sodium-bicarbonate and Hyperglycemia

To review current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema.. The authors selected articles from MEDLINE with the keywords diabetes, ketoacidosis, hyperglycemia and cerebral edema, and priority was given to studies including children and that contained complete texts published in English, Portuguese or Spanish. Chapters of books published in Brazil describing the treatment of DKA in pediatric intensive care unit were also reviewed. Based on the reviewed literature and on the author's experience, the most efficient and recommended measures for DKA management are presented.. Normal saline solution (NaCl 0.9%) has been increasingly used for fast replacement and hydration, as a substitute to diluted (hypotonic) solutions, as well as contraindication of sodium bicarbonate to repair metabolic acidosis in DKA. Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. For fast corrections of glucose oscillations, a practical scheme using two bags of electrolytic solutions is presented. Cerebral edema, its physiopathological mechanism and current treatment are reviewed.. Use of continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.

Topics: Brain Edema; Child; Contraindications; Critical Care; Dehydration; Diabetic Ketoacidosis; Fluid Therapy; Humans; Hydrogen-Ion Concentration; Hyperglycemia; Insulin; Insulin, Long-Acting; Intensive Care Units, Pediatric; Isotonic Solutions; Sodium Bicarbonate

To report diagnostic, clinical and therapeutic aspects of cyanide intoxication resulting from ingestion of cyanogenic glucoside-containing apricot seeds.. Thirteen patients admitted to the Pediatric Intensive Care Unit (PICU) of Erciyes University between 2005 and 2009 with cyanide intoxication associated with ingestion of apricot seeds were reviewed retrospectively.. Of the 13 patients, four were male. The mean time of onset of symptoms was 60 minutes (range 20 minutes to 3 hours). On admission, all patients underwent gastric lavage and received activated charcoal. In addition to signs of mild poisoning related to cyanide intoxication, there was severe intoxication requiring mechanical ventilation (in four cases), hypotension (in two), coma (in two) and convulsions (in one). Metabolic acidosis (lactic acidosis) was detected in nine patients and these were treated with sodium bicarbonate. Hyperglycaemia occurred in nine patients and blood glucose levels normalised spontaneously in six but three required insulin therapy for 3-6 hours. Six patients received antidote treatment: high-dose hydroxocobalamin in four and two were treated with a cyanide antidote kit in addition to high-dose hydroxocobalamin. One patient required anticonvulsive therapy. All patients recovered and were discharged from the PICU within a mean (SD, range) 3.1 (1.7, 2-6) days.. Cyanide poisoning associated with ingestion of apricot seeds is an important poison in children, many of whom require intensive care.

Topics: Acidosis; Antidotes; Charcoal; Child; Child, Preschool; Coma; Cyanides; Eating; Female; Gastric Lavage; Hematinics; Humans; Hydroxocobalamin; Hyperglycemia; Insulin; Male; Poisoning; Prunus; Respiratory Insufficiency; Retrospective Studies; Seeds; Seizures; Sodium Bicarbonate; Turkey

Topics: Acid-Base Equilibrium; Diabetic Ketoacidosis; Humans; Hydrogen-Ion Concentration; Hyperglycemia; Sodium Bicarbonate

To determine the sensitivity and specificity of the urine ketone dip test as a screening test for ketonemia in hyperglycemic patients and to compare the performance of the urine ketone dip test with the anion gap and serum bicarbonate level.. This was a prospective study conducted in an urban, university-affiliated public hospital emergency department. Inclusion criteria consisted of (1) patients with known diabetes and hyperglycemia (glucose level>200 mg/dL) and any complaint of illness, or (2) patients with hyperglycemia and symptoms of undiagnosed diabetes mellitus. Urine ketone dip test, serum ketone, and electrolyte levels were determined on all subjects. Sensitivity, specificity, and predictive values along with 95% confidence intervals (CIs) were calculated.. The study group comprised 697 patients, including 98 patients with diabetic ketoacidosis (DKA) and 88 with diabetic ketosis (DK). The sensitivity, specificity, positive, and negative predictive values of the urine ketone dip test for the detection of DKA were 99% (95% CI 97% to 100%), 69% (95% CI 66% to 73%), 35% (95% CI 29% to 41%), and 100% (95% CI 99% to 100%), respectively. For DKA and DK, the sensitivity, specificity, positive, and negative predictive values of the urine ketone dip test were 95% (95% CI 90% to 97%), 80% (95% CI 76% to 83%), 63% (95% CI 57% to 69%) and 98% (95% CI 96% to 99%). The anion gap and serum bicarbonate level were less sensitive but more specific than the urine ketone dip test for the detection of DKA and DK.. The urine ketone dip test has high sensitivity for detecting DKA and a high negative predictive value for excluding DKA in hyperglycemic patients with diabetes with any symptoms of illness. The urine ketone dip test is a better screening test for DKA and DK than the anion gap or serum bicarbonate.

