Quality of Life Assessment Among Patients Living With Hepatosplenic Schistosomiasis and Schistosomal Myeloradiculopathy.

Schistosomiasis is a major public health problem in tropical areas of the world. Health-related quality of life (HRQOL) measurement is being widely used to evaluate the impact of a disease or treatment in several aspects of daily life. However, few studies evaluated the impact of severe forms of schistosomiasis on HRQOL of affected individuals and compared them to healthy controls with a similar socio-demographic background. Our aims were to evaluate the HRQOL in patients with hepatosplenic schistosomiasis (HS) and schistosomal myeloradiculopathy (SMR) and healthy volunteers (HV) and determine if clinical complications of the disease are associated with HRQOL scores. We interviewed and evaluated the HRQOL in 49 patients with HS, 22 patients with SMR, and 26 HV from an outpatient clinic of the Federal University of Minas Gerais University Hospital using the WHOQOL-BREF questionnaire. SMR and HS patients had a significantly lower overall quality of life score when comparing with the HV control group (p = 0.003 and p = 0.005, respectively). Multivariate ordinal regression model adjusted for sex, age, and educational level indicated that HS and SMR patients have three and five times more chances of having a lower quality of life than healthy volunteers (Odds Ratio 3.13 and 5.04, respectively). There was no association between complications of HS disease and quality of life scores. In contrast, worse quality of life was observed in SMR patients that presented back or leg pain, leg paresthesia, and bladder dysfunction. In conclusion, HS and SMR significantly impact the overall quality of life of the affected individuals, reinforcing the importance of efforts to control and eradicate this debilitating disease and suggesting that multidisciplinary clinical management of schistosomiasis patients would be more appropriate and could potentially improve patient's quality of life.

EDTA-dependent pseudothrombocytopenia in patients with hepatosplenic schistosomiasis mansoni: a clinical management alert.

BACKGROUND: Hepatosplenic schistosomiasis mansoni (HS) is associated with thrombocytopenia. Accurate platelet counts are required for identification and management of HS patients. EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is an in vitro phenomenon of anticoagulant-activated platelet agglutination resulting in low platelet counts by automated methods. The prevalence of EDTA-PCTP in schistosomiasis is unknown and only one case has been described. Our aims were to determine the prevalence of EDTA-PTCP in HS and evaluate alternative methods to overcome this analytical error. METHODS: Blood samples from 56 HS patients and 56 healthy volunteers were collected, and platelet counts were obtained using standard microscopy and automated (electric impedance) methods. Automated platelet counts and the presence of platelet clumps in blood smears were evaluated in samples collected in EDTA or sodium citrate tubes 20 and 180 min after blood collection. RESULTS: EDTA-PTCP was more frequent in HS patients than healthy volunteers (8.92% vs 0.00%, p<0.0285). Platelet clumps and PTCP were also observed in samples collected in sodium citrate tubes, refuting its use as an alternative method. CONCLUSIONS: Automated platelet counts in blood samples from HS patients should be performed right after blood collection in EDTA tubes and verified by manual counts in blood smears.

Vestibular Evoked Myogenic Potential on Ocular, Cervical, and Soleus Muscles to Assess the Extent of Neurological Impairment in HTLV-1 Infection.

