Severe Hypertriglyceridemia In Diabetic Ketoacidosis Accompanied By Acute Pancreatitis: Case Report
Go to: CASE REPORT A 20-yr-old female visited the emergency department because of a 1-day history of vomiting (10 times) and was experiencing epigastric pain with diarrhea on March 23, 2009. The upper gastric pain was continuous without radiation. The patient had been drinking almost daily alcoholic beverages soju (alcohol concentration in the range of 19-22%) for 5 days prior to admission. The patient had a smoking history of one pack-year. Two years previously, the patient experienced DKA accompanied by acute pancreatitis. At that time, the patient had been diagnosed with type 1 diabetes mellitus. Insulin treatment began at that time. However, 7 months prior to the current admission, the patient ceased taking insulin. Upon admission, the patient was determined to be 161 cm in height, 55 kg in weight with a body mass index of 21.2. On admission, the patient was alert but appeared acutely ill. Initial vital signs were blood pressure 90/60 mmHg, pulse rate of 88 beats/min, respiratory rate of 20/min and body temperature of 36.5℃. Physical examination revealed a dehydrated tongue and skin turgor. There was no evidence of xanthoma, xanthelasma or eruptive xanthoma. No palpable lymph node enlargement was apparent on head and neck examination, and no abdominal tenderness on abdominal examination. Bowel sound was normoactive. Initial laboratory findings were ABGA (pH 7.148, pCO2 12.9 mmHg, pO2 126 mmHg, HCO3- 8.4 mM/L, SaO2 98.0%), glucose level 281 mg/dL, hemoglobin A1c 13.8% , C-peptide (premeal) 0.441 ng/mL (normal reference: 1.1-4.4 ng/mL), total cholesterol 1,640 mg/dL, TG 15,240 mg/dL, measured low density lipoprotein cholesterol (LDL-C) 246 mg/dL (determined by homogeneous enzymatic colorimetry method assay), high density lipoprotein cholesterol (HDL-C) 69 mg/dL, ser Continue reading >>
Urinalysis Chapter 3
What determines the physical examination of urine? Flashcards Matching Hangman Crossword Type In Quiz Test StudyStack Study Table Bug Match Hungry Bug Unscramble Chopped Targets Physical Examination of the Urine Question Answer What determines the physical examination of urine? Color, clarity, specific gravity, Osmolarity, and volume if timed. What are the common colors of urine? Pale yellow, yellow, dark yellow, and amber. What is the yellow color of urine caused by? the presence of a pigment, named urochrome. What is urochrome? is a product of endogenous metabolism, and under normal conditions the body produces it at a constant rate. What is uroerythrin? A pink pigment present in urine in smaller amounts, and it is most evident in specimens that have been refrigerated, resulting in the precipitation of amorphous urates. What is urobilin? is an oxidation product of the normal urinary constituent urobilinogen, imparts an orange-brown color to urine that is not fresh. What does Dark yellow/Amber/Orange urine mean? It can be caused by the presence of the abnormal pigment bilirubin. What do techs do if it is suspected that specimen contains bilirubin? It is shaken and a yellow foam appears. What does yellow-orange specimen mean? it is caused by the administration of phenazopyridine(Pyridium) or azo-gantrisin compounds to persons with urinary tract infections. What does Red/Pink/Brown urine mean? blood in urine. What color is produced when the oxidation of hemoglobin to methemoglobin has occured from urine remaining in an acidic conditions for several hours? brown What does a fresh brown color mean when the urine contains blood indicate? It could indicate glomerular bleeding resulting from the conversion of hemoglobin to methemoglobin. If RBC are present what does the urine Continue reading >>
Stress Induced Hyperglycemia In A Term Baby Mimicking Diabetic Ketoacidosis With Stroke
Go to: Stress/sepsis induced transient hyperglycemia in the newborn may present with extremely high blood sugar values and may mimic neonatal diabetes mellitus. We present a case of neonatal septicemia with stress induced hyperglycemia mimicking neonatal diabetes mellitus. Extremely high blood sugar values upto 1529 mg/dl with metabolic acidosis were noted in a term good weight baby causing a diagnostic dilemma. It can be seen even in term babies, contrary to the belief that it occurs in preterm and small for gestation babies. Considering the prognostic implications it may cause it is important that hyperglycemia is promptly treated by insulin infusion. Keywords: Hyperglycemia, insulin therapy, neonatal diabetes, stress Go to: Stress induced hyperglycemia is a known complication of Neonatal sepsis, but sometimes it may become very difficult to distinguish it from neonatal diabetes mellitus. We present a case of neonatal