waved in the face of anyone who was following or advocated a low-carb diet as proof that such a diet is dangerous and can cause diabetic ketoacidosis (DKA). Well, now we’ve got an answer. Next time someone tells you that it has been proven that low-carb diets are dangerous and can cause ketoacidosis, you can resort to poker terminology and reply that you’ll see their ketoacidosis and raise them a renal failure. A few days ago I got wind of a paper published a few years ago that can be used as a counterpoint to the above mentioned idiotic paper in The Lancet that has given low-carbers such a bad time. This paper, published in the journal Renal Failure in 1998, is, like the other paper, a case report. The short version is as follows: An obese young man arrived comatose in the emergency room. In an effort to lose weight he had been consuming a high-carbohydrate canned beverage as his sole source of nutrition for the two weeks prior. His blood sugar–at about 20 times normal–was extremely elevated and led to a diagnosis of diabetic ketoacidosis. The physicians on staff treated the patient appropriately, and he, over the next 20 hours or so, regained consciousness as his blood sugar levels and other lab parameters began to normalize. During a lab analysis 22 hours after admission the doctors found the patient to be breaking down and rel Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Diabetes And Kidney Damage (nephropathy)

Diabetes And Kidney Damage (nephropathy)

Over time, high blood sugars can cause damage to the kidneys. This is called kidney disease, kidney damage or nephropathy. Your kidneys contain special filters that help clean your blood, remove waste, and control your fluid balance. These filters are called nephrons. Over time, high blood sugar can damage them and cause them to leak protein, called albumin, into your urine. You may experience no symptoms if the damage is minor. However, the extra protein (albumin) can show up on routine blood work conducted by your doctor. Untreated, damage to your kidneys can grow until kidney dialysis or a kidney transplant are necessary. Long-term studies show that achieving your HbA1c targets dramatically lowers your risk for kidney disease.1 The National Institute of Health’s (NIH) Medline Plus center states that kidney damage is more likely to occur if you: Have uncontrolled blood sugar Have high blood pressure Have type 1 diabetes that began before you were 20 years old Have family members who also have diabetes and kidney problems Smoke Are African American, Mexican American, or Native American See your healthcare provider yearly to get tested for any early signs of kidney damage or signs that there could soon be damage to the kidneys. There are different tests available that your healthcare provider should use. Urine albumin test (microalbuminuria): This involves a urine sample which is tested for the presence of a protein called albumin which may leak into the urine from the kidneys. This may indicate the presence of kidney damage. Blood urea nitrogen test (BUN): This involves a sample of blood from a vein and checks kidney function. Serum creatinine: This can be done by urine or blood sample and measures creatinine which should normally be removed by your kidneys so testin Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. INTRODUCTION — Chronic kidney disease (CKD) is associated with insulin resistance and, in advanced CKD, decreased insulin degradation. The latter can lead to a marked decrease in insulin requirement or even the cessation of insulin therapy in patients with type 2 diabetes. Both of these abnormalities are at least partially reversed with the institution of dialysis. (See "Carbohydrate and insulin metabolism in chronic kidney disease".) Because of the uncertainty in predicting insulin requirements, careful individualized therapy is essential among patients who have advanced CKD or are initiating dialysis. The insulin requirement in any given patient depends upon the net balance between improving tissue sensitivity and restoring normal hepatic insulin metabolism. In addition, among patients on peritoneal dialysis, glucose contained in peritoneal dialysate tends to increase the need for diabetes therapy. Changes in dietary intake and exercise (ie, reduced intake due to anorexia prior to starting dialysis) can also affect the response to administered insulin. Furthermore, the uremic environment can affect methods used to assess glycemic control, and the metabolism of most oral diabetes agents is prolonged, making them more difficult to use. This topic reviews glycemic targets, methods of monitoring glycemic control, and suggested treatment regimens for patients on hemodialysis and peritoneal dialysis. The treatment of diabetes Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

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