Introduction: Vestibular Evoked Myogenic Potential (VEMP) can be used to test central vestibular pathways from the midbrain to the lumbar spine, according to the muscle tested. Purpose: to compare the spinal cord alteration in individuals with HTLV-1-associated myelopathy (HAM) and with HTLV-1-asymptomatic infection using the VEMP recorded from different muscles. Methods: VEMP was recorded in 90 individuals of whom 30 had HAM, 30 were HTLV-1 asymptomatic carriers, and 30 negative controls. VEMP was recorded in the oculomotor muscle (oVEMP), testing the vestibulo-ocular reflex, and in the cervical muscle (cVEMP) and soleus muscle (sVEMP), testing the vestibulospinal reflex, respectively, in the cervical and in the lumbar spinal level. The type of stimulation was auditory for oVEMP and cVEMP, and galvanic for sVEMP. The compared variables were the latencies of the electrophysiological waves. Results: HTLV-1-asymptomatic group was similar to the controls regarding oVEMP (p = 0.461), but different regarding cVEMP (p < 0.001) and sVEMP (p < 0.001). HAM group has presented the worst latencies and was different from the HTLV-1-asymptomatic group in the VEMP of all the tested muscles (p < 0.001). The concomitant occurrence of VEMP alterations in the three recorded muscles of the same individual was found in 2 (6.7%) asymptomatic carriers and in 20 (66.7%) patients with HAM (p = 0.001). The analysis of VEMP alteration per group and per muscle has showed that, in HTLV-1-asymptomatic group, oVEMP was altered in 3 (10.0%) individuals, cVEMP in 10 (33.3%) and sVEMP in 13 (43.3%). In HAM group, oVEMP was altered in 23 (76.6%) individuals, cVEMP in 27 (90%), and sVEMP in 30 (100%). Conclusion: HTLV-1-neurological damage has followed an ascendant progression beginning at the lumbar spine in the stage of a clinically asymptomatic infection, whereas HAM has affected not only the spine, but also the midbrain.

Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease.

PURPOSE: Vestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulo-collic reflexes involved in the function of the otolithic organs and their afferent pathways. We compared the results of cervical and ocular VEMP in HTLV-1 associated myelopathy (HAM) and HTLV-1-asymptomatic infection. PARTICIPANTS AND METHODS: This cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 seronegative controls. The groups were similar regarding age and gender. Participants underwent simultaneous ocular and cervical VEMP. The stimulus to generate VEMP was a low-frequency tone burst sound tone burst, with an intensity of 120 decibels normalized hearing level, bandpass filter from 10 to 1,500 Hertz (Hz), with 100 stimuli at 500 Hz and 50 milliseconds recording time. The latencies of the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP were compared among the groups. The absence or delay of the electrophysiological waves were considered abnormal results. RESULTS: Ocular VEMP was similar among the groups for N10 (p = 0.375) and different for P15 (p≤0.001). Cervical VEMP was different for P13 (p = 0.001) and N23 (p = 0.003). About ocular VEMP, in the HTLV-1-asymptomatic group, normal waves were found in 23(88.5%) individuals; in HAM group, normal waves were found in 7(26.9%). About cervical VEMP, 18(69.2%) asymptomatic carriers presented normal waves and only 3(11.5%) patients with HAM presented normal waves. Abnormalities in both VEMPs were found in 1(3.8%) asymptomatic carrier and in 16(61.5%) patients with HAM. CONCLUSION: Neurological impairment in HAM was not restricted to the spinal cord. The mesencephalic connections, tested by ocular VEMP, have been also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.

Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura / Applications of vestibular-evoked myogenic potentials: a systematic literature review

RESUMO Objetivos Revisar a literatura científica sobre as principais técnicas usadas para gerar o potencial evocado miogênico vestibular (VEMP) e suas aplicações clínicas. Estratégia de pesquisa Os artigos que descrevem os métodos de registro e as aplicações do VEMP foram localizados nas bases de dados PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. O levantamento realizado limitou-se aos artigos publicados nos idiomas Inglês, Português e Espanhol, entre janeiro de 2012 e maio de 2018. Critérios de seleção Artigos sobre os aspectos técnicos para a realização do VEMP ocular, cervical ou do músculo sóleo, com estimulação auditiva ou galvânica e artigos sobre as aplicações clínicas do VEMP foram incluídos; artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Resultados A estratégia de busca resultou na seleção de 28 artigos. Os estudos evidenciaram três métodos de registro do VEMP: cervical, ocular e no músculo sóleo. As aplicações clínicas do VEMP incluíram doença de Ménière, neurite vestibular, síndrome da deiscência do canal semicircular superior, doença de Parkinson, lesões centrais isquêmicas e mielopatias motoras. Conclusão Independentemente da técnica de registro, o VEMP mostrou-se útil como ferramenta complementar para o diagnóstico de doenças vestibulares periféricas e centrais.

