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1.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S90-S96, set. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138652

RESUMO

RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.


ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cetose/etiologia , Cetose/terapia , Pandemias , Betacoronavirus , Cetose/diagnóstico
2.
Ann Biol Clin (Paris) ; 78(3): 323-328, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32540819

RESUMO

Ketosis is a metabolic situation involving an increase in blood and urine concentrations of ketones that, when prolonged, leads to acidosis. Moderate ketosis usually appears after a fast of a few hours, but its prolongation exposes to hyperketosis. Observation: A 25-year-old woman presented to the emergency department for cohercitive vomiting. She was fasting for a long time in a spiritual setting and had a restricted diet limited to water and vitamin supplements. Clinical and biological assessment was in favour of fasting ketoacidosis. Evolution was favorable with intravenous hydration, poly-ionic and micronutrient supplementation and a gradual resumption of oral feeding. Conclusion: We report the case of a patient with fasting ketoacidosis. Besides consequences of this ketoacidosis, the challenge was also in resuming oral feeding in order to avoid a potentially fatal inappropriate renutrition syndrome.


Assuntos
Jejum/efeitos adversos , Cetose/etiologia , Inanição/complicações , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Acidose/terapia , Adulto , Jejum/sangue , Feminino , Hidratação , Humanos , Cetose/sangue , Cetose/diagnóstico , Cetose/terapia , Nutrição Parenteral , Inanição/sangue , Inanição/terapia , Fatores de Tempo
3.
Rinsho Shinkeigaku ; 60(4): 268-271, 2020 Apr 24.
Artigo em Japonês | MEDLINE | ID: mdl-32238745

RESUMO

We report a case of a 29-year-old woman with spinal muscular atrophy (SMA) type II who developed severe ketoacidosis after short-term starvation. She was hospitalized with lower respiratory tract infection. Although her symptoms improved after administration of intravenous antibiotic agents, her food intake gradually decreased. On the 7th day of hospitalization, she experienced abdominal pain followed by vomiting, after which she was unable to eat. Approximately 12 h later, she suffered from shock, accompanied with disturbance of consciousness, and she was admitted to the intensive care unit. She was diagnosed with ketoacidosis based on arterial blood gas analyses and urine test results. On receiving continuous infusion of glucose and insulin, her ketoacidosis was rapidly resolved and her symptoms completely recovered by the next day. To prevent the recurrence of ketoacidosis, we provided a diet plan based on indirect calorimetry results. However, ketoacidosis recurred twice, at 12 months and 16 months after discharge, both within 24 h of the onset of the fasting state. In addition to insufficient glycogen storage because of chronic malnutrition, poor gluconeogenesis or poor ketone body consumption due to skeletal muscle atrophy was believed to increase the risk of acute-onset, severe ketoacidosis after short-term starvation. Clinicians must note that patients with SMA are prone to ketoacidosis and that they must be promptly treated.


Assuntos
Cetose/etiologia , Atrofias Musculares Espinais da Infância/complicações , Inanição/complicações , Adulto , Feminino , Humanos , Cetose/diagnóstico , Índice de Gravidade de Doença
4.
J Dairy Sci ; 103(1): 783-790, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31668443

RESUMO

Hyperketonemia and metritis are common in the weeks after calving. This study tested if feeding and agonistic behaviors before calving were associated with the development of hyperketonemia (HYK) and metritis after calving. Holstein cows on 5 commercial farms were monitored for HYK (as identified using a cow-side ß-hydroxybutyrate test) and metritis (using visual and olfactory assessment of vaginal discharge); both tests were conducted twice a week for 2 wk. Based on this assessment, we selected a balanced sample of cows that remained healthy (no signs of illness; n = 20), cows diagnosed with either HYK (n = 20) or metritis (n = 20), and cows with both HYK and metritis (n = 20). Video recordings from the 8 wk before calving (scored every 2 wk for 90 min immediately after fresh feed delivery) were used to evaluate feeding behavior and competition at the feed bunk. Feeding behavior before calving was associated with postpartum diagnosis of HYK and metritis. Specifically, cows that spent less time eating had higher odds of HYK and metritis. Odds of remaining healthy (compared with becoming sick with at least 1 condition) increased by 1.3 times for every additional 15 min spent eating. Additionally, cows that were involved in fewer agonistic interactions prepartum were more likely to be diagnosed with both conditions during the postpartum period. Odds of remaining healthy (compared with becoming sick with at least one condition) increased by 1.9 times for every 6 additional interactions. We conclude that prepartum feeding and agonistic behaviors can be used to identify animals at risk of HYK and metritis postpartum.


