Dextrose Solution Research Articles

Radiofrequency ablation of benign thyroid nodules: the value of anterolateral hydrodissection.

This study aimed to evaluate the technical feasibility, efficacy, and safety of anterolateral hydrodissection (ALHD) in radiofrequency ablation (RFA) for benign thyroid nodules. Between November 2019 and April 2020, 39 patients underwent 41 sessions of RFA with the ALHD technique to treat benign thyroid nodules. ALHD was performed with cold (0°C-4°C) 5% dextrose solution during RFA to minimize pain and secure sufficient safety margins from critical neck structures. The initial ablation ratio (IAR) was measured to assess the technique's efficiency. Ultrasound examinations, symptoms, and cosmetic scores were evaluated pre-procedure and at 6 and 12 months post-procedure. Procedure-related pain during RFA and complications were recorded. The mean index nodule volume was 20.5±21.6 mL. ALHD was technically feasible in all patients. The mean IAR was 90.7%±8.3%, and significant reductions in mean nodule volume were noted at 6- and 12-month follow-ups (P<0.001, 63.9%±19.0%, and 76.3%±18.9%, respectively). Symptom and cosmetic scores showed significant improvements at 6- and 12-month follow-ups (P<0.001). Pain during the procedure was well-controlled with ALHD in all patients. After the initial use of 5-10 mL of lidocaine at the start of the procedure, no further lidocaine injection was given to any patient. Transient voice change was observed in one patient, but the patient recovered spontaneously within 30 minutes. The ALHD technique was technically feasible and effective in all patients, achieving a mean IAR of 90.7%. The ALHD technique also had a pain-relieving effect, resulting in only low amounts of lidocaine administration being required during the procedure.

Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy.

Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy.

A Severe Case of Hypokalemic Metabolic Alkalosis: A Quiz

A Severe Case of Hypokalemic Metabolic Alkalosis: A Quiz

Prolotherapy Injection with Hyperosmolar Dextrose Solution in the Treatment of Achilles Tendinopathy: A Pilot Study

Prolotherapy Injection with Hyperosmolar Dextrose Solution in the Treatment of Achilles Tendinopathy: A Pilot Study

Effect of aqueous solutions of KCl, MgCl2, Dextrose and Urea on solvation behavior of aqueous myo-Inositol

Owing to the indispensable role of myo-Inositol (MI), a cyclic polyol, in biological, pharmaceutical and food industries, in this investigation, we herewith report the systematic data of densities (ρ) and speed of sound (u) of MI in water, aqueous electrolytic (0.06 mol∙kg−1 KCl/MgCl2) and non-electrolytic (0.06 mol∙kg−1 Dextrose/Urea) solutions at seven different temperatures T/K (=288.15–318.15) and ambient pressure over the dilute concentration range of (0.03–0.2) mol∙kg−1. The experimental data of density (ρ) and speed of sound (u) were further processed to obtain respective derived parameters, such as apparent molar volume of solute Vϕ, isentropic compressibility of solution κs and apparent molar isentropic compression of the solute Ks,ϕ. The limiting values of apparent molar volume Vϕ0, apparent molar isentropic compression Ksϕ0 and apparent molar expansibility Eϕ0 of solute have been computed. Further, the coefficient of thermal expansion α∗, second order derivative of limiting apparent molal volume ∂2Vϕ0/∂T2, hydration number (nH) and transfer properties (ΔtrVϕ0andΔtrKs,ϕ0) of MI have also been obtained. An attempt has been made to analyse the molecular interactions through the coulomb attenuated hybrid exchange–correlation density functional theory (DFT) by gaussian tool. The effect of temperature and the studied electrolytic and non-electrolytic moieties (i.e., KCl, MgCl2, Dextrose and Urea) have been discussed in the light of prevailing interactions between solute-co-solute and solvent molecules on the basis of co-sphere overlap model.

Facile Technology for Extemporaneous Preparation of Long-Acting Injectable Microparticulate Suspensions at the Patient Side

In this study, we present an innovative and facile in situ approach for extemporaneous preparation of sterile microparticles. An amazingly simple approach, in situ technology circumvents the stability, and scale up challenges as well as sterilization issues associated with long-acting particulate systems. Monophasic preconcentrates of donepezil base (DPZ), a model drug with a biodegradable polymer poly (DL-lactide-co-glycolide) (PLGA), with stabilizer were prepared by simple solution and sterilized by filtration (0.22 micron). The sterile preconcentrates when added to aqueous dextrose solution (total volume < 3mL) generated ready-to-inject DPZ PLGA microparticles (DPZ-PLGA-MP) with high reproducibility, entrapment efficiency (> 80%), and size ~ 80 micron. DPZ micro suspension(DPZ-MS) with high precipitation efficiency (> 90%) and size ~ 80 micron was obtained in a similar manner omitting PLGA. XRD and DSC study confirmed decreased crystallinity in the presence of PLGA. No interaction between PLGA and DPZ was evident in the FTIR study. The microparticulate dispersions exhibited good in vitro injectability when tested using the texture analyzer (force < 5 N). When evaluated using the dialysis bag method (Himedia 12-14kDa molecular weight cutoff), both microparticulate formulations exhibited controlled release up to 1week in vitro. Further, low burst release of ~ 10% at the end of 6h in the ex vivo chicken muscle study proposes great promise. Our data propose the facile extemporaneous generation of microparticles as a practical and promising approach for development of long-acting injectables. This facile approach could serve as platform technology for other drug candidates.

