Background. Diabetic ketoacidosis is an acute complication of diabetes, a severe metabolic disorder that requires urgent treatment. The aim of the paper is to present a case with steroid induced diabetes with complications. Case report. A young 25 year old man without any co-morbids, presented to the emergency department with fever, vomiting, coughing and buttock pain which started 3 days before. On the right gluteus there was a hematoma approx. 10cm x 5cm with fluctuation. The patient had hyperglycemia ( 9.1mmol/l), associated with high anion-gap metabolic acidosis, acute kidney injury, grossly elevated muscle enzymes, hyperkalemia, hyperphosphatemia, hypoalbuminemia, hypocalcemia and hypomagnesemia and deranged liver function tests. The urine dip-stick was grossly cola-coloured and biochemically was positive for glucose, ketones and proteins. An abscess drainage was performed and Streptococcus pyogenes was isolated on culture and sensitivity. The patient was treated for Diabetic Ketoacidosis, complicated by an acute kidney injury and infection. Diabetes is confirmed based on glycosylated hemoglobin. Conclusion. The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, in patients who abuse steroids or have risk factors for diabetes and obesity.
We reviewed several important parameters in pulmonary thromboembolism (PTE) and showed how not only absolute values but also relative are relevant in clinical practice. The vast majority of parameters depend both on previous values and co-morbidities; failure to realize this can result in misclassification of a patient and inappropriate treatment. For example, the absolute value systolic blood pressure (BP) less than 90 mmHg is crucial for urgent treatment (e.g. thrombolysis); obviously, the same admission systolic BP (sBP) of 87 mmHg may not have the same significance if previous usual sBP was also 87 mmHg or it was 220 mmHg. Moreover, cardiac troponin is also very important for the risk stratification; the same troponin concentration ought not to be interpreted equally if it is due to acute pulmonary thromboembolism or if it is chronic and due to e.g. renal failure. The interpretation of important dichotomous parameters (normal or pathologic values) in PTE does depend on previous values (if available) and co-morbidities. This principle should be recognized and used in clinical practice, while risk-stratifying patients.
Introduction/Objective Diabetic ketoacidosis (DKA) is a common and most severe acute complication of diabetes. It is a severe metabolic disorder with a high morbidity rate. This article aims to evaluate patients hospitalized with DKA and analyze their findings. Methodology The retrospective study included 63 patients with DKA. Data has been obtained from medical histories and patient logs at the Clinic of Endocrinology, Clinical Centre Nis. Results The following results were obtained: 31.74% of the patients were male with an average of 56.25 years of age, while 68.26% of the patients were female with an average of 49.75 years of age. The total age average was 53.71 years. Average glycemic values on admission were 24.36 mmol / l, the pH was 7.14, the bicarbonate level was 11.2mmol/l. The patients had been diagnosed with diabetes for an average of 15.2 years at the time of treatment. Type 2 diabetes was present in 53,97% of the patients, while 46.03% of the patients suffered from Type 1 diabetes. The duration of hospitalization was approximately 7.89 days. The required time for resolving ketoacidosis was 16.21 hours. The time required to begin the administration of the GPI (glucose, potassium, insulin) infusion as a form of therapy was 4.88 hours. After administering the GPI solution, the glycemic value was 10.9 mmol/l. The most common precipitating factor for DKA was infection (48.32%), followed by the absence of insulin in therapy (43.13%), while other causes accounted for 8.55% of the cases. Conclusion Treating patients with diabetic ketoacidosis was based on current therapeutic algorithms. Our one-year study presents their findings and treatment protocols. Since the incidence of diabetes mellitus is on the rise, its complications are also becoming more frequent which is why prevention is much needed.
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