Starvation ketoacidosis on the acute medical take

Gall, Alexander; Duncan, R. Paul; Badshah, Amit

doi:10.7861/clinmed.2020-0012

Cited by 6 publications

(8 citation statements)

References 5 publications

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“…However, such patients tend to have a low-to-normal blood glucose reading at presentation. 4 In our opinion, her weight loss and muscle wasting were more likely contributed by catabolic states observed in DKA.…”

Section: Differential Diagnosismentioning

confidence: 70%

Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

2021

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A 54-year-old woman with insulin-requiring type 2 diabetes mellitus presented with acute shortness of breath and drowsiness on a background of polydipsia, weakness and significant weight loss. One year ago, she had decided to stop her insulin and other medications and adopt lifestyle modifications instead. Initial emergency department (ED) blood samples were highly lipaemic and appeared strawberry pink. She was eventually diagnosed with diabetic ketoacidosis (DKA) with severe hypertriglyceridaemia, intubated for airway protection, and managed with fluid resuscitation and intravenous insulin to good effect. We share an uncommon DKA presentation at the ED. History was limited as the patient was drowsy and minimally communicative. Physical examination was unremarkable. Blood investigations were also delayed in view of the need for additional centrifugation. These contributed to a paucity of information in the acute setting and resulted in a diagnostic challenge.

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Section: Differential Diagnosismentioning

confidence: 70%

Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

2021

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“…Gall et al have reported two cases of SKA ( 9 ). The first patient was a 28 years old male patient with a known history of depression with a history of self-harm who presented to ED after being found in his room with a decreased level of consciousness.…”

Section: Discussionmentioning

confidence: 99%

“…She was treated first as DKA and received insulin with IV dextrose until the next day when she was diagnosed with SKA with suspicion of alcohol ketoacidosis (AKA). At that time, insulin was discontinued, and she was kept on IV dextrose with IV thiamine till improvement ( 9 ). Unlike our patient, these two patients had different causes of their HAGMA.…”

Section: Discussionmentioning

confidence: 99%

A Liraglutide Injection Superimposing a Starvation Acidosis: a Case Report

Alghamdi¹,

Almulhim²,

alkhadra³

et al. 2022

Med Arch

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Background: Metabolic acidosis is defined by reduced serum bicarbonate level; this reduction can be from the addition of acid, reduced acid excretion, or loss of alkali. Starvation acidosis is one of the differential diagnoses of high anion gap metabolic acidosis (HAGMA). Objective: We report a rare case presentation of HAGMA associated with Liraglutide and low carbohydrates diet. Case presentation: A 27-year-old female patient presented to the Emergency Department (ED) with a complaint of nausea and vomiting for two days. She was following a strict low carbohydrate diet for three months to reduce her weight as her body mass index (BMI) was 30 kg/m3. Her bedside investigations were significant for HAGMA. The patient was seen by the endocrine service and was admitted as a case of starvation ketoacidosis (SKA) vs. euglycemic diabetic ketoacidosis (DKA). The patient was treated with D10W 250 cc/hr with insulin infusion, her the anion gap was closed after 5 hours. She was discharged home as SKA secondary to diet with the possibility of drug superimposing the starvation state. She was given a follow-up clinic regularly to monitor her clinical status. Conclusion: This case highlights the possibility of a HAGMA as a rare complication of a low carbohydrate diet with the possibility of Liraglutide injection attribution in developing such critical complication. Further studies are needed to evaluate the safety of a low carbohydrate diet and the effect of Liraglutide injection on these patients following this diet.

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“…Ketones are often elevated in starvation as an alternate fuel source and can be sufficiently elevated to constitute a starvation ketoacidosis 58 . Alcoholism is a common comorbidity in cases of eating disorder–associated starvation, however, and alcoholic ketoacidosis may coexist with starvation ketoacidosis 58 . Because of low muscle mass, creatinine levels are often within normal or low ranges, despite a functionally low glomerular filtration rate, and must be kept in mind when considering renal impairment 8,59 …”

Section: Causes and Featuresmentioning

confidence: 99%

“…58 Alcoholism is a common comorbidity in cases of eating disorder-associated starvation, however, and alcoholic ketoacidosis may coexist with starvation ketoacidosis. 58 Because of low muscle mass, creatinine levels are often within normal or low ranges, despite a functionally low glomerular filtration rate, and must be kept in mind when considering renal impairment. 8,59 Testing for decreased serum prealbumin levels can be a useful indicator of starvation/undernourishment in the clinical and postmortem settings; however, serum albumin testing is unreliable and may actually be increased in dehydration.…”

Section: Ancillary Laboratory Investigationsmentioning

confidence: 99%

A Guide to the Postmortem Investigation of Starvation in Adults

Garland

Irvine

2022

Am J Forensic Med Pathol

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Starvation is a rare cause of death in developed countries and is a complex multifaceted pathological process. To complicate the forensic investigation of starvation further, many medical conditions independent of starvation may cause wasting. This article provides one of the first comprehensive guides to the postmortem investigation of starvation in adults, with reference tables on organ-specific macroscopic and microscopic features, as well as features for excluding alternative causes of wasting. The eclectic literature on this complex topic is summarized in an accessible and easily referenced format, including mechanisms of death and ancillary postmortem investigations.

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Starvation ketoacidosis on the acute medical take

Cited by 6 publications

References 5 publications

Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

Strawberry pink blood: hypertriglyceridaemia and diabetic ketoacidosis secondary to poorly controlled type 2 diabetes mellitus

A Liraglutide Injection Superimposing a Starvation Acidosis: a Case Report

A Guide to the Postmortem Investigation of Starvation in Adults

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