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The incidence of DKA increased significantly with age in girls but there was no age effect in boys. In females, pair-wise comparisons subject to Bonferroni correction, i.e., significant at the α=0.017 level.|~|/files/powerpoints_images/node243137/Slide10.JPG|~|563|~|422|~|0
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The incidence of DKA increased significantly with age in girls but t... |
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The Proportion of Children with Recurrent DKA , shown on this graph, was only 5%. However, 60% of all DKA episodes occurred in these 5% of children who had 2 or more events |~|/files/powerpoints_images/node243137/Slide11.JPG|~|563|~|422|~|0
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The Proportion of Children with Recurrent DKA , shown on this graph, ... |
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Average cost of hospitalization of a diabetic patient doubles, if DKA is present |~|/files/powerpoints_images/node243137/Slide13.JPG|~|563|~|422|~|0
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Average cost of hospitalization of a diabetic patient doubles, if DKA... |
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Patients met diagnostic criteria for cerebral edema 3.1 /-2.6 hours prior to neurological collapse. Presence of one “diagnostic criteria” , two “major criteria” or one major and two minor criteria – associated with 92% sensitivity ; 4% false positive rate. |~|/files/powerpoints_images/node243137/Slide30.JPG|~|563|~|422|~|0
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Patients met diagnostic criteria for cerebral edema 3.1 /-2.6 hours ... |
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Some have suggested early and late peaks.|~|/files/powerpoints_images/node243137/Slide31.JPG|~|563|~|422|~|0
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Some have suggested early and late peaks. |
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Ketone bodies are produced in large amounts as a physiological metabolic response in situations of little or no dietary carbohydrate intake. As well as prolonged exercise and pregnancyIn contrast to these benign situations, ketosis may herald dangerously low levels of effective insulin, or increase in insulin resistance. Ketosis may also develop in alcohol and salicylate intoxication and inborn metabolic errors, for instance defects of glycogen metabolism.|~|/files/powerpoints_images/node243137/Slide34.JPG|~|563|~|422|~|0
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Ketone bodies are produced in large amounts as a physiological metabo... |
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The Abbott / MediSense device is known in the U.S. as Precision Xtra and as Optium Exceed in most other countries.|~|/files/powerpoints_images/node243137/Slide37.JPG|~|563|~|422|~|0
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The Abbott / MediSense device is known in the U.S. as Precision Xtra ... |
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In a normal sate, after a meal, most of the energy is derived from glucose oxidation and the excess of food is deposited as fat.|~|/files/powerpoints_images/node243137/Slide44.JPG|~|563|~|422|~|0
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In a normal sate, after a meal, most of the energy is derived from gl... |
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Post-prandial insulin facilitates glucose oxidation and lipogenesis, while supressing fat mobilization and oxidation. |~|/files/powerpoints_images/node243137/Slide45.JPG|~|563|~|422|~|0
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Post-prandial insulin facilitates glucose oxidation and lipogenesis, ... |
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Insulin suppresses also the HMG CoA synthase and production of ketone bodies from acetyl CoA. The blood levels of ketone bodies (acetoacetate, beta-hydroxybutyrate and acetone) are low and not a significant source of energy. The ratio between acetoacetate and beta-hydroxybutyrate is about 1 :1|~|/files/powerpoints_images/node243137/Slide46.JPG|~|563|~|422|~|0
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Insulin suppresses also the HMG CoA synthase and production of ketone... |
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In DKA, lack of insulin and excess of counter-regulatory hormones, primarily glucagon leads to: a) diminished glucose utilization; (b) activation of lipolysis and lipid oxidation as alternative source of energy; (c) increased production of ketone bodies that can also be as a source of energy. The blood levels of ketone bodies increases, especially of beta-hydroxybutyrate; the ratio between acetoacetate and beta-hydroxybutyrate increases to about 1 :10. |~|/files/powerpoints_images/node243137/Slide47.JPG|~|563|~|422|~|0
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In DKA, lack of insulin and excess of counter-regulatory hormones, pr... |