Assuntos
Comportamento Agonístico , Doenças dos Bovinos/etiologia , Endometrite/veterinária , Comportamento Alimentar , Cetose/veterinária , Ácido 3-Hidroxibutírico , Ração Animal/análise , Criação de Animais Domésticos , Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Endometrite/etiologia , Feminino , Humanos , Cetose/etiologia , Lactação , Período Pós-Parto , Fatores de Risco
5.
J Dairy Sci ; 103(1): 649-665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704020

RESUMO

In this longitudinal study, we tested the hypothesis that cows that are lame around dry-off are at increased risk of transition diseases (TD), including metritis, subclinical ketosis (SCK), retained fetal membranes, hypocalcemia, or displaced abomasum. We also hypothesized that the relationship between lameness and TD would be mediated through reduced feeding time. We enrolled 461 cows at 9 wk before their expected calving date on 6 commercial freestall farms in the lower Fraser Valley, British Columbia, Canada. Cows were gait-scored weekly using a scale of 1 to 5. Lameness status was classified based on consecutive gait scores as lame (2 consecutive gait scores = 3 or 1 score ≥4) or sound (2 consecutive gait scores ≤2). Lameness status was summarized as (1) lameness at dry-off (sound or lame); (2) lameness group (always sound = sound on all visits, chronically lame = lame on all visits, and other = changed from sound to lame or vice versa); and (3) proportion of weeks lame during the dry period. Body condition scores were recorded at dry-off and at calving and collectively used to calculate change in body condition for each cow. A subsample of cows (n = 159) was evaluated for feeding time once a week during the dry period. All cows were evaluated for SCK (positive = ß-hydroxybutyrate ≥1.2 mmol/L) and metritis (positive = foul smell, red/brown watery vaginal discharge) every 3 to 4 d between d 3 and 17 after calving. We retrieved data on treatment of retained fetal membranes, hypocalcemia, and displaced abomasum during the first 17 d after calving, cow parity, and milk production in the previous lactation from farm records. We created a binary variable, TD (any of SCK, metritis, retained fetal membranes, hypocalcemia, or displaced abomasum), to differentiate between healthy cows and cows that developed TD. Lameness at dry-off was associated with the occurrence of metritis and TD, but not with SCK. Cows that were chronically lame and cows that had an increased proportion of weeks lame during the dry period had higher occurrence of metritis and TD. Lameness was also associated with reduced feeding time, which in turn was associated with increased likelihood of SCK and TD, but not with metritis. Lameness was not associated with change in body condition; however, cows that lost body condition score during the dry period had increased odds of developing SCK, metritis, and TD. Change in body condition was highly associated with body condition score at dry-off. These results suggest that association between lameness and TD is partially mediated through reduced feeding time.


