Stroke and diabetic ketoacidosis – some diagnostic and therapeutic considerations

Abstract

Cerebrovascular insult (CVI) is a known and important risk factor for the development of diabetic ketoacidosis (DKA); still, it seems that the prevalence of DKA among the patients suffering CVI and its influence on stroke outcome might be underestimated. Diabetic ketoacidosis itself has been reported to be a risk factor for the occurrence of stroke in children and youth. A cerebral hypoperfusion in untreated DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. All these were noted following DKA episodes in children. At least some of these mechanisms may be operative in adults and complicate the course and outcome of CVI. There is a considerable overlap of symptoms, signs, and laboratory findings in the two conditions, making their interpretation difficult, particularly in the elderly and less communicative patients. Serum pH and bicarbonate, blood gases, and anion gap levels should be routinely measured in all type 1 and type 2 diabetics, regardless of symptomatology, for the early detection of existing or pending ketoacidosis. The capacity for rehydration in patients with stroke is limited, and the treatment of the cerebrovascular disease requires intensive use of osmotic and loop diuretics. Fluid repletion may be difficult, and the precise management algorithms are required. Intravenous insulin is the backbone of treatment, although its effect may be diminished due to delayed fluid replenishment. Therefore, the clinical course of diabetic ketoacidosis in patients with CVI may be prolonged and complicated.

The Relation of Intra-Abdominal Adipose Tissue Accumulation and the Development of Vulnerable Carotid Atherosclerotic Plaques in Diabetes Mellitus.

“…Intraabdominal adipocytes secrete retinol-binding protein 4 which may increase insulin resistance. A large amount of free fatty acids are released from the visceral adipocytes and a systemic inflammation vascular and coagulation disorders that accompany diabetes may predispose to cardiovascular incidents [13]. Our results also show that the intraabdominal adipose tissue thickness was inherently related to the diabetes morbidity and the increased incidence of arterial hypertension.…”

Myricetin against ischemic cerebral injury in rat middle cerebral artery occlusion model

“…Stroke is the loss of brain function due to a disturbance in the blood supply to the brain, also referred to as a cerebrovascular accident, or, 'brain attack' (1,2). Stroke is the second leading cause of mortality worldwide, and another primary manifestation of stroke is disability.…”

Hiperinsulinemia and ketotic hypoglycemia as the most common forms of hypoglycemic states in childhood

“…Kod te dece, obično je za nastanak hipoglikemije, dovoljno da gladuju 12-18 sati, a kod zdravog deteta, obično je potrebno izostavljanje obroka 36 sati [14].Nivo ketona u krvi je, u najvećem broju slučajeva samo umereno povišen, ali u slučaju izraženog dejstva kontraregulatornih hormuna u intenzivnom stresnom stanju, može nastati i prava ketoacidoza. Ketoacidoza kod dece i adolescenata može biti povezana sa ketoacidozom [33].…”