septicemia with stress induced hyperglycemia mimicking neonatal diabetes mellitus. Extremely high blood sugar values with metabolic acidosis were noted in a term good weight baby caused a diagnostic dilemma. Go to: CASE REPORT The present case report is about a 3 kg term neonate who presented on the 9th day of life with a history of fever for 2 days, lethargy and one episode of seizure. At admission, he was in a state of shock with severe dehydration. Anterior fontanel was bulging. He was given two boluses of normal saline, radiant warmer care and intravenous antibiotics (cefotaxime and vancomycin) were started. Inotropic support with dopamine was given in view of septic shock. The blood sugar was 1529 mg/dL and arterial blood gases revealed mild metabolic acidosis (pH - 7.289 and HCO3-11.5). Urine ketones were however negative. Dehydration was corrected Continue reading >>
Turbidity
1.6 Nephelometry and Turbidimetry Turbidity results in a decrease of intensity of the light beam that passes though a turbid solution due to light scattering, reflectance, and absorption. Measurement of this decreased intensity of light is measured in turbidimetric assays. However, in nephelometry, light scattering is measured. In common nephelometry, scattered light is measured at a right angle to the scattered light. Antigen–antibody reactions may cause turbidity, and either turbidimetry or nephelometry can be used in an immunoassay for quantification of an analyte. Therefore, both nephelometry and turbidimetry are spectroscopic techniques. Although nephelometry can be used for analysis of small molecules, it is more commonly used for analysis of relatively big molecules such as immunoglobulin, rheumatoid factor, etc. Color and turbidity are analyzed by visual inspection. Normal urine is clear to slightly turbid and light yellow to amber. Dilute urine tends to be colorless, and concentrated urine is dark yellow. Different colors and their significance are listed in Table 7-3. Significant disease may exist even if the urine is normal in color and turbidity. If urine discoloration is noted, one should review the patient's history for drug administration and carefully examine the urine sediment. Hematuria, hemoglobinuria, and bilirubinuria are the most common causes of discolored urine. Pyuria, hematuria, crystalluria, and lipiduria are common causes of increased turbidity. 8.3.4 Detection and Interpretation of Results 8.3.4.1 Turbidity Detection The turbidity of magnesium pyrophosphate, a byproduct of the LAMP reaction, is formed in proportion to the amount of amplified products. Because LAMP can yield extremely large amounts of amplified products, white turbidity can Continue reading >>
Ketoacidosis
ketoacidosis [ke″to-as″ĭ-do´sis] the accumulation of ketone bodies in the blood, which results in metabolic acidosis; it is often associated with uncontrolled diabetes mellitus. See also ketosis. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. ke·to·ac·i·do·sis (kē'tō-as'i-dō'sis), Acidosis, as in diabetes or starvation, caused by the enhanced production of ketone bodies. ketoacidosis /ke·to·ac·i·do·sis/ (ke″to-as″ĭ-do´sis) acidosis accompanied by the accumulation of ketone bodies in the body tissues and fluids. ketoacidosis (kē′tō-ăs′ĭ-dō′sĭs) n. pl. ketoaci·doses (-dō′sēz) 1. Metabolic acidosis caused by an abnormally high concentration of ketone bodies in the blood and body tissues. 2. This condition occurring as a complication of untreated or improperly controlled diabetes mellitus, especially type 1 diabetes, characterized by thirst, fatigue, a fruity odor on the breath, and other symptoms, and having the potential to progress to coma or death. Also called diabetic ketoacidosis. ketoacidosis [kē′tōas′idō′sis] acidosis accompanied by an accumulation of ketones in the body, resulting from extensive breakdown of fats because of faulty carbohydrate metabolism. It occurs primarily as a complication of diabetes mellitus and is characterized by a fruity odor of acetone on the breath, mental confusion, dyspnea, nausea, vomiting, dehydration, weight loss, and, if untreated, coma. Emergency treatment includes the administration of insulin and IV fluids and the evaluation and correction of electrolyte imbalance. Nasogastric intubation and bladder catheterization may be required if the patient is comatose. Continue reading >>
Pseudohyponatremia