Assuntos
Doenças dos Bovinos/etiologia , Comportamento Alimentar , Ácido 3-Hidroxibutírico/sangue , Animais , Colúmbia Britânica , Bovinos , Doenças dos Bovinos/epidemiologia , Indústria de Laticínios , Fazendas , Feminino , Marcha , Nível de Saúde , Cetose/etiologia , Cetose/veterinária , Lactação , Estudos Longitudinais , Paridade , Placenta Retida/veterinária , Gravidez , Fatores de Risco
6.
Eur J Appl Physiol ; 120(1): 191-202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31729600

RESUMO

PURPOSE: We investigated the effect of the racemic ß-hydroxybutyrate precursor, R,S-1,3-butanediol (BD), on T-cell-related cytokine gene expression within stimulated peripheral blood mononuclear cells (PBMC) following prolonged, strenuous exercise. METHODS: A repeated-measures, randomised, crossover study was conducted in nine healthy, trained male cyclists (age, 26.7 ± 5.2 years; VO2peak, 63.9 ± 2.5 mL kg-1 min-1). Participants ingested 0.35 g kg-1 of BD or placebo 30 min before and 60 min during 85 min of steady-state (SS) exercise, which preceded a ~ 30 min time-trial (TT) (7 kJ kg-1). Blood samples were collected at pre-supplement, pre-exercise, post-SS, post-TT and 1-h post-TT. Whole blood cultures were stimulated with Staphylococcal enterotoxin B (SEB) for 24 h to determine T-cell-related interleukin (IL)-4, IL-10 and interferon (IFN)-γ mRNA expression within isolated PBMCs in vitro. RESULTS: Serum cortisol, total circulating leukocyte and lymphocyte, and T-cell subset concentrations were similar between trials during exercise and recovery (all p > 0.05). BD ingestion increased T-cell-related IFN-γ mRNA expression compared with placebo throughout exercise and recovery (p = 0.011); however, IL-4 and IL-10 mRNA expression and the IFN-γ/IL-4 mRNA expression ratio were unaltered (all p > 0.05). CONCLUSION: Acute hyperketonaemia appears to transiently amplify the initiation of the pro-inflammatory T-cell-related IFN-γ response to an immune challenge in vitro during and following prolonged, strenuous exercise; suggesting enhanced type-1 T-cell immunity at the gene level.


Assuntos
Citocinas/metabolismo , Cetose/sangue , Condicionamento Físico Humano/métodos , Linfócitos T/imunologia , Adulto , Butileno Glicóis/farmacologia , Citocinas/genética , Enterotoxinas/farmacologia , Humanos , Cetose/etiologia , Masculino , Monócitos/metabolismo , Linfócitos T/efeitos dos fármacos
7.
Rev Med Chil ; 148(6): 875-880, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-33480389

RESUMO

Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels < 3 µg/mL, acetaminophen levels < 1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.


Assuntos
Cetose , Atrofia Muscular Espinal , Adulto , Bicarbonatos , Feminino , Glucose , Humanos , Cetose/etiologia , Atrofia Muscular Espinal/complicações , Estresse Fisiológico
8.
Am J Case Rep ; 20: 1728-1731, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31756175

RESUMO

BACKGROUND The low-carbohydrate, high-fat ketogenic diet has been popularized in the press recently, touting multiple health benefits such as weight loss and increased energy. In this diet, participants intentionally push themselves into a state of ketosis and usually do not develop metabolic complications or illness unless put under certain circumstances such as stress and prolonged fasting. CASE REPORT We report a case of starvation ketoacidosis in a 60-year-old male with well-controlled diabetes mellitus type II following a strict ketogenic diet who then underwent prolonged fasting. CONCLUSIONS Although the ketogenic diet with or without periods of fasting might yield short-term weight loss, it has potentially dangerous side effects, including ketoacidosis. It is recommended that people, especially those with comorbidities such as diabetes mellitus type II, consult their physicians before initiating this diet. Clinicians must keep a broad differential when evaluating acute metabolic acidosis.


