Severe Hypercalcemia in an Adolescent with New-Onset Diabetes Mellitus and Diabetic Ketoacidosis

Gurnurkar, Shilpa; DiLillo, Emily; Carakushansky, Mauri

doi:10.7759/cureus.8435

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…Increased lipase due to insulin deficiency leads to the accumulation of ketone bodies, resulting in high anion gap metabolic acidosis [20] . Hypovolemia and metabolic acidosis can both trigger hypercalcemia, which causes elevations in gastrin and acetylcholine [23] . This leads to an increase in gastric acid secretions and therefore predisposes affected patients to peptic ulcers, and possibly, to AEN [24] .…”

Section: Discussionmentioning

confidence: 99%

“…[20] Hypovolemia and metabolic acidosis can both trigger hypercalcemia, which causes elevations in gastrin and acetylcholine. [23] This leads to an increase in gastric acid secretions and therefore predisposes affected patients to peptic ulcers, and possibly, to AEN. [24] Finally, DKA is associated with elevated proinflammatory cytokines such as interleukins and C-reactive protein, which may aggravate hypoperfusion via thrombus formation.…”

Section: Diabetic Ketoacidosismentioning

confidence: 99%

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Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis

2021

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The similarities and differences between acute esophageal necrosis and severe reflux esophagitis have not been elucidated. We compared Los Angeles classification Grade C reflux esophagitis, Grade D reflux esophagitis, and acute esophageal necrosis to consider the similarities and differences between acute esophageal necrosis and severe reflux esophagitis.We retrospectively reviewed records of patients who underwent esophagogastroduodenoscopy at a tertiary referral center from January 2012 to December 2019. Data on patients diagnosed as Grade C reflux, Grade D reflux, or acute esophageal necrosis for the first time were extracted for analysis.A total of 213 patients were enrolled in the study, composed of 130 Grade C reflux, 74 Grade D reflux, and 9 acute esophageal necrosis patients. Compared to Grade C reflux patients, Grade D reflux and acute esophageal necrosis patients were more likely to be transfused (P = .013 and P = .011, respectively), to have duodenal ulcers (P = .025 and P = .049, respectively), and to have psychiatric illnesses (P = .022 and P = .018, respectively). Compared to both Grade C and D reflux, acute esophageal necrosis patients were more likely to present with shock (P = .003 and P < .001, respectively), have type 1 diabetes (P = .030 and P = .004, respectively), and present in winter (P < .001 and P < .001, respectively). Significant step-wise differences (Grade C < Grade D < acute esophageal necrosis) were observed in the need for admission (P < .001 and P = .009), coffee ground emesis (P < .001 and P = .022), and stigmata of hemorrhage on endoscopy (P = .002 and P < .001). Admission (P = .003) and coffee ground emesis (P = .003) independently predicted either Grade D reflux or acute esophageal necrosis over Grade C reflux on multivariate analysis.Shock, type 1 diabetes, and winter may predict acute esophageal necrosis, while the need for admission and coffee ground emesis may predict Grade D reflux or acute esophageal necrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Diabetic Ketoacidosismentioning

confidence: 99%

Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis

2021

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“…DKA may present with mild hypernatremia due to severe dehydration. However, exact mechanism of severe hypernatremia is unknown [7]. The mechanism of severe hypernatremia in patients with new-onset DM is proposed that the increased proximal renal tubular sodium reabsorption due to negative feedback of hyperinsulinemia may be exceptionally efficient and in sodium retention [8].…”

Section: Discussionmentioning

confidence: 99%

Severe Hypernatremia in Combined Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Case Report of Two Japanese Children

Shima

Umino

Kitamura

et al. 2020

Cureus

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As sodium level in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) is usually low, normal, or slightly elevated, severe hypernatremia with DKA and/or HHS is rare. Case 1 was a 14-year-old boy, presenting with typical laboratory test values and symptoms consistent with DKA and HHS. His corrected sodium level, 172 mEq/L, might have occurred as a result of consuming 6 L/day of highly carbonated, carbohydrate-and sodium-rich drinks during the week preceding the diagnosis. This patient developed right lung artery thrombosis, which did not require treatment. Case 2 was a 10-year-old girl, presenting with typical laboratory test values and symptoms of DKA and HHS. Her corrected sodium level, 175 mEq/L, might have occurred as a result of large electrolyte-free water loss associated with osmotic diuresis. These two cases of patients presenting with DKA-HHS and severe hypernatremia are the first to be reported in Japan.

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“…On the other hand, Gurnurkar et al [10] discussed a case of an adolescent with newly diagnosed diabetes mellitus who developed severe hypercalcemia during DKA. The study emphasizes the importance of monitoring calcium levels during managing DKA in adolescents, as severe hypercalcemia is a rare and potentially life-threatening complication associated with DKA.…”

Section: Reviewmentioning

confidence: 99%

“…Gurnurkar et al [10] highlighted a case study where a pediatric patient's severe hypercalcemia, a rare and life-threatening condition, was linked to DKA. They postulated that dehydration and metabolic acidosis could contribute to this condition and emphasized the importance of appropriate fluid selection, such as Plasma-Lyte A, in managing such cases effectively.…”

Section: Reviewmentioning

confidence: 99%

Plasma-Lyte-148 Versus Normal Saline 0.9% in Diabetic Ketoacidosis Management: A Review

Othman¹,

Nashwan²,

Alfayoumi³

et al. 2023

Cureus

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Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus characterized by hyperglycemia, ketonemia, circulatory collapse, hypokalemia, and metabolic acidosis. The therapeutic management of DKA includes vigilant fluid resuscitation to address dehydration and electrolyte imbalances and restore hemodynamic stability. The choice of fluid, either isotonic saline or a balanced electrolyte solution like Plasma-Lyte 148 (PL), is pivotal in the clinical outcomes of DKA patients. Recent studies have compared the effectiveness of these fluid solutions in DKA management, focusing on different clinical outcomes such as the resolution of metabolic acidosis, electrolyte imbalances, the incidence of acute kidney injury, and length of hospital stay. This review examines the literature comparing isotonic saline and balanced electrolyte solutions for fluid resuscitation in DKA, analyzing the associated clinical outcomes. Through synthesizing research findings, this review aims to elucidate the efficacy and potential advantages of utilizing PL as an alternative to traditional isotonic saline for fluid resuscitation in treating DKA. This would further facilitate evidence-based decision-making among healthcare professionals and contribute to optimizing DKA management strategies. Understanding the intricacies and implications of fluid resuscitation is crucial, given its profound impact on patient outcomes in DKA management.

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Severe Hypercalcemia in an Adolescent with New-Onset Diabetes Mellitus and Diabetic Ketoacidosis

Cited by 3 publications

References 11 publications

Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis

Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis

Severe Hypernatremia in Combined Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Case Report of Two Japanese Children

Plasma-Lyte-148 Versus Normal Saline 0.9% in Diabetic Ketoacidosis Management: A Review

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