Atypical Diabetic Ketoacidosis: Case Report

Demirci, Hüseyin; Cosar, Ramazan; Çiftçi, Özcan; Sarı, Işılay Kalan

doi:10.5152/balkanmedj.2015.15123

Cited by 9 publications

(13 citation statements)

References 10 publications

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“…The decedent in their study and from the present study (Case 1) had a history of diabetes. However, the decedent in Case 2 had no history of diabetes which is similar to what was reported by Demirci et al 5F‐MDMB‐PICA is a full agonist to the CB 1 receptor and may produce severe adverse side effects such as hyperglycemia . In cases of ketoacidosis with or without history of diabetes, comprehensive toxicology screens may be valuable in determining root cause.…”

Section: Discussionsupporting

confidence: 76%

5F‐MDMB‐PICA metabolite identification and cannabinoid receptor activity

Truver

Watanabe

Åstrand

et al. 2019

Drug Testing and Analysis

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According to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), there were 179 different synthetic cannabinoids reported as of 2017. In the USA, 5F‐MDMB‐PINACA, or 5F‐ADB, accounted for 28% of cannabinoid seizures 2016–2018. The synthetic cannabinoid, 5F‐MDMB‐PICA, is structurally similar to 5F‐MDMB‐PINACA with an indole group replacing the indazole. Limited data exist from in vivo or in vitro metabolic studies of these synthetic cannabinoids, so potential metabolites to identify use may be missed. The goals of this study were to (a) investigate 5F‐MDMB‐PICA and 5F‐MDMB‐PINACA in vitro metabolism utilizing human hepatocytes; (b) to verify in vitro metabolites by analyzing authentic case specimens; and (c) to identify the potency and efficacy of 5F‐MDMB‐PICA and 5F‐MDMB‐PINACA by examining activity at the CB1 receptor. Biotransformations found in this study included phase I transformations and phase II transformations. A total of 22 5F‐MDMB‐PICA metabolites (A1 to A22) were identified. From hepatocyte incubations and urine samples, 21 metabolites (B1 to B21) were identified with 3 compounds unique to urine specimens for 5F‐MDMB‐PINACA. Phase II glucuronides were identified in 5F‐MDMB‐PICA (n = 3) and 5F‐MDMB‐PINACA (n = 5). For both compounds, ester hydrolysis and ester hydrolysis in combination with oxidative defluorination were the most prevalent metabolites produced in vitro. Additionally, the conversion of ester hydrolysis with oxidative defluorination to pentanoic acid for the first time was identified for 5F‐MDMB‐PICA. Therefore, these metabolites would be potentially good biomarkers for screening urine of suspected intoxication of 5F‐MDMB‐PICA or 5F‐MDMB‐PINACA. Both 5F‐MDMB‐PICA and 5F‐MDMB‐PINACA were acting as full agonists at the CB1 receptor with higher efficacy and similar potency as JWH‐018.

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Section: Discussionsupporting

confidence: 76%

5F‐MDMB‐PICA metabolite identification and cannabinoid receptor activity

Truver

Watanabe

Åstrand

et al. 2019

Drug Testing and Analysis

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“…This review demonstrates that 45% of the patients who went to emergency departments had symptoms or signs that were resolved after a short period (1–24 hours) of monitoring in a quiet environment. 12,20,21,26,27,33,35–37,39,42,45,46,50,51 However, SCs mostly caused health effects (55% of patients; e.g., severe agitation, severe tachycardia, hypertensive crisis, convulsions, and kidney damage) that led to hospitalization longer than 24 hours, 10,11,1315–16,18,23–25,28,33,38,41–44,53–55 and/or persistent psychiatric symptoms (for several months), 10,11,19,23,43 and were highlighted as being involved in 24 cases of deaths. 29…”

Section: Resultsmentioning

confidence: 99%

“…After examining the full text of 120 articles, 46 articles fulfilled the search criteria. 10 – 55 These studies included 29 case reports (Table 2) and 17 case series (Table 3). Among these, 7 publications reported deaths related to exposure to SCs (Table 4).…”

Section: Methodsmentioning

confidence: 99%

Acute Effects of Synthetic Cannabinoids: Update 2015

Tournebize¹,

Gibaja²,

Kahn

2017

Substance Abuse

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“…Cocaine stimulates cortisol and catecholamine release and may be associated with insulin omission and starvation; however, no association was found between active cocaine use and hyperglycaemic crisis . Synthetic cannabinoids may be associated with prolonged acidosis and a tendency to hypokalaemia . Conversely cannabis use in T1DM with DKA is associated with significantly higher bicarbonate and chronic alkalosis.…”

Section: Methodsmentioning

confidence: 96%

Review article: Ketoacidosis in the emergency department

Morton

2020

Emerg Medicine Australasia

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Diabetic ketoacidosis, a life‐threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium‐glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. Ketoacidosis with these medications may be prolonged and recur after initial resolution. Checkpoint inhibitors may present with fulminant diabetic ketoacidosis in individuals with previously normal glucose tolerance. Ketoacidosis may also occur as a result of starvation and alcohol excess, as well as a number of rare causes. Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.

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Atypical Diabetic Ketoacidosis: Case Report

Cited by 9 publications

References 10 publications

5F‐MDMB‐PICA metabolite identification and cannabinoid receptor activity

5F‐MDMB‐PICA metabolite identification and cannabinoid receptor activity

Acute Effects of Synthetic Cannabinoids: Update 2015

Review article: Ketoacidosis in the emergency department

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