Assuntos
Dieta Cetogênica/efeitos adversos , Jejum/efeitos adversos , Cetose/etiologia , Inanição/complicações , Diabetes Mellitus Tipo 2 , Dietas da Moda/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Síncope
9.
J Dairy Sci ; 102(10): 9151-9164, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326169

RESUMO

The main objective of this study was to determine the association of dry matter intake as percentage of body weight (DMI%BW) and energy balance (EB) prepartum (-21 d relative to parturition) and postpartum (28 d) with ketosis (n = 189) and clinical mastitis (n = 79). For this, DMI%BW and EB were the independent variables and ketosis and clinical mastitis were the dependent variables. A secondary objective was to evaluate prepartum DMI%BW and EB as predictors of ketosis and clinical mastitis. For this, ketosis and clinical mastitis were the independent variables and DMI%BW and EB were the dependent variables. Data from 476 cows from 9 experiments were compiled. Clinical mastitis was diagnosed if milk from 1 or more quarters was abnormal in color, viscosity, or consistency, with or without accompanying heat, pain, redness, or swelling of the quarter or generalized illness, during the first 28 d postpartum. Ketosis was defined as the presence of acetoacetate in urine that resulted in any color change [5 mg/dL (trace) or higher] in the urine test strip (Ketostix, Bayer, Leverkusen, Germany). Cows that developed ketosis had lesser DMI%BW and lesser EB on d -5, -3, -2, and -1 than cows without ketosis. Each 0.1-percentage point decrease in the average DMI%BW and each 1-Mcal decrease in the average of EB in the last 3 d prepartum increased the odds of having ketosis by 8 and 5%, respectively. Cut-offs for DMI%BW and EB during the last 3 d prepartum to predict ketosis were established and were ≤1.5%/d and ≤1.1 Mcal/d, respectively. Cows that developed ketosis had lesser postpartum DMI%BW and EB and greater energy-corrected milk (ECM) than cows without ketosis. Cows that developed clinical mastitis had lesser DMI%BW but similar prepartum EB compared with cows without clinical mastitis. Each 0.1-percentage point decrease in the average DMI%BW and each 1-Mcal decrease in the average EB in the last 3 d prepartum increased the odds of having clinical mastitis by 10 and 8%, respectively. The average DMI%BW and EB during the last 3 d prepartum produced significant cut-offs to predict clinical mastitis postpartum, which were ≤1.2%/d and ≤1.0 Mcal/d, respectively. Cows that developed clinical mastitis had lesser postpartum DMI%BW from d 3 to 15 and on d 17; greater EB on d 18, from d 21 to 23, and on d 26; and lesser ECM. The main limitation in this study is that the time-order of disease relative to DMI%BW and ECM is inconsistent such that postpartum outcomes were measured before and after disease, which was diagnosed at variable intervals after calving. In summary, measures of prepartum DMI were associated with and were predictors of ketosis and clinical mastitis postpartum, although the effect sizes were small.


Assuntos
Dieta/veterinária , Cetose/veterinária , Mastite Bovina/etiologia , Complicações na Gravidez/veterinária , Animais , Peso Corporal , Bovinos , Metabolismo Energético , Feminino , Alemanha , Cetose/etiologia , Lactação , Leite , Parto , Período Pós-Parto , Gravidez , Complicações na Gravidez/etiologia
10.
Pan Afr Med J ; 33: 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303952

RESUMO

Sickle cell anaemia (SCA) and type 1 diabetes mellitus (type 1 DM) are chronic medical conditions whose co-existence is uncommon in childhood. Furthermore, complications of SCA such as mesenteric crisis typically present with abdominal pain, which is also common in children with diabetic ketoacidosis (DKA) and this may possess diagnostic challenge. Herewith in, we report a rare case of a nine-year-old child with homozygous sickle cell anaemia, who presented with features of mesenteric crisis and diabetic ketoacidosis. The DKA was diagnosed based on the presence of hyperglycaemia (32.2 mmol/L), ketonaemia (4.6 mmol/L) and acidosis (11.6 mmol/L). The fluids deficit was corrected over 24 hours, with improvement in the vaso-occlusive crises (VOC) without precipitating cerebral oedema.


