The urine anion gap: the critical clue to resolve a diagnostic dilemma in a patient with ketoacidosis.

Usually, ketoacidosis presents few if any diagnostic or therapeutic problems; in this article, we report a case where ketoacidosis was clinically occult and biochemically obscure. The patient presented with acute pancreatitis associated with a modest antecedent alcohol intake. Metabolic acidosis with a normal anion gap (10 meq/L) was observed together with moderate hyperglycemia and a 2 + (but not 4 +) test for serum ketones. None of the usual causes of metabolic acidosis with a normal anion gap was identified nor was there an obvious explanation for a reduction in unmeasured anion gap (e.g., hypoalbuminemia, dysproteinemia, or the presence of abnormal halides). Despite the initial normal anion gap, ketoacidosis was suspected clinically and this was confirmed by the elevated serum B-hydroxybutyrate of 8 mmol/L. We deduced that the serum unmeasured anions, which should have been increased by at least 8 meq/L, were being underestimated because of the effect of hypertriglyceridemia on the serum chloride determination. When the serum chloride was reestimated by a method not influenced by hyperlipidemia, the value was 102 mmol/L not 112 mmol/L and, when reevaluated, the anion gap was indeed appropriately elevated. In addition, the urine anion gap (Na + K - Cl) was 103 meq/L in the absence of renal disease. This indicated that the expected large quantity of urinary ammonium must have been masked by an even greater quantity of unmeasured anion; in this case proven by direct measurement to be B-hydroxybutyrate. Finally, metabolism of the alcohol ingested, which yields hepatic NADH, could explain, in part, the modest hyperglycemia and the absence of a 4 + test for serum ketones.(ABSTRACT TRUNCATED AT 250 WORDS)

Leguminous seeds in the dietary management of hyperlipidemia.

Seven male hyperlipidemic patients substituted approximately 140g dried beans daily for other sources of starch in their diet over a 4-month period. After this, mean fasting serum triglyceride levels were reduced by 25 +/- 5% (p less than 0.01) while total serum cholesterol levels were 7 +/- 2% (p less than 0.5) lower than the values measured during the previous five clinic attendances (12 +/- 2.5 months). However, low- and high-density lipoprotein cholesterol levels remained unaltered. While taking beans a nonsignificant fall (0.7 kg) was seen in body weight. Nevertheless no change was seen in macronutrient intake determined by 1-wk diet histories recorded both before and four times during the study, although cholesterol intake decreased by 80 mg (p less than 0.02). Reintroduction of dried leguminous seeds into a Western diet may be a useful adjunct to the management of hyperlipidemia.

Serum triglyceride: method of estimation and levels in normal humans.

Previously described glycerol methods for estimation of serum triglyceride were modified. Conditions during saponification and colour development were altered so as to minimize the possibility of glycerol loss. Using this modification, serum triglyceride was determined in 100 healthy men and women, aged 15 to 79 years. There was a log normal distribution. In both sexes the level increased up to the sixth decade and then decreased. In each decade men had higher levels than women. The geometric mean (and 95% limits) for men was 129 mg. % (68-248); for women, 105 mg. % (54-206); and for the entire group, 117 mg. % (59-233). Comparison of results from several laboratories using different methods showed wide variation in serum triglyceride levels.

Variations in paper electrophoretic serum lipoprotein patterns in healthy subjects.

The normal variations in the paper electrophoretic lipoprotein patterns in 240 healthy Canadian males and females, aged 10 to 59 years, have been described and compared with serum cholesterol and triglyceride levels.The incidence of abnormal chylomicra, beta and pre-beta lipoproteins was similar in both sexes and increased with age in both sexes.Chylomicron bands and/or pre-beta trails from the origin occurred in 4% of subjects, pre-beta bands in 27% and "abnormally" dense beta bands in 28%.Five per cent of subjects were considered to have definite hyperlipoproteinemia, another 19% had slight and 21% had questionable hyperlipoproteinemia. Fifty-five per cent were normal.

A method of cholecystography applicable to small laboratory animals.

A method of intraperitoneal cholecystography is described and was tested on mice with experimentally induced gallstones. The presence of stones in the gallbladder was predicted with an accuracy of 95.5%, using doses of 3 ml of 51.6% meglumine iodipamide (Cholografin) per kg diluted 10-fold, followed a few days later by a repeat dose of 5 ml per kg in cases of nonvisualization of the gallbladder. Pilot studies on guinea pigs and rabbits suggest that this method is applicable to these animals too, although a higher dose of contrast medium is required.

Beneficial effect of a low glycaemic index diet in type 2 diabetes.

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well-controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol l-1 using a randomized, crossover design. Patients were given pre-weighed diets (59% energy as carbohydrate, 21% fat, and 24 g 1000-kcal-1 dietary fibre) for two 2-week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 +/- 108 (+/- SE) vs 204 +/- 112 mmol min l-1; p less than 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2-week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 +/- 0.12 vs 3.28 +/- 0.16 mmol l-1, p less than 0.05, and 5.5 +/- 0.4 vs 5.9 +/- 0.5 mmol l-1, p less than 0.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)