Post-bariatric surgery starvation ketoacidosis and lipase elevation in the absence of DKA or pancreatitis

Song, Runbo; Cao, Shanjin

doi:10.1016/j.ajem.2017.10.068

Cited by 9 publications

(6 citation statements)

References 13 publications

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“…It is imperative, therefore, that patients at risk should have their fluid status, electrolyte levels, acid–base balance, and nutritional parameters closely monitored. Comprehensive monitoring may benefit from quantitative measurement of ketone bodies (e.g., BrAce), which could be used to enhance post‐bariatric diabetes management and distinguish between types and degrees of ketoacidosis such as SGLT2‐associated euglycemic ketoacidosis and post‐surgery starvation ketoacidosis 111,112 …”

Section: Ketosis For Therapymentioning

confidence: 99%

“…It is important to distinguish diabetic from starvation ketoacidosis since glucose administration can be a life‐saving measure in the latter situation. Although DKA after bariatric surgery is an uncommon event, it has been documented in patients with type 1 diabetes who have undergone gastric bypass 112 . Anesthesia and surgical stress, abrupt discontinuation of insulin or inadequate treatment in the perioperative period, postoperative infection, prolonged poor oral intake, and severe dehydration can be the precipitating causes for postoperative DKA 115 …”

Section: Ketosis For Therapymentioning

confidence: 99%

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Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Anderson

Mattar

Greenway

et al. 2021

Obesity Science & Practice

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Background The ketone bodies β‐hydroxybutyrate (BOHB) and acetone are generated as a byproduct of the fat metabolism process. In healthy individuals, ketone body levels are ∼0.1 mM for BOHB and ∼1 part per million for breath acetone (BrAce). These levels can increase dramatically as a consequence of a disease process or when used therapeutically for disease treatment. For example, increased ketone body concentration during weight loss is an indication of elevated fat metabolism. Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss. Methods This review of the literature provides metabolic mechanisms and typical concentration ranges of ketone bodies, which can give new insights into these conditions and rationale for measuring ketone bodies. Results Diseases such as heart failure and ketoacidosis can affect caloric intake and macronutrient management, which can elevate BOHB 30‐fold and BrAce 1000‐fold. Other diseases associated with obesity, such as brain dysfunction, cancer, and diabetes, may cause dysfunction because of an inability to use glucose, excessive reliance on glucose, or poor insulin signaling. Elevating ketone body concentrations (e.g., nutritional ketosis) may improve these conditions by forcing utilization of ketone bodies, in place of glucose, for fuel. During weight loss, monitoring ketone body concentration can demonstrate program compliance and can be used to optimize the weight‐loss plan. Conclusions The role of ketone bodies in states of pathologic and therapeutic ketosis indicates that accurate measurement and monitoring of BOHB or BrAce will likely improve disease management. Bariatric surgery is examined as a case study for monitoring both types of ketosis.

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Section: Ketosis For Therapymentioning

confidence: 99%

Section: Ketosis For Therapymentioning

confidence: 99%

Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Anderson

Mattar

Greenway

et al. 2021

Obesity Science & Practice

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“…This fact can, during extreme circumstances, lead to clinical ketoacidosiseven in individuals without diabetes. 16,17 Finally, the maintenance of SGLT2i (dapagliflozin) treatment in a patient with endogenous insulin deficit and the abrupt insulin suspension, must also have contributed to this adverse outcome.…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis after bariatric surgery: a case report.

Mendonça¹,

Silva²,

Chaves³

et al. 2021

Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo

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“…It has been reported that DKA can induce abdominal pain in 40–75% cases and the severity can mimic acute abdomen, thus masking and delaying diagnosis of the underlying etiology [ 12 , 13 ]. DKA can also induce leukocytosis [ 1 ] and cause nonspecific amylase and lipase elevation [ 12 , 14 , 15 ], thus making it challenging to differentiate DKA from acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Prediabetes Directly Deteriorates into Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome Triggered by Acute Pancreatitis: A Case Report Illustrating a “Chicken and Egg” Paradigm in Ketosis-Prone Diabetes

Song

Cao

2018

Diabetes Ther

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IntroductionDiabetic crises occur most often in patients with type 1 diabetes and occasionally in type 2 diabetes, especially under stressful conditions. However, a diabetic crisis occurring directly from prediabetes is an unusual phenomenon.Case ReportA 45-year-old woman presented with postprandial left upper quadrant abdominal pain, nausea, and vomiting. She had a past medical history of prediabetes with impaired fasting glucose and HbA1c 6.4%. On admission, routine laboratory tests showed high anion gap metabolic acidosis (pH 6.92), anion gap 41 mmol/L, blood glucose 931 mg/dL, beta-hydroxybutyrate 28 mmol/L, and calculated effective osmolarity 322 mOsm/kg; she was diagnosed with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS), and DKA-related abdominal pain. Later, the patient was found to have elevated lipase and amylase, and diagnosed with acute pancreatitis. Since DKA can induce abdominal pain and nonspecific lipase elevation, both of which are characteristics of acute pancreatitis, while acute pancreatitis can conversely trigger DKA, there exists a “chicken and egg” paradigm. Therefore, the differential diagnosis is discussed.ConclusionIt is important to differentiate DKA from concomitant causes of abdominal pain to avoid missing the underlying etiology, which can be the trigger for DKA. During diabetic crises, treating the underlying trigger is just as important as managing metabolic derangements in order to achieve favorable outcomes; meanwhile, managing acute pancreatitis-associated hyperglycemia can promote recovery. Additionally, diabetic crisis that directly evolves from prediabetes illustrates an atypical form of diabetes called ketosis-prone diabetes; we briefly discuss its clinical characteristics, classification, and follow-up.

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Post-bariatric surgery starvation ketoacidosis and lipase elevation in the absence of DKA or pancreatitis

Cited by 9 publications

References 13 publications

Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Diabetic ketoacidosis after bariatric surgery: a case report.

Prediabetes Directly Deteriorates into Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome Triggered by Acute Pancreatitis: A Case Report Illustrating a “Chicken and Egg” Paradigm in Ketosis-Prone Diabetes

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