Assuntos
Anemia Falciforme/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/diagnóstico , Criança , Cetoacidose Diabética/fisiopatologia , Cetoacidose Diabética/terapia , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Cetose/diagnóstico , Cetose/etiologia , Masculino
11.
J Dairy Res ; 86(2): 162-164, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31113526

RESUMO

This research communication describes the possible association between feed sorting and the risk of metabolic disorders in dairy cows. Feed sorting, that is selecting smaller size TMR particles over longer length fibers, can lead to imbalanced energy input. In addition, sorting can lead to lower nutritive value of leftover TMR. To detect a possible relationship between TMR sorting and the occurrence of metabolic disorders in large-scale herds, TMR separation and metabolic profile tests were performed in 22 Hungarian dairies. Feed sorting was defined as >5% alteration in the mass proportion of any of the TMR fractions between the time of feed distribution and 5-6 h later. The prevalence of ketosis and subclinical acidosis differed between feed sorting and non-sorting groups. Inhomogeneous TMR seems to be a predisposing factor for imbalanced energy status. TMR homogeneity measurements should be routinely included in herd health monitoring.


Assuntos
Ração Animal , Doenças dos Bovinos/etiologia , Indústria de Laticínios , Comportamento Alimentar , Cetose/veterinária , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Dieta/veterinária , Ingestão de Energia , Hungria/epidemiologia , Cetose/etiologia
12.
Med J Malaysia ; 74(2): 174-175, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31079130

RESUMO

Methylacetoacetyl-coenzyme A thiolase (MAT) deficiency is an autosomal recessive disease caused by a defect of mitochondrial acetoacetyl-CoA thiolase (T2). There is an error of isoleucine catabolism and ketone body utilization due to mutations in the acetyl-Coenzyme A acetyltransferase 1 (ACAT1) gene. We report a case of a 14 months old Sabahan boy with beta deficiency who presented with severe sepsis and ketoacidosis who subsequently recovered.


Assuntos
Acetil-CoA C-Aciltransferase/deficiência , Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Acetil-CoA C-Acetiltransferase/genética , Acetil-CoA C-Acetiltransferase/metabolismo , Acetil-CoA C-Aciltransferase/genética , Adolescente , Erros Inatos do Metabolismo dos Aminoácidos/complicações , Erros Inatos do Metabolismo dos Aminoácidos/genética , Humanos , Isoleucina/metabolismo , Cetose/etiologia , Masculino , Sepse/etiologia
13.
J Pak Med Assoc ; 69(5): 745-746, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105303

RESUMO

Fasting during Ramadan is obligatory for all able bodiedadult Muslims. Though children are exempt from fasting, many children (and their parents) do observe the Ramadan fast. Responsible diabetes care professionals are expected to offer appropriate and pragmatic advice to children in their care. This communication describes the physiology of fasting in children, and assists physicians in sharing medically accurate information with them. Counselling regarding fasting must be made an integral part of diabetes care in Ramadan-observing families.


Assuntos
Diabetes Mellitus/metabolismo , Jejum/metabolismo , Islamismo , Adolescente , Criança , Pré-Escolar , Diabetes Mellitus/terapia , Jejum/efeitos adversos , Humanos , Hipoglicemia/etiologia , Hipoglicemia/metabolismo , Lactente , Recém-Nascido , Cetose/etiologia , Cetose/metabolismo
14.
JPEN J Parenter Enteral Nutr ; 43(7): 937-940, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30997672

RESUMO

Diabetic ketoacidosis is defined as hyperglycemia >250 mg/dL with metabolic acidosis of arterial pH <7.3, serum bicarbonate <18 mEq/L with positive urine and serum ketones and an anion gap >10. Euglycemic ketoacidosis has been reported in patients with type 2 diabetes and in patients with type 1 diabetes. However, as a surgical complication, euglycemic ketoacidosis has not been reported. We report 2 cases from 2 teaching tertiary care centers of patients with type 2 diabetes who developed high-gap ketoacidosis in an intensive care unit while recovering from emergent abdominal surgery. Both patients developed altered mental status, metabolic acidosis with a bicarbonate level as low as 14 mEq/L, and an anion gap > 18, without hyperglycemia. Both patients had ß-hydroxybutyrate levels > 5 mmol/L.


