Bone calcium changes during diabetic ketoacidosis: A comparison with lactic acidosis due to volume depletion

Topaloğlu, Ali Kemal; Yıldızdaş, Dinçer; Yılmaz, Hayri Levent; Mungan, Neslihan; Yüksel, Bilgin; Özer, Güler

doi:10.1016/j.bone.2005.03.012

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…In DKA, which is a life-threatening complication of DM, a hypovolemic condition might be the most important causative factor for the occurrence of hypercalcemia [ 29 ]. Metabolic acidosis and bone resorption decreases bone formation, and bone resorption is a process subsequent to severe insulin deficiency and metabolic acidosis [ 59 ]. As well as bone resorption, insulin growth factor-1 deficiency and hypophosphatemia are potential factors for hypercalcemia in DM [ 3 4 29 59 ].…”

Section: Relationship Between Hypercalcemia and Diabetesmentioning

confidence: 99%

Calcium homeostasis in diabetes mellitus

2017

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Diabetes mellitus (DM) is becoming a lifestyle-related pandemic disease. Diabetic patients frequently develop electrolyte disorders, especially diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. Such patients show characteristic potassium, magnesium, phosphate, and calcium depletion. In this review, we discuss a homeostatic mechanism that links calcium and DM. We also provide a synthesis of the evidence in favor or against this linking mechanism by presenting recent clinical indications, mainly from veterinary research. There are consistent results supporting the use of calcium and vitamin D supplementation to reduce the risk of DM. Clinical trials support a marginal reduction in circulating lipids, and some meta-analyses support an increase in insulin sensitivity, following vitamin D supplementation. This review provides an overview of the calcium and vitamin D disturbances occurring in DM and describes the underlying mechanisms. Such elucidation will help indicate potential pathophysiology-based precautionary and therapeutic approaches and contribute to lowering the incidence of DM.

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Section: Relationship Between Hypercalcemia and Diabetesmentioning

confidence: 99%

Calcium homeostasis in diabetes mellitus

2017

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“…This and decreased insulin levels partially explain the more severe urinary calcium loss observed in diabetic ketoacidosis relative to lactic acidosis. 66…”

Section: Different Exogenous Acidsmentioning

confidence: 99%

Acidosis and Urinary Calcium Excretion: Insights from Genetic Disorders

Alexander

Cordat

Chambrey

et al. 2016

JASN

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Metabolic acidosis is associated with increased urinary calcium excretion and related sequelae, including nephrocalcinosis and nephrolithiasis. The increased urinary calcium excretion induced by metabolic acidosis predominantly results from increased mobilization of calcium out of bone and inhibition of calcium transport processes within the renal tubule. The mechanisms whereby acid alters the integrity and stability of bone have been examined extensively in the published literature. Here, after briefly reviewing this literature, we consider the effects of acid on calcium transport in the renal tubule and then discuss why not all gene defects that cause renal tubular acidosis are associated with hypercalciuria and nephrocalcinosis.

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“…In our previous series, the most common alteration in liver function tests was an elevated ALP, but GGT levels were not measured and diagnostic imaging procedures to study the biliary tract were not done. Although there is evidence that chronic glue sniffing and severe acidosis (including RTA-1) are associated with osteomalacia and increased bone resorption ([ 17 ]; Fulop et al, 2004; [ 48 ]), it is unlikely that elevated levels of ALP are originated from bone in toluene intoxication. First of all, in both non-toluene causes of RTA-1 (Sjögren’s syndrome) and severe acidosis (diabetic ketoacidosis), ALP levels have actually been found to be decreased [ 21 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

et al. 2015

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BackgroundToluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication.MethodsWe prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication.ResultsThe main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80 % of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities.ConclusionThe hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

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Bone calcium changes during diabetic ketoacidosis: A comparison with lactic acidosis due to volume depletion

Cited by 20 publications

References 24 publications

Calcium homeostasis in diabetes mellitus

Calcium homeostasis in diabetes mellitus

Acidosis and Urinary Calcium Excretion: Insights from Genetic Disorders

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

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