Journal Conference

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Journal Conference

• Instructor VS. ?????
• Present by R1 ???
• 92-09-29

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Iten PX. Meier M. Beta-hydroxybutyric acid--an
indicator for an alcoholic ketoacidosis as cause
of death in deceased alcohol abusers. Journal
Article Journal of Forensic Sciences.
45(3)624-32, 2000 May.

• In 100 chronic alcoholism cases
• In 25 cases of sudden and unexpected death of
  alcoholics we found pathologically increased
  levels of BHBA of 1260 to 47200 (median 8000)
  micromol/L
• The control group of 69 postmortem cases revealed
  that BHBA concentrations below 500
• Our study shows that BHBA values over 2500
  micromol/L could lead to death, if no medical
  attention is sought.

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Marinella MA. Alcoholic ketoacidosis presenting
with extreme hypoglycemia. Journal Article
American Journal of Emergency Medicine.
15(3)280-1, 1997 May. UI 9148987

• A 66-year-old man with a history of chronic
  alcoholism
• Kussmaul respirations following several days of
  fasting accompanied by vomiting, in the presence
  of continued ethanol intake
• glucose lt20 mg/dL and an anion gap of 36.
• If the serum glucose level is less than the anion
  gap, the diagnosis of alcoholic ketoacidosis
  should be considered

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Differences in Metabolic and Hormonal Milie in
Diabetic- and Alcoholic-Induced
KetoacidosisUmpierrez, Guillermo E. DiGirolamo,
Mario Tuvlin, Jeffrey A. Isaacs, Scott D.
Bhoola, Snehal M. Kokko, Juha P.

• DKA and AKA are two medical emergencies
  characterized by elevated total ketone body
  concentration
• 12 patients with DKA and 8 patients with AKA
• determination of serum ketone bodies, lactate and
  pyruvate, insulin, and counterregulatory hormones
  (glucagon, cortisol, growth hormone, and
  catecholamines).

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• Metabolic profile
• plasma glucose DKA AKA 320 66
• BHBA/acetoacetate ratio 31 vs. 71
• lactate/pyruvate ratio 111 vs. 191
• resolve ketoacidosis 16 2 hour vs. 6 1
  hour

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• Hormonal profile
• insulin concentration 7.8 2 vs. 10.3 3
• glucagon level 203 15 vs. 188 pg/mL
• cortisol, growth hormone, and epinephrine were
  higher in patients with DKA
• did not reach statistical significance