Topics: Acid-Base Equilibrium; Adolescent; Adult; Aged; Aged, 80 and over; Blood Gas Analysis; Cost Savings; Diabetes Complications; Diabetic Ketoacidosis; Emergency Treatment; Female; Humans; Hyperglycemia; Ketone Bodies; Ketosis; Male; Mass Screening; Middle Aged; Prospective Studies; Reagent Strips; Reproducibility of Results; Sensitivity and Specificity; Sodium Bicarbonate

Reports of acute toxicity following sulfasalazine ingestion are rare. A case of an acute ingestion of sulfasalazine 50 g and paracetamol 50 g resulting in severe lactic acidosis, seizures, coagulopathy, hyperglycemia, ketosis, and methemoglobinemia is reported. Despite the ingestion of a large amount of paracetamol with serum paracetamol 5486 nmol/L (844 mg/L), significant hepatotoxicity did not occur. The patient recovered fully following administration of intravenous N-acetylcysteine, methylene blue, sodium bicarbonate, and supportive therapy.

Topics: Acetaminophen; Acetylcysteine; Acidosis, Lactic; Acute Disease; Adult; Anti-Inflammatory Agents; Blood Coagulation Disorders; Blood Platelets; Drug Combinations; Drug Overdose; Humans; Hyperglycemia; Infusions, Intravenous; Male; Methemoglobinemia; Methylene Blue; Partial Thromboplastin Time; Sodium Bicarbonate; Suicide, Attempted; Sulfasalazine

Both hyperglycemia and hyperinsulinemia stimulate whole body and muscle glucose disposal. To define the impact of increased lactate concentration (4-5 mM) on muscle glucose disposal during hyperglycemia, we studied anesthetized normal rats infused with either sodium lactate or sodium bicarbonate as control. Animals were studied under hyperglycemic clamp (13 mM) using [3-3H]glucose (study 1) and 2-deoxy-[1-3H]glucose (study 2) to assess glucose rate of disappearance (Rd), glycolytic flux (GF), glycogen synthesis, and glucose utilization index by different tissues. Moreover, in study 3, the effect of lactate on the pattern of plasma insulin response to hyperglycemia was evaluated. In study 1, lactate infusion resulted in an increased Rd (38.7 +/- 1.7 vs. 32.3 +/- 1.3 mg.min-1.kg-1; P < 0.01), which was explained by an enhanced rate of glycogen synthesis (23.0 +/- 1.7 vs. 14.7 +/- 1.2 mg.min-1.kg-1; P < 0.001), whereas GF was unchanged. In study 2, lactate-infused animals showed an increased 2-deoxy-glucose disposal and a stimulated glycogen synthase activity as well as an increased glycogen accumulation at the end of the study in several skeletal muscles. In study 3, lactate did not induce any change in either early or late insulin response to hyperglycemia. In conclusion, our results show that muscle glycogen deposition may be enhanced by elevated lactate levels under hyperglycemic conditions and support a role for lactate in the regulation of glucose homeostasis.

Topics: Animals; Deoxyglucose; Glucose; Glucose Clamp Technique; Glycogen; Glycogen Synthase; Glycolysis; Hyperglycemia; Infusions, Intravenous; Kinetics; Male; Muscle, Skeletal; Rats; Rats, Sprague-Dawley; Sodium Bicarbonate; Sodium Lactate; Tritium

To investigate the effect of low-dose versus high-dose insulin treatment of Kussmaul's coma, the authors treated 2 groups of relevant patients. Group I treated with low-dose insulin in combination with other therapeutic measures achieved a progressive decrease of glycemia within 8 hours. Complications were not registered. Group II on high-dose insulin scheme exhibited a drop in blood sugar resultant in hypoglycemia in 4, hypotonia in 2, brain edema in 1 patient. The absence of complications, availability and simplicity support the advantages of the low-dose regime which is now widely introduced into clinical practice.

Topics: Adolescent; Adult; Aged; Bicarbonates; Diabetic Coma; Diabetic Ketoacidosis; Drug Therapy, Combination; Female; Humans; Hyperglycemia; Hypoglycemia; Infusions, Intravenous; Injections, Intramuscular; Insulin; Male; Middle Aged; Sodium; Sodium Bicarbonate

Four cases of the iatrogenic nondiabetic hyperosmolar state are presented. The clinical presentation, biochemical findings and management are discussed. No hypertonic solution should be infused at a rate above the level of patient tolerance; irrigation of a hollow viscus with a hypertonic solution should be avoided, and salt should not be used as an emetic. Patients under stress are particularly prone to this condition, largely because of the high circulating cortisol levels. The use of corticosteroids, salt-containing solutions in excess of patient requirements, water depletion and intravenous nutrition in the absence of careful biochemical monitoring, are all factors which may precipitate the hyperosmolar state in the critically ill.

Topics: Acid-Base Imbalance; Adult; Aged; Bicarbonates; Cerebral Hemorrhage; Citrates; Female; Glucose Solution, Hypertonic; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Hypernatremia; Iatrogenic Disease; Male; Middle Aged; Osmolar Concentration; Saline Solution, Hypertonic; Seizures; Sodium Bicarbonate