Measurement of plasma/serum sodium concentration is one of the most frequently requested blood tests in clinical practice. Although usually performed in the laboratory, the test is also available at the point of care using technology incorporated into blood gas and other point-of-care analyzers. In health, sodium concentration is maintained between 135 and 145 mmol/L, so that hyponatremia (reduction in plasma sodium) is diagnosed if the concentration falls below 135 mmol/L. Effective, safe correction of plasma sodium depends on establishing the cause. Initial assessment of the hyponatremic patient should include due consideration of the rare possibility that the result is spuriously low: that this is not true hyponatremia but so-called "pseudo"hyponatremia. The main purpose of this article is to outline how some laboratory methods can, in certain well-defined clinical situations, give rise to a falsely low plasma sodium concentration, and thereby a diagnosis of pseudohyponatremia. Indicators that help establish a diagnosis of pseudohyponatremia will be discussed, and with the help of two published case histories, the danger of failing to recognize pseudohyponatremia will be highlighted. The article begins, however, with a brief overview of normal sodium metabolism and hyponatremia. Continue reading >>
Corneal Hydrops Induced By Diabetic Ketoacidosis: A Case Report
Go to: Case report A 20-year-old male patient was admitted to the Department of Endocrinology of the Zaozhuang Municipal Hospital (Zaozhuang, China) on July 31, 2013 presenting with diabetic ketoacidosis. The patient reported inflammation in the left eye, a foreign body sensation in both eyes and impaired visual acuity for 3 days, together with palpitation and shortness of breath for 3 h. The present study was approved by the Ethics Committee of Zaozhuang Municipal Hospital and informed consent was obtained from the patient. The physical examination revealed no abnormality. The patient was conscious but in a depressed mood. In addition, an odor described as resembling ‘rotten apples’ was detected during deep respiration. Poor skin elasticity was manifested. Rough sounds were heard in the lungs upon breathing, with no dry or wet rales and a heart rate of 126 bpm. Low skin temperature was detected in the distal end of the limbs and no hydrops was observed in either of the lower extremities. Weak arterial pulse was noted on the dorsa of the feet. No Babinski sign was identified. Ophthalmology consultation was performed due inhibited vision in the left eye. The ophthalmological examination indicated that light perception was present in the visual acuity of the left eye, and intraocular pressure was found to be 13.0 mmHg. Mild swelling was observed in the eyelid, along with mixed hyperemia. Gray, homogeneous haze was observed in the cornea, which led to the diagnosis of diabetic ketoacidosis-induced corneal hydrops (Fig. 1). Following admission to the hospital, dual-channel fluid infusion (administration of 0.9% sodium chloride followed by 5% glucose) was performed to replenish blood volume. A small dose of insulin (22 units; Novo Nordisk Co., Ltd., Beijing, China) was p Continue reading >>
Diabetic Ketoacidosis Complicated By The Use Of Ecstasy: A Case Report
Abstract Ecstasy (3,4-methylenedioxymethamphetamin), a hallucinogenic amphetamine, is often used by young people, especially at 'raves'. This illicit drug can cause many metabolic changes and its use, when associated with prolonged exercise, may exacerbate ketoacidosis in type 1 diabetic patients. This is a case of ketoacidosis complicated by the use of ecstasy in a 19-year-old insulin-dependent diabetic Caucasian woman. The use of ecstasy may trigger diabetic ketoacidosis in patients with a preexisting metabolic disorder Introduction A considerable number of young people are exposed to 3,4-methylenedioxymethamphetamine (MDMA -, also known as 'ecstasy') [1], a synthetic compound with structural and pharmacological characteristics similar to those of amphetamines. The use of this drug has increased considerably over the last 15 years [2]. The drug was originally developed as an appetite suppressant, although it was never promoted commercially for that purpose. Given its psycho-affective properties of inducing euphoria, disinhibition and sexual arousal, the drug was later used as an adjunct to psychotherapy. In the 1980s, MDMA became a trendy drug of abuse, particularly at rave parties and dance clubs. However, its potential for abuse was soon recognized, thus prompting government officials to place restrictions on its use [3]. In Brazil, the first shipments of ecstasy arrived in São Paulo in 1994, mainly from Amsterdam, and began to be trafficked, mostly at raves and dance clubs [4]. Ecstasy is mistakenly seen by young people as a 'safe' drug compared with amphetamines. However, it not only has some of the toxicity of amphetamines but also other detrimental acute effects (including increased risk of fatal arrhythmias, rhabdomyolysis, acute kidney failure, hyponatremia) Continue reading >>
Diabetic Ketoacidosis Appearing As Carbon Monoxide Poisoning