ABSTRACT Purpose To review the scientific literature on the main techniques used to generate vestibular-evoked myogenic potential (VEMP) and its clinical applications. Research strategy A search for articles describing VEMP recording methods and applications was conducted in the PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The search was limited to articles published in English, Portuguese, and Spanish between January 2012 and May 2018. Selection criteria Articles addressing the technical aspects for performing ocular, cervical or soleus VEMP with auditory or galvanic stimulation and articles on the clinical applications of VEMP were included in this review, whereas articles repeated in the databases, literature reviews, case reports, letters, and editorials were excluded. Results The search strategy resulted in the selection of 28 articles. The studies evidenced three methods of VEMP recording: responses from the cervical, ocular and soleus muscle. Clinical applications of VEMP included Meniere's disease, vestibular neuritis, superior semicircular canal dehiscence syndrome, Parkinson's disease, central ischemic lesions, and motor myelopathies. Conclusion Regardless of the recording technique, VEMP has proved to be useful as a complementary tool for the diagnosis of peripheral and central vestibular diseases.

Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals.

INTRODUCTION: The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS: A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS: Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS: Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.

Prevalence of low bone mass and changes in vitamin D levels in human immunodeficiency virus-infected adults unexposed to antiretrovirals

Abstract INTRODUCTION: The prevalence of low bone mass is 3 times higher in people living with human immunodeficiency virus (PLWH) and using antiretrovirals than in the HIV-unaffected population. Changes in vitamin D levels is one of the factors associated with decreased bone mass. The objective of this study is to evaluate the low bone mass and altered vitamin D levels in PLWH who have not been exposed to antiretrovirals. METHODS: A cross-sectional study was carried out with HIV-infected individuals between the ages of 18 and 55 years immediately prior to the start of antiretroviral therapy in a specialized reference center focusing on infectious and parasitic diseases. Results of clinical examination (patient's weight, height, blood pressure, and clinical history), laboratory tests, and X-ray absorptiometry, were collected. RESULTS: Sixty patients were included, with a mean age of 34 years. Nine (16.7%) patients presented with low bone mass and 4 (7.1%) patients showed low total femur BMD. Analysis revealed that 23.3% and 36.7% of the patients had deficient and insufficient levels of 25-hydroxyvitamin D3, respectively. CONCLUSIONS: Our study population presented with compromised bone health and with low bone mineral density and 25-(OH)-vitamin D levels.

Intrarater and interrater agreement and reliability of vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) for HTLV-1 associated myelopathy testing.

BACKGROUND: The vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) has been used to assess the function of the vestibulospinal motor tract and is a candidate biomarker to predict and monitor the human T-cell lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM). This study determined the agreement and reliability of this exam. METHODS: Galvanic-VEMP was performed in 96 participants, of which 24 patients presented HAM, 27 HTLV-1-asymptomatic carriers, and 45 HTLV-1-negative asymptomatic controls. Galvanic vestibular stimulation was achieved by passing a binaural and bipolar current at a 2 milliamperes (mA) intensity for 400 milliseconds (ms) between the mastoid processes. Galvanic-VEMP electromyographic wave responses of short latency (SL) and medium latency (ML) were recorded from the gastrocnemius muscle. Intrarater (test-retest) and interrater (two independent examiners) agreement and reliability were assessed by standard error of measurement (SEM), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and Kappa coefficient. RESULTS: In the total sample (n = 96), SL and ML medians were 56 ms (IQR 52-66) and 120 ms (IQR 107-130), respectively. The intrarater repeatability measures for SL and ML were, respectively: SEM of 6 and 8 ms; CR of 16 and 22 ms; ICC of 0.80 (p<0.001) and 0.91 (p<0.001); and a Kappa coefficient of 0.53 (p<0.001) and 0.82 (p<0.001). The interrater reproducibility measures for SL and ML were, respectively: SEM of 3 and 10 ms; CR of 8 and 27 ms; ICC of 0.95 (p<0.001) and 0.86 (p<0.001); and a Kappa coefficient of 0.77 (p<0.001) and 0.88 (p<0.001). CONCLUSION: Galvanic-VEMP is a reliable and reproducible method to define the integrity of the vestibulospinal tract. Longitudinal studies will clarify its validity in the clinical context, aimed at achieving an early diagnosis and the monitoring of HAM.

Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients.

INTRODUCTION: Mortality among HIV patients is 3-15 times higher than that among the general population. Currently, most deaths are due to non-infectious diseases. Chronic inflammation and adverse events due to antiretroviral therapy play crucial roles in increasing cardiovascular risk (CVR). METHODS: This cross-sectional study aimed to evaluate carotid intima-media thickness (CIMT) and inflammatory biomarkers (D-dimer, ADAMTS13, GDF-15, sICAM-1, MPO, myoglobin, NGAL, SAA, sVCAM-1, and p-selectin) among naïve patients. RESULTS: Sixty-seven participants were included: median age, 32 years; males, 82.1%; non-white, 61.1%; higher education level, 62.7%; and exposed to HIV through sexual relationship (men who have sex with men), 68.7%. The median viral load and LTCD4+ value were 42,033 copies/mL and 426 cells/mm³. The prevalence of arterial hypertension was 16.4%; those of diabetes mellitus and dyslipidemia were 3% and 70.1%, respectively. The CIMT was 494.08 (± 96.84mm). The mean vascular age was 33.2 ± 18.9 years, one year longer than the chronological age, without statistical significance. CONCLUSIONS: The majority of participants had a low CVR (94%). After reclassification, considering the CIMT percentiles, 13 (19.4%) patients had medium/ high CVR, while 54 (80.6%) patients had low CVR. The difference between the proportions of CVR when considering the CIMT and its corresponding percentile was statistically relevant. Body mass index was the only predictor of higher CVR (p = 0.03). No biomarker was found to predict CVR. People living with HIV have a high prevalence of dyslipidemia before ARV therapy.

Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients

Abstract INTRODUCTION Mortality among HIV patients is 3-15 times higher than that among the general population. Currently, most deaths are due to non-infectious diseases. Chronic inflammation and adverse events due to antiretroviral therapy play crucial roles in increasing cardiovascular risk (CVR). METHODS: This cross-sectional study aimed to evaluate carotid intima-media thickness (CIMT) and inflammatory biomarkers (D-dimer, ADAMTS13, GDF-15, sICAM-1, MPO, myoglobin, NGAL, SAA, sVCAM-1, and p-selectin) among naïve patients. RESULTS: Sixty-seven participants were included: median age, 32 years; males, 82.1%; non-white, 61.1%; higher education level, 62.7%; and exposed to HIV through sexual relationship (men who have sex with men), 68.7%. The median viral load and LTCD4+ value were 42,033 copies/mL and 426 cells/mm³. The prevalence of arterial hypertension was 16.4%; those of diabetes mellitus and dyslipidemia were 3% and 70.1%, respectively. The CIMT was 494.08 (± 96.84mm). The mean vascular age was 33.2 ± 18.9 years, one year longer than the chronological age, without statistical significance. CONCLUSIONS The majority of participants had a low CVR (94%). After reclassification, considering the CIMT percentiles, 13 (19.4%) patients had medium/ high CVR, while 54 (80.6%) patients had low CVR. The difference between the proportions of CVR when considering the CIMT and its corresponding percentile was statistically relevant. Body mass index was the only predictor of higher CVR (p = 0.03). No biomarker was found to predict CVR. People living with HIV have a high prevalence of dyslipidemia before ARV therapy.

