Severe Prolonged SGLT2i-induced Euglycemic Diabetic Ketoacidosis Refractory to Standard Therapy and Dialysis: Case Report and Literature Review.

Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are oral hypoglycemic agents that have insulin-independent glucose-lowering effects mediated by increasing the renal excretion of glucose by inhibiting the SGLT2-mediated renal glucose reabsorption. An increasingly recognized complication induced by SGLT2i is euglycemic diabetic ketoacidosis (eDKA). Here, we describe the case of a 26-year-old male patient with type 2 diabetes mellitus and morbid obesity. Prior to presentation he was on multiple oral hypoglycemic agents including SGLT2i. He developed life-threatening severe prolonged eDKA associated with SGLT2i (Canagliflozin), precipitated by adenovirus infection. The acidosis was not responding to standard DKA therapy and renal replacement therapy but was managed effectively with insulin titration based on capillary ketone measurements. After reviewing the literature on severe prolonged eDKA induced by SGLT2 and treatment modalities used, we present previously reported cases similar to ours.

Time resolved study of three ruthenium(II) complexes at micellar surfaces: A new long excited state lifetime probe for determining critical micelle concentration of surfactant nano-aggregates.

Three different ruthenium complexes have been synthesized and their luminescence properties in different solvent environments are reported. Luminescence intensities and excited state lifetimes of Ru-I, Ru-II and Ru-III vary with solvent viscosity. The excited state lifetime of Ru-I linearly increases in the viscosity range 1.76-12,100cP. Ru-II shows two linear increases: one in the low and another in the high viscosity ranges, whereas Ru-III illustrates a linear enhancement only in the low viscosity range. Interestingly, luminescence intensities and excited state lifetimes of Ru-I, Ru-II and Ru-III are found to be sensitive to nano-aggregation. However, the surfactant head charge and that of the ruthenium center as well as the hydrophobic tail of the ancillary ligand of the complexes have a great role in deciding the nature of the interaction and on the excited state properties at micellar surfaces. It is proposed that the long lifetime of Ru-III in water could be due to the coiling of the carbon chain of the ancillary ligand around the ruthenium center. At micelle surface, this coiling of the carbon chain is lost due to the parallel alignment with surfactants and thus quenching of the excited state lifetime is seen. Furthermore, it is shown that the variation of the excited state lifetime with respect to the change in surfactant concentration is a result of the formation of micelles from the surfactant monomer, thus, a novel technique for the determination of the critical micelle concentration (cmc) based on the long excited state lifetime of Ru-III located at the micellar nano-aggregates is reported.

Comparison between short- and long-acting erythropoiesis-stimulating agents in hemodialysis patients: target hemoglobin, variability, and outcome.

PURPOSE: Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin-stimulating agents such as Aranesp and Eprex in achieving these targets. METHODS: Randomized, prospective, open-labeled study of 24 weeks includes stable patients on HD >3 months, age >18 years, and on Eprex for >3 months. Patients were randomized into two groups: A-(Aranesp group):HD patients on Eprex Q TIW or BIW were converted to Aranesp Q weekly, by using the conversion factor of 200:1 and those on Eprex Q weekly to Aranesp Q 2 weeks; B-(Eprex group):patients continued on Eprex treatment. Hemoglobin target was set at (105-125 g/l). Primary end points were percentage of patients achieving target Hb, hemoglobin variability, and number of dose changes in each group. RESULTS: This study consisted of 139 HD patients: 72 in the Aranesp and 67 in the Eprex-mean (SD) age 54 (16.2) years, 77 (55 %) males. About 46 % were diabetic. Target Hb achieved in 64.8 % of the Aranesp and 59.7 % in the Eprex (p = 0.006). Hb variability was less frequent in the Aranesp group (p = 0.2). Mean number of dose changes was 1.3 (0.87) in the Aranesp and 1.9 (1.2) in the Eprex (p < 0.001). There was 1 vascular access thrombosis in the Aranesp and 8 in the Eprex (p < 0.001). There was no difference in hospitalization and death number between the 2 groups. CONCLUSIONS: Aranesp Q weekly or every 2 weeks is more efficient in achieving target Hb, with less dose changes and minor vascular access complications.