THE VALUE of the differential spectrophotometer in determining hemoglobin values and saturations of carboxyhemoglobin (COHb) and oxyhemoglobin (O2Hb) has been demonstrated.1 The differential spectrophotometer (IL 182 CO-Oximeter) is used in our pulmonary function laboratory for routine blood-gas analysis. Recently, a comatose patient was first seen in the emergency room with metabolic acidosis. Carbon monoxide poisoning was suspected on the basis of initial arterial blood-gas testing, which showed a markedly increased level of COHb. However, it was subsequently determined that the patient had very high levels of serum lipids resulting in interference with the analyzer's spectrophotometric method for measuring hemoglobin, COHb, and O2Hb. Since this problem with the differential spectrophotometer we use has not previously been described, we decided to collect some quantitative data on the effect of serum lipids on the performance of this machine. Report of a Case The patient was a 27-year-old woman Continue reading >>
Diabetic Ketoacidosis
Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>
Turbid Urine-10 Causes, Symptoms & Treatment
Turbid urine is also known by many other names like foamy urine, cloudy urine, and albinuria. It is a presentation of many types of diseases or disorders. Turbid urine is mainly caused by disorders of the urinary tract which includes the kidneys, ureters, bladder and the urethra. Any type of infection affecting the urinary tract can lead to turbid urine. Also, swelling or inflammation of the urinary tract can produce cloudy urine. Some disorders of the reproductive tract can also lead to urine being turbid. In some people, some systemic diseases can also lead to the formation of turbid urine. Normally, the color of your urine is either transparent or clear or light yellow. If the appearance of the urine becomes turbid or cloudy, it is not normal. It certainly indicates a disorder. So, you will need to consult your doctor and get your urine tested. Your doctor will provide appropriate treatment based on the condition that you are suffering from. There are many causes of cloudy or turbid urine as we have just mentioned. Let us explore them in detail. Urinary tract infection: Urinary tract infection is abbreviated as UTI. UTI is the most common cause of turbid urine. Many people suffer from UTI on a day to day basis. Many of the patients seen by a general physician or general practitioner are sufferers of UTI’s. Women tend to develop UTI more commonly than men. This is due to the fact that women have short urethra through which the microbes or bacteria causing UTI can easily enter the urinary tract. UTI can also occur more commonly in people having Diabetes, people maintaining poor personal hygiene, people with indwelling urinary catheters, etc. UTI can affect any part of the urinary tract including the urethra, bladder, ureter, and kidneys. The infection of the lower pa Continue reading >>
Urinalysis
Please contact us for pricing and turn around times or if you have any questions about the services we offer. Urine screening tests (routine urinalysis, urine chemistry, and urine microbiology) may be done to help find the cause for many types of symptoms. A routine urinalysis usually includes the following tests: Color: Many factors affect urine color, including fluid balance, diet, medications and disease. Clarity: Urine is normally clear. This test determines the cloudiness of urine, also called opacity or turbidity. Bacteria, blood, sperm, crystals or mucus can make urine appear cloudy. Odor: Urine usually does not smell very strong but has a slightly "nutty" (aromatic) odor. Some diseases can cause a change in the normal odor of urine. For example, an infection with E. coli bacteria can cause a foul odor, while diabetes or starvation can cause a sweet, fruity odor. Specific gravity: This measures the amount of substances dissolved in the urine. It also indicates how well the kidneys are able to adjust the amount of water in urine. The higher the specific gravity, the more solid material is dissolved in the urine. pH: The pH is a measure of how acidic or alkaline (basic) the urine is. Sometimes the pH of urine may be adjusted by certain types of treatment to keep urine either acidic or alkaline to prevent formation of certain types of kidney stones. Protein: Protein is normally not detected in the urine. Some diseases, especially kidney disease, may also cause protein in the urine. Glucose: Glucose is the type of sugar usually found in blood. Normally there is very little or no glucose in urine. However, when the blood sugar level is very high, as in uncontrolled diabetes, it spills over into the urine. Glucose can also be present in urine when the kidneys are damag Continue reading >>
