Background: Pseudo hypobicarbonatemia is a rare phenomenon associated with spuriously low bicarbonate levels in the presence of elevated triglycerides (TG). TG's interfere with commonly used enzymatic assays in BMP, giving falsely low bicarbonate levels. It adds to the diagnostic dilemma and possible extensive workup to identify the cause. Previous case reports have used plasmapheresis in these settings. We report the successful use of insulin infusion in managing a case of pseudo-acidosis secondary to severely high TG levels.Case presentation: Our was a 53-year-old female who presented with complaints of progressive fatigue. Her bicarbonate was 5 mmol/L on workup, anion gap was 30 mmol/L, with elevated TG levels.(5904 mg/dL). Arterial blood gas analysis showed normal pH (7.32) and normal calculated bicarbonate. (22.8mEq/L) Insulin infusion was started along with adding feno brate and atorvastatin. TG levels decreased progressively to 509 mg/dL with an associated normalization of bicarbonate levels and aniongap acidosis on BMP. The patient was discharged on day 8 of her hospital stay. Conclusion:Hyper TG can lead to pseudo hypobicarbonatemia, presenting as pseudo anion gap metabolic acidosis. It is essential to correlate the lab ndings in the perspective of clinical ndings to avoid over-testing and clinical misdiagnosis. In addition, these patients can be managed safely with insulin infusion in resource-limited settings.
Mitral annular disjunction (MAD) is the atrial displacement of the mitral valve (MV) hinge point, especially along the posterior mitral leaflet, which leads to inhomogeneous blood flow into the left ventricle, causing chronic fibrotic changes, malignant arrhythmias, and even sudden cardiac arrest. Some studies suggest that MAD is a part of normal heart morphology; however, the origin is still controversial. MAD commonly occurs with MV prolapse and myxomatous degenerative MV disease. In almost 20% of cases, MAD can occur independently as well. The prevalence of MAD in normal hearts varies from 8.6% to 96%, depending on the imaging modality and the cutoff used to define MAD. Transthoracic echocardiography is often the initial screening test, but the low sensitivity of transthoracic echocardiography to identify MAD makes it easy to miss the diagnosis altogether. More advanced imaging, especially cardiac MRI, is the gold standard for diagnosing MAD and risk stratification. MAD is an independent predictor of malignant arrhythmia. Among patients with MAD, risk stratification is based on the age at diagnosis, previous syncopal attacks, premature ventricular contractions, papillary muscle fibrosis, and longitudinal disjunction distance. Most asymptomatic patients are managed conservatively; however, radiofrequency ablation should be considered in patients with high-risk or symptomatic MAD due to the risk of ventricular arrhythmias and sudden cardiac death.
Background: A plant-based diet is associated with lower cardiovascular disease and mortality incidence. This article reports a case of a post coronary artery bypass graft, morbidly obese, uncontrolled diabetic patient who was able to reduce weight, reduce blood pressure medications, and come off insulin with a strictly plant-based diet. Case report: A 61-year-old man was seen in follow-up post coronary artery bypass grafting. He had a history of hypertension, hyperlipidemia, diabetes, morbid obesity, coronary artery disease post-stenting in 2000, and heart failure preserved ejection fraction. Post-discharge, he felt tired, had gained 7 lb with hemoglobin A1c (HbA1c) 10% on high-dose insulin, and had uncontrolled hypertension on amlodipine, bumetanide, and carvedilol. He was started on a strictly plant-based diet. He was compliant on subsequent visits. At six months follow-up, he had excellent blood pressure and glucose control. He was able to come off amlodipine, bumetanide, and insulin completely. He lost 70 lb and was more active. Discussion: A plant-based diet effectively reduces obesity, diabetes, hypertension, hyperlipidemia, and heart disease. Epidemiological studies have shown lower cardiovascular and all-cause mortality with a plant-based diet. Conclusion: A whole food, plant-based diet should be recommended to prevent and control cardiovascular risk factors and overall cardiovascular morbidity and mortality.
Background: Pseudo hypobicarbonatemia is a rare phenomenon associated with spuriously low bicarbonate levels in the presence of elevated triglycerides (TG). TG's interfere with commonly used enzymatic assays in BMP, giving falsely low bicarbonate levels. It adds to the diagnostic dilemma and possible extensive workup to identify the cause. Previous case reports have used plasmapheresis in these settings. We report the successful use of insulin infusion in managing a case of pseudo-acidosis secondary to severely high TG levels. Case presentation: Our patient was a 53-year-old female who presented with complaints of progressive fatigue. Her bicarbonate was 5 mmol/L on workup, anion gap was 30 mmol/L, with elevated TG levels. (5904 mg/dL). Arterial blood gas analysis showed normal pH (7.32) and normal calculated bicarbonate. (22.8mEq/L) Insulin infusion was started along with adding fenofibrate and atorvastatin. TG levels decreased progressively to 509 mg/dL with an associated normalization of bicarbonate levels and anion-gap acidosis on BMP. The patient was discharged on day 8 of her hospital stay. Conclusion: Hyper TG can lead to pseudo hypobicarbonatemia, presenting as pseudo anion gap metabolic acidosis. It is essential to correlate the lab findings in the perspective of clinical findings to avoid over-testing and clinical misdiagnosis. In addition, these patients can be managed safely with insulin infusion in resource-limited settings.
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