Assuntos
Abdome/cirurgia , Acidose/etiologia , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Cetose/etiologia , Complicações Pós-Operatórias/sangue , Ácido 3-Hidroxibutírico/sangue , Acidose/sangue , Acidose/diagnóstico , Idoso , Ânions , Bicarbonatos/sangue , Cetoacidose Diabética , Feminino , Humanos , Hiperglicemia , Cetose/sangue , Cetose/diagnóstico , Masculino , Complicações Pós-Operatórias/diagnóstico
15.
Expert Opin Pharmacother ; 20(7): 781-790, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30835599

RESUMO

INTRODUCTION: Accumulating data from recent studies has altered the gold standard of care for diabetes treatment. In patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD) or those at high risk for CVD, subsequently to lifestyle changes and metformin therapy, the administration of an SGLT-2 inhibitor with established benefits for cardiovascular outcome (CVOT) should be considered. Areas covered: Tofogliflozin is the most selective SGLT-2 inhibitor and has been approved for the treatment of T2D in Japan. This review summarizes the available data on Tofogliflozin as compared to other SGLT-2 inhibitors, and primarily the three SGLT-2 inhibitors with published CVOT: Empagliflozin, Canagliflozin and Dapagliflozin. Expert opinion: Tofogliflozin's higher selectivity profile increases the positive effects on cardiovascular (CV) outcomes and death and reduces side effects. However, the clinical data on Tofogliflozin from both clinical and real-world studies remain sparse and much less abundant than the other main 3 SGLT-2 inhibitors, thus calling for caution and underscoring the need for further research.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/farmacocinética , Doenças Cardiovasculares/etiologia , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/patologia , Glucosídeos/efeitos adversos , Glucosídeos/farmacocinética , Hemoglobina A Glicada/análise , Meia-Vida , Humanos , Hipoglicemia/etiologia , Cetose/etiologia , Nefropatias/tratamento farmacológico , Nefropatias/patologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/farmacocinética , Resultado do Tratamento
16.
Nat Commun ; 10(1): 548, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30710078

RESUMO

Sodium-glucose transport protein 2 (SGLT2) inhibitors are a class of anti-diabetic agents; however, concerns have been raised about their potential to induce euglycemic ketoacidosis and to increase both glucose production and glucagon secretion. The mechanisms behind these alterations are unknown. Here we show that the SGLT2 inhibitor (SGLT2i) dapagliflozin promotes ketoacidosis in both healthy and type 2 diabetic rats in the setting of insulinopenia through increased plasma catecholamine and corticosterone concentrations secondary to volume depletion. These derangements increase white adipose tissue (WAT) lipolysis and hepatic acetyl-CoA content, rates of hepatic glucose production, and hepatic ketogenesis. Treatment with a loop diuretic, furosemide, under insulinopenic conditions replicates the effect of dapagliflozin and causes ketoacidosis. Furthermore, the effects of SGLT2 inhibition to promote ketoacidosis are independent from hyperglucagonemia. Taken together these data in rats identify the combination of insulinopenia and dehydration as a potential target to prevent euglycemic ketoacidosis associated with SGLT2i.


Assuntos
Desidratação/complicações , Insulina/metabolismo , Cetose/induzido quimicamente , Cetose/etiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Animais , Compostos Benzidrílicos/efeitos adversos , Desidratação/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Modelos Animais de Doenças , Glucocorticoides/metabolismo , Glucose/metabolismo , Glucosídeos/efeitos adversos , Humanos , Cetose/patologia , Lipólise/efeitos dos fármacos , Fígado/efeitos dos fármacos , Fígado/metabolismo , Masculino , Ratos Sprague-Dawley , Receptores Adrenérgicos beta 1/metabolismo
17.
Intern Med J ; 49(2): 256-259, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30754085

RESUMO

Ketoacidosis is uncommon in non-diabetic women, but occurs in the postpartum period as a rare complication of continuing to breastfeed during periods of acute illness. We report a case of a lactating woman who presented with severe symptomatic ketoacidosis in the early postpartum period. We also review the pathophysiology and management of lactation ketoacidosis.