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Most validation studies have found a strong correlation between the bedside meter and the reference laboratory values, at least up to 3-4 mmol/L. This was also the case in our study of 68 children with DKA, where we analyzed 505 paired sets of bedside and reference B-OHB measurements.|~|/files/powerpoints_images/node243137/Slide49.JPG|~|563|~|422|~|0
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Most validation studies have found a strong correlation between the b... |
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Another standard way to look at this is the Bland-Altman plot analysis showing the difference between results obtained using the two methods by their average. In our study, the agreement between the meter and the reference method was very good for lower values but less accurate for higher values, similar to previous reports.|~|/files/powerpoints_images/node243137/Slide50.JPG|~|563|~|422|~|0
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Another standard way to look at this is the Bland-Altman plot analysi... |
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Measurement of beta-OHB in blood, as expected, is a more sensitive approach to detecting ketosis than urine analysis. Importantly, a negative blood beta-OHB test is superior to negative urine test in ruling out ketosis (NPV.).|~|/files/powerpoints_images/node243137/Slide54.JPG|~|563|~|422|~|0
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Measurement of beta-OHB in blood, as expected, is a more sensitive ap... |
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Four studies, summarized here, have looked at this issue. Each used a different cut-off level for blood beta-OHB. It appears that a cut-off of 2 or 3 mmol/l provides optimal combination of sensitivity and specificity and could be recommended for initial diagnosis in the ED. Hyperglycemic patients with beta-OHB below 3 mmol/L are very unlikely to have DKA (NPV= 100%).|~|/files/powerpoints_images/node243137/Slide58.JPG|~|563|~|422|~|0
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Four studies, summarized here, have looked at this issue. Each used a... |
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Data from Prisco et al. elegantly illustrates this point. Among 118 children with newly diagnosed diabetes, 28 had initial venous pH<7.25. Only one of these had B-OHB <2.8. It is worth noting that among children with pH>7.25, about a half had B-OHB >3 mmol/L and probably compensated metabolic acidosis.|~|/files/powerpoints_images/node243137/Slide59.JPG|~|563|~|422|~|0
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Data from Prisco et al. elegantly illustrates this point. Among 118 c... |
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In our recent paper, we found very good correlation between the bedside meter β-OHB levels and pH, bicarbonate and pCO2, but not BG or BUN. The correlation coefficients were similar for the bedside meter and the reference laboratory method. |~|/files/powerpoints_images/node243137/Slide61.JPG|~|563|~|422|~|0
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In our recent paper, we found very good correlation between the bedsi... |
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pH, bicarbonate, pCO2 were entered into separate time series analysis models with treatment duration as a measure of time and subject as the repeated measure. The results confirmed that bedside levels of β-OHB correlated very closely with time dependent levels of venous pH, bicarbonate and pCO2. |~|/files/powerpoints_images/node243137/Slide62.JPG|~|563|~|422|~|0
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pH, bicarbonate, pCO2 were entered into separate time series analysis... |
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In the majority of type 1 diabetic children, normalization of blood beta-hydroxybutyrate precedes urine ketone disappearance by several hours. A small subset of patients shows an atypical disappearance of ketones from urine that comes first before disappearance of blood beta-hydroxybutyrate.|~|/files/powerpoints_images/node243137/Slide65.JPG|~|563|~|422|~|0
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In the majority of type 1 diabetic children, normalization of blood b... |
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This is a typical profile of bedside beta-hydroxybutyrate throughout the tratment of DKA in an individual patient.The time of treatments with IV fluids infusion. The dashed horizontal line shows the cut-off point of 1 mmol/L. The solid line represents pH 0f 7.3. Triangles represent blood pH and circles houry bedside beta-hydroxybutyrate values.|~|/files/powerpoints_images/node243137/Slide66.JPG|~|563|~|422|~|0
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This is a typical profile of bedside beta-hydroxybutyrate throughout ... |
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Neuro status: mental status, level of alertness, ability to arouse. |~|/files/powerpoints_images/node243137/Slide69.JPG|~|563|~|422|~|0
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Neuro status: mental status, level of alertness, ability to arouse. |
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