Glucose 6 Phosphate Dehydrogenase Deficiency Unmasked by Diabetic Ketoacidosis: An Underrated Phenomenon

Agarwal, Ayushi; Nayak, Manjushree; Patil, Asha; Manohar, Chethan

doi:10.7860/jcdr/2013/6159.3892

Cited by 11 publications

(11 citation statements)

References 7 publications

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“…People with G6PD deficiency can develop severe haemolytic anaemia in conjunction with new‐onset diabetes, particularly within the setting of ketoacidosis. This phenomenon has been reported previously, but is uncommon .…”

Section: Introductionsupporting

confidence: 71%

“…Evidence of haemolysis in people with diabetes and G6PD deficiency was first reported in 1972 [2]. Since that time, sporadic cases have appeared in the literature, highlighting the rare precipitating factors of acute haemolytic anaemia in G6PD-deficient individuals [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Seventeen papers have been published, involving 23 individuals from around 12 countries; most of these individuals had hyperglycaemia with or without diabetic ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

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Glucose‐6‐phosphate dehydrogenase deficiency induced haemolysis in a woman with newly diagnosed diabetes after normalisation of hyperglycaemia

ALjishi

Al-Darwish

2017

Diabet. Med.

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Glucose‐6‐phosphate dehydrogenase deficiency induced haemolysis in a woman with newly diagnosed diabetes after normalisation of hyperglycaemia

ALjishi

Al-Darwish

2017

Diabet. Med.

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“…G6PD deficiency is linked to certain chronic and infectious diseases [1,[37][38][39]. The significance of the G6PD expression in the inflammatory response, especially in airway epithelial cells, is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Diminished COX-2/PGE2-Mediated Antiviral Response Due to Impaired NOX/MAPK Signaling in G6PD-Knockdown Lung Epithelial Cells

Lin

Yen

et al. 2016

PLoS ONE

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Glucose-6-phosphate dehydrogenase (G6PD) provides the reducing agent NADPH to meet the cellular needs for reductive biosynthesis and the maintenance of redox homeostasis. G6PD-deficient cells experience a high level of oxidative stress and an increased susceptibility to viral infections. Cyclooxygenase-2 (COX-2) is a key mediator in the regulation of viral replication and inflammatory response. In the current study, the role of G6PD on the inflammatory response was determined in both scramble control and G6PD-knockdown (G6PD-kd) A549 cells upon tumor necrosis factor-α (TNF-α) stimulation. A decreased expression pattern of induced COX-2 and reduced production of downstream PGE2 occurred upon TNF-α stimulation in G6PD-kd A549 cells compared with scramble control A549 cells. TNF-α-induced antiviral activity revealed that decreased COX-2 expression enhanced the susceptibility to coronavirus 229E infection in G6PD-kd A549 cells and was a result of the decreased phosphorylation levels of MAPK (p38 and ERK1/2) and NF-κB. The impaired inflammatory response in G6PD-kd A549 cells was found to be mediated through NADPH oxidase (NOX) signaling as elucidated by cell pretreatment with a NOX2-siRNA or NOX inhibitor, diphenyleneiodonium chloride (DPI). In addition, NOX activity with TNF-α treatment in G6PD-kd A549 cells was not up-regulated and was coupled with a decrease in NOX subunit expression at the transcriptional level, implying that TNF-α-mediated NOX signaling requires the participation of G6PD. Together, these data suggest that G6PD deficiency affects the cellular inflammatory response and the decreased TNF-α-mediated antiviral response in G6PD-kd A549 cells is a result of dysregulated NOX/MAPK/NF-κB/COX-2 signaling.

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“…In such patients, it is advocated that one should be less aggressive in treating hyperglycaemia to avoid rapidly induced euglycaemia, which may cause haemolysis. Published case study reports show that ketosis prone G6PD deficient diabetic patient experienced haemolytic crisis during a decompensation of hyperglycaemia which might precipitate a sudden change in glucose level [24] [26] [27]. The limitation for this study is that the sample size is small and needs to be expanded for a study with this importance.…”

Section: Discussionmentioning

confidence: 99%

An Assessment of Frequent Haemolytic Crisis in G6PD Deficiency Subjects Linked with Chronic Disease States in Al Ahsa Community, Saudi Arabia

Emeka¹,

Hilal²,

Asif³

et al. 2015

Health

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The main treatment strategy for glucose-6-phosphate dehydrogenase (G6PD) deficiency is averting the use of oxidative precipitants like drugs or foods that trigger haemolysis. However, subjects could experience acute crisis in a comorbidity state of diabetes, hypertension or infection. In addition, the condition could in turn predispose carriers to these chronic diseases. Aim of the study was to evaluate the frequency of haemolytic crisis in carriers with attendant chronic diseases, and also assess awareness and knowledge of aggravated reactions from these conditions. 282 subjects consented and participated in the study. A cross-sectional semi-structured interview questionnaire conducted from May to August 2013 was adopted. Questions focused on demographics, awareness and when disease was diagnosed, type and frequency of crisis, family history, screening and presence of other diseases and awareness of trigger from these conditions. A total of 69.9% were G6PD deficiency gene carriers and mostly fell within the age group of 31 -40 (43.6%). 75.6% of the carriers were not aware that other disease conditions could exacerbate crisis. Non-drug related crisis was 85.3% compared with 14.7 drug related reactions. Out of the 69.9% carriers, 17.3% are diabetics, 18.3% of them are hypertensive and 25.9% are with bleeding disorders. Also, 29.1% had frequent episodes with bacterial infection. Symptoms experienced that were not drug related included, 44.8% attacks of pallor, 25.3% jaundice, 28.5% with shortness of breath, while 21.7% had dark urine frequently. No routine screening for other diseased conditions was carried out for these subjects despite experiencing frequent crisis that were not drug related. Carriers * Corresponding author. P. Emeka et al. 626with other diseased conditions experienced more non-drug related crisis and were not aware of it.

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Glucose 6 Phosphate Dehydrogenase Deficiency Unmasked by Diabetic Ketoacidosis: An Underrated Phenomenon

Cited by 11 publications

References 7 publications

Glucose‐6‐phosphate dehydrogenase deficiency induced haemolysis in a woman with newly diagnosed diabetes after normalisation of hyperglycaemia

Glucose‐6‐phosphate dehydrogenase deficiency induced haemolysis in a woman with newly diagnosed diabetes after normalisation of hyperglycaemia

Diminished COX-2/PGE2-Mediated Antiviral Response Due to Impaired NOX/MAPK Signaling in G6PD-Knockdown Lung Epithelial Cells

An Assessment of Frequent Haemolytic Crisis in G6PD Deficiency Subjects Linked with Chronic Disease States in Al Ahsa Community, Saudi Arabia

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