Assuntos
Diarreia/fisiopatologia , Cetose/diagnóstico , Cetose/terapia , Lactação , Adulto , Bicarbonatos/administração & dosagem , Feminino , Glucose/administração & dosagem , Humanos , Cetose/etiologia
18.
Trop Anim Health Prod ; 51(6): 1481-1487, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30715655

RESUMO

Ketosis is a metabolic disorder that has an important impact on health and productivity in dairy cattle during early lactation. In Colombia, the incidence and risk factors for ketosis development have not been studied. The objectives of the present study were to determine the incidence of subclinical (SCK) and clinical ketosis (CK) and to determine the risk factors associated with ketosis within the first 6 weeks of lactation in dairy cattle in Colombia. A prospective cohort study was carried out. A convenience sample of 150 lactating dairy cows from ten commercial dairy farms in the Cundi-Boyacencian Andean plateau were tested weekly using a point of care device to measure ß-hydroxybutyrate during the first 6 weeks of lactation. Incidence of SCK and CK was calculated. Risk factors were evaluated using a survey for each animal and for each farm. Potential risk factors were evaluated using a X2 test, Relative Risk was calculated for significant variables by the X2 test (P ≤ 0.05) and these variables were included in the logistic regression model. Cumulative incidence of SCK was 25.33%, 3.33% for CK, and overall incidence of ketosis was 26%. In the logistic regression model, parity 3 or more, herd size > 150 animals, body condition score ≥ 3, retained placenta, and metritis were determined as risk factors for ketosis. The results of this study confirm previous reports in which a high body condition score, increased parity, herd size, retained placenta, and metritis are associated with an increased risk of ketosis in stabled and grazing cattle.


Assuntos
Doenças dos Bovinos/epidemiologia , Cetose/veterinária , Ácido 3-Hidroxibutírico/sangue , Animais , Bovinos , Colômbia/epidemiologia , Feminino , Incidência , Cetose/epidemiologia , Cetose/etiologia , Lactação , Modelos Logísticos , Paridade , Placenta Retida , Gravidez , Estudos Prospectivos , Fatores de Risco
19.
Yonsei Med J ; 60(3): 308-311, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799594

RESUMO

Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency is a rare inborn error of ketone body utilization, characterized by episodic or permanent ketosis. SCOT deficiency is caused by mutations in the OXCT1 gene, which is mapped to 5p13 and consists of 17 exons. A 12-month-old girl presented with severe ketoacidosis and was treated with continuous renal replacement therapy. She had two previously unrecognized mild-form episodes of ketoacidosis followed by febrile illness. While high levels of ketone bodies were found in her blood and urine, other laboratory investigations, including serum glucose, were unremarkable. We identified novel compound heterozygous mutations in OXCT1:c.1118T>G (p.Ile373Ser) and a large deletion ranging from exon 8 to 16 through targeted exome sequencing and microarray analysis. This is the first Korean case of SCOT deficiency caused by novel mutations in OXCT1, resulting in life-threatening ketoacidosis. In patients with unexplained episodic ketosis, or high anion gap metabolic acidosis in infancy, an inherited disorder in ketone body metabolism should be suspected.


Assuntos
Acidose/genética , Coenzima A-Transferases/deficiência , Cetose/etiologia , Mutação/genética , Sequência de Bases , Coenzima A-Transferases/genética , Éxons/genética , Feminino , Heterozigoto , Humanos , Lactente , Corpos Cetônicos/sangue , Corpos Cetônicos/urina
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