Alterações metabólicas e estimativa de risco cardiovascular em pessoas vivendo com HIV/AIDS doze meses após o início da TARV / Metabolic changes and estimating cardiovascular risk of people living with HIV/AIDS twelve months after the start of HAART

A incidência de doenças cardiovasculares (DCV) chega a ser duas vezes maior em pessoas vivendo com HIV/AIDS (PVHA) devido aos danos pró-inflamatório causado pelo vírus e efeitos tóxicos de antirretrovirais incluindo as dislipidemias. O objetivo deste trabalho foi acompanhar o risco de DCV e marcadores metabólicos em PVHA. Trata-se de estudo longitudinal realizado antes e após 12 meses de inicio de antirretrovirais. Coletou-se variáveis socioeconômicas, clínicas, antropométricas e laboratoriais, e calculou-se escores de Framingham e PROCAM. Utilizaram-se os testes de Wilcoxon, T-Student e Qui-Quadrado na comparação das variáveis. A amostra basal deste estudo foi composta por 91 PVHA. Desses, 85% eram homens com mediana de idade igual a 31 anos e 94,5% declararam não ter história pregressa de dislipidemias. Foi observado aumento nos níveis de colesterol total (p0,05). Portanto, para a definição de risco real de DCV nesta população temos que considerar a inclusão de outras variáveis como alguns biomarcadores e, ainda, a mensuração ultrassonográfica da camada íntima carotídeas. Sendo assim, o cuidado compartilhado com outras áreas da saúde como nutricionistas e educadores físicos visando estimular a mudança de estilo de vida, pode qualificar o acompanhamento de PVHA reduzindo a incidência de eventos não infecciosos. (AU)

The incidence of cardiovascular disease (CVD) is up to twice as high in people living with HIV / AIDS (PLWHA) because of the proinflammatory damage caused by the virus and antiretroviral toxicities including dyslipidemias. The objective of this study was to monitor the risk of CVD and metabolic markers in PLWHA. This is a longitudinal study before and after 12 months of antiretroviral beginning. They were collected socioeconomic, clinical, anthropometric and laboratory variables, and calculated scores of Framingham and PROCAM. They used the Wilcoxon paired tests, T-Student and Chi-square partition in the comparison of variables. The baseline sample was composed of 91 PLWHA. Of these, 85% were male with median age 31 years and 94.5% did not have a history of dyslipidemia. There was an increase in total cholesterol levels (p 0.05). Therefore, to define real risk of CVD in this population we have to consider the inclusion of other variables as some biomarkers, and also ultrasound measurement of carotid intima layer. Thus, the shared care with other health areas as physical nutritionists and educators to stimulate the change of lifestyle, can qualify PLWHA monitoring reducing the incidence of non-infectious events. (AU)

Correction: Vestibular Evoked Myogenic Potential (VEMP) Triggered by Galvanic Vestibular Stimulation (GVS): A Promising Tool to Assess Spinal Cord Function in Schistosomal Myeloradiculopathy.

[This corrects the article DOI: 10.1371/journal.pntd.0004672.].

Vestibular Evoked Myogenic Potential (VEMP) Triggered by Galvanic Vestibular Stimulation (GVS): A Promising Tool to Assess Spinal Cord Function in Schistosomal Myeloradiculopathy.

BACKGROUND: Schistosomal myeloradiculopathy (SMR), the most severe and disabling ectopic form of Schistosoma mansoni infection, is caused by embolized ova eliciting local inflammation in the spinal cord and nerve roots. The treatment involves the use of praziquantel and long-term corticotherapy. The assessment of therapeutic response relies on neurological examination. Supplementary electrophysiological exams may improve prediction and monitoring of functional outcome. Vestibular evoked myogenic potential (VEMP) triggered by galvanic vestibular stimulation (GVS) is a simple, safe, low-cost and noninvasive electrophysiological technique that has been used to test the vestibulospinal tract in motor myelopathies. This paper reports the results of VEMP with GVS in patients with SMR. METHODS: A cross-sectional comparative study enrolled 22 patients with definite SMR and 22 healthy controls that were submitted to clinical, neurological examination and GVS. Galvanic stimulus was applied in the mastoid bones in a transcranial configuration for testing VEMP, which was recorded by electromyography (EMG) in the gastrocnemii muscles. The VEMP variables of interest were blindly measured by two independent examiners. They were the short-latency (SL) and the medium-latency (ML) components of the biphasic EMG wave. RESULTS: VEMP showed the components SL (p = 0.001) and ML (p<0.001) delayed in SMR compared to controls. The delay of SL (p = 0.010) and of ML (p = 0.020) was associated with gait dysfunction. CONCLUSION: VEMP triggered by GVS identified alterations in patients with SMR and provided additional functional information that justifies its use as a supplementary test in motor myelopathies.

