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Yuan S, Liao J, Cai R, Xiong Y, Zhan H, Zheng Z. Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China. J Int Med Res 2021; 48:300060520912128. [PMID: 32223650 PMCID: PMC7132570 DOI: 10.1177/0300060520912128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Shiwen Yuan
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Jinli Liao
- Department of Emergency Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruibin Cai
- Department of Emergency Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Xiong
- Department of Emergency Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Zhan
- Department of Emergency Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziyu Zheng
- Department of Emergency Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Vitelli A, Apuzzi V, Calderaro F, Fattoruso O, Bassi V. A Triad of Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Undiagnosed Type 2 Diabetes Mellitus. Cureus 2020; 12:e8299. [PMID: 32607288 PMCID: PMC7320639 DOI: 10.7759/cureus.8299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A 24-year-old obese Caucasian male, without relevant anamnesis, who was admitted to the ER presented with abdominal pain, nausea and vomiting, hyperglycemia, and diabetic ketoacidosis (DKA). The diagnosis of acute pancreatitis (AP) was supported by increased serum levels of triglycerides and lipase associated with abdominal CT scans. The patient was treated for five days with IV regular insulin, hydration, electrolytes replacement, and statin/fibrate therapy with clinical improvement. Some 10% hemoglobin A1c value, normal C-peptide level and negative glutamic acid decarboxylase (GAD-65), and islet cell autoantibodies suggested the diagnosis of a new-onset type 2 diabetes mellitus (DM) presenting with an uncommon triad of DKA and hypertriglyceridemia (HTG)-induced AP. Anamnestic history suggested that DKA was dependent on sugar-sweetened soft drinks abuse (soft drink ketosis), a clinical association more frequent in Asian than in Western patients.
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Affiliation(s)
- Alessandra Vitelli
- U.O.C. Medicina Generale E Lungodegenza, San Giovanni Bosco, Asl Napoli 1 Centro, Naples, ITA
| | - Valentina Apuzzi
- U.O.C. Medicina Generale E Lungodegenza, San Giovanni Bosco, Asl Napoli 1 Centro, Naples, ITA
| | - Francesco Calderaro
- U.O.C. Medicina Genereale E Lungodegenza, San Giovanni Bosco, Asl Napoli 1 Centro, Naples, ITA
| | - Olimpia Fattoruso
- Pathology, San Giovanni Bosco Hospital, ASL Napoli 1 Centro, Naples, ITA
| | - Vincenzo Bassi
- U. O. C. Di Medicina Generale E Lungodegenza, San Giovanni Bosco Hospital, Asl Napoli 1 Centro, Naples, ITA
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Tsuchiya S, Sawada S, Takeda K, Takahashi K, Nakajima T, Kohata M, Kurosawa S, Satake C, Imai J, Kikuchi K, Aiba S, Katagiri H. Eruptive xanthomas in a patient with soft-drink diabetic ketosis and apolipoprotein E4/2. Endocr J 2019; 66:107-114. [PMID: 30393272 DOI: 10.1507/endocrj.ej18-0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soft-drink diabetic ketosis, characterized by acute onset ketosis induced by excessive ingestion of sugar-containing drinks, is often seen in obese, young patients, even with undiagnosed type 2 diabetes. We herein report a 15-year-old obese patient with the apolipoprotein E4/2 phenotype, in whom eruptive xanthomas lead to a diagnosis of soft-drink diabetic ketosis. He developed multiple asymptomatic yellowish papules on the auricles, back, buttocks and the extensor surfaces of the elbows and knees. He initially visited a dermatology clinic and his blood triglyceride and HbA1c levels were found to be 6,490 mg/dL and 16.5%, respectively. He was referred to our hospital for treatment of hyperglycemia and hypertyriglyceridemia. On admission, he had ketonuria and increased blood levels of 3-hydroxybutylate and acetoacetate. He habitually drank 1-3 litters of sweet beverages daily to quench his thirst. Therefore, "soft-drink diabetic ketosis" was diagnosed. Severe hypertriglyceridemia was considered to have been a consequence of impaired insulin action and his apolipoprotein E4/2 phenotype. We treated the diabetic ketosis and hypertriglyceridemia with intensive insulin therapy and a fat-restricted diet. At discharge, he no longer required insulin therapy and his blood glucose levels were controlled with metformin and voglibose. Along with amelioration of the hyperglycemia, triglyceride levels decreased to 247 mg/dL without administration of anti-hyperlipidemia agents. The eruptive xanthoma lesions gradually diminished in size and number and eventually disappeared by 12 months. This case provides an instructive example of eruptive xanthomas serving as a sign of severe dysregulation, not only of lipid, but also glucose, metabolism.
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Affiliation(s)
- Satoko Tsuchiya
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Shojiro Sawada
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Kana Takeda
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Kenji Takahashi
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Takeko Nakajima
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Masato Kohata
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Satoko Kurosawa
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Chihiro Satake
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Junta Imai
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Katsuko Kikuchi
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
| | - Hideki Katagiri
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi 980-8575, Japan
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