Cetoacidose diabética em crianças e adolescentes / Diabetic ketoacidosis in children and adolescents

A cetoacidose diabética (CAD) constitui um distúrbio endócrino caracterizado por acidose metabólica, cetose (pH arterial < 7,3 ou venoso < 7,25 e/ou HCO3- < 15mEq/L), hiperglicemia (> 200 mg/dL) e graus variados de desidratação em portadores de diabetes mellitus (DM). É motivo habitual de admissão em emergência ou Unidade de Terapia Intensiva pediátrica. É a causa mais frequente de morte em crianças e adolescentes com DM tipo 1. Resulta da deficiência de insulina e aumento dos níveis circulantes de hormônios contrarreguladores. A abordagem da CAD em pediatria não deve prescindir das particularidades existentes nessa população quando comparada à de adultos. Os principais fatores desencadeantes são as infecções e a omissão de insulina. A terapêutica na emergência visa a: corrigir a desidratação e os distúrbios eletrolíticos; reverter a cetose e a acidose; restabelecer a glicemia normal; evitar complicações; identificar e tratar a causa precipitante; e prevenir novos episódios. Este artigo atualiza sobre a CAD, tratando, em especial, sobre seus aspectos da fisiopatologia, diagnóstico, classificação, manifestações clínicas, abordagem terapêutica, complicações e profilaxia.

The diabetic ketoacidosis (DK) is an endocrine disorder characterized by metabolic acidosis and ketosis (arterial pH < 7,3 or venous pH < 7,25 and HCO3- < 15 mEq/L), hyperglycemia (higher than 200 mg/dL) and different degrees of dehydration in patients with Diabetes Mellitus (DM). It is a usual reason for admission in emergency services or pediatric ICU, as well as the most frequent cause of death in children and teenagers with type 1 DM. This pathology results from lack of insulin and elevation of counter-regulatory hormone levels. The DK’s approach in pediatric patients must consider the singular characteristics of this age group. The main trigger factors are infections and omission of insulin. The therapeutic at the emergency aims to: correct the dehydration and electrolyte disturbances, ketosis, acidosis and hyperglycemia; avoid complications; identify and treat the trigger factors; and prevent new events. The aim of this review is to present updates on DK, dealing in particular with aspects of physiopathology, diagnosis, classification, clinical findings, therapeutic approach, complications and prophylaxis.

Cetoacidose diabética em pediatria: relato de caso / Diabetic ketoacidosis in children: case report

A cetoacidose diabética é a principal complicação aguda do Diabetes Mellitus (DM) e responsável por importante causa de morte, principalmente devido ao desenvolvimento de edema cerebral. É discutida neste trabalho a evolução clínica de um jovem de 10 anos de idade, diabético tipo I, admitido no Pronto Socorro do Hospital das Clínicas da UFMG com sintomatologia compatível com cetoacidose diabética, com melhora inicial dos padrões laboratoriais não acompanhada de melhora clínica.

The diabetic ketoacidosis is the main Diabetes Mellitus (DM) acute complication and responsible for an important cause of death, mainly due to the development of cerebral edema. This article reports a case of a 10 year old boy, previously diagnosed with DM I, admitted to the pediatric emergency of Hospital das Clínicas da UFMG with signs and symptoms compatible with diabetic ketoacidosis. Despite the initial improvement of laboratorial findings, there was not a significant clinical recovery. This scenery required new arrangements, like the use of sodium bicarbonate, which is not recommended by current consensus guidelines, considering that the patient’s venous pH was higher than 6,9.