Effects of gruel feeding and oral dextrose on the survivability of pigs after weaning.

Two experiments were conducted in a 14,400 head nursery using 3,087 (experiment 1) and 988 (experiment 2) pigs to determine the effect of gruel feeding (experiment 1) and supplemental oral dextrose (experiment 2) on nursery pig survivability after weaning. Upon arrival to the nursery, for experiment 1, the smallest 10% of pigs were selected and randomly placed in pens with 61 to 108 pigs per pen. Pens of small pigs were assigned to one of two treatments in a completely randomized design. Treatments consisted of gruel feeding two or four times per day for 14 d postplacement. At each gruel feeding, approximately 1.13 kg of solid feed was added to a round bowl (Rotecna S.A., Agramunt, Spain) located at the front of each pen and water added at a decreasing rate over time. In experiment 2, every other pig removed for welfare considerations (lameness, sick, or unthrifty) from the general population or pens of small pigs received a single 10 mL oral dose of a 50% dextrose solution (Vet One, MWI Animal Health, Boise, ID), as a source of glucose, before being placed in a removal pen. All removed pigs were tagged and weighed, body temperature recorded, and blood glucose concentration measured prior to and 30 min after entering removal pens. Overall, gruel feeding small pigs two or four times per day for 14 d postplacement did not influence (P > 0.10) mortality from weaning to the end of gruel feeding (3.78% vs. 4.25%, respectively). Likewise, dextrose administration did not influence (P > 0.10) pig mortality after removal to approximately 38 d postweaning (21.4% vs. 23.4% respectively), even though blood glucose concentration increased (P < 0.001) 30 min after removal for pigs administered dextrose. An interaction was observed for blood glucose concentration and body temperature (P < 0.001) where pigs with blood glucose concentrations less than 70 mg/dL had increased mortality as body temperature increased. In contrast, pigs with a blood glucose concentration of 70 mg/dL or greater had decreased mortality as body temperature increased. Pigs weighing less than 4.5 kg also had increased mortality (P < 0.001) compared with pigs weighing greater than or equal to 4.5 kg at removal. In summary, gruel feeding four times per day vs. two times per day or providing a dextrose supplement to pigs removed from the general population did not improve the survivability of pigs after weaning. Additionally, pigs removed with decreased body weight or with body temperature or blood glucose concentrations below or above the normal range had decreased survivability.

Investigating influences of intravenous fluids on HUVEC and U937 monocyte cell lines using the magnetic levitation method.

Intravenous fluids are being widely used in patients of all ages for preventing or treating dehydration in the intensive care units, surgeries in the operation rooms, or administering chemotherapeutic drugs at hospitals. Dextrose, Ringer, and NaCl solutions are widely received as intravenous fluids by hospitalized patients. Despite their widespread administration for over 100 years, studies on their influences on different cell types have been very limited. Increasing evidence suggests that treatment outcomes might be altered by the choice of the administered intravenous fluids. In this study, we investigated the influences of intravenous fluids on human endothelial (HUVEC) and monocyte (U937) cell lines using the magnetic levitation technique. Our magnetic levitation platform provides label-free manipulation of single cells without altering their phenotypic or genetic properties. It allows for monitoring and quantifying behavior of single cells by measuring their levitation heights, deformation indices, and areas. Our results indicate that HUVEC and U937 cell lines respond differently to different intravenous fluids. Dextrose solution decreased the viability of both cell lines while increasing the heterogeneity of areas, deformation, and levitation heights of HUVEC cells. We strongly believe that improved outcomes can be achieved when the influences of intravenous fluids on different cell types are revealed using robust, label-free, and efficient methods.

Effects of Dextrose Supplementation on Chloral Hydrate Sedation: A Double-Blinded, Randomized, Prospective Study.

Sedation plays a crucial role in successful pediatric imaging, and chloral hydrate is commonly used for this purpose. However, the challenges associated with chloral hydrate administration, such as its unpleasant taste and potential induction of vomiting, remain a concern. Sweet oral solutions have emerged as potential solutions for reducing distress and providing analgesia. This study compared the efficacy of dextrose combined with chloral hydrate with that of conventional sedation methods. This prospective, double-blind, randomized controlled clinical study enrolled 160 pediatric outpatients scheduled for echocardiography. Chloral hydrate syrup (100 mg/mL) was supplemented with a dextrose solution (dextrose group) or distilled water (control group) in a 1:10 volume ratio. The sedation achievement time, Skeie scale score, revised Face, Legs, Activity, Cry, and Consolability (FLACC) score, and side effects (nausea, vomiting, hypoxia, and respiratory depression) were assessed. No significant difference in average time to achieve sedation was observed between the dextrose and control groups (24.4±17.8 vs. 24.7±17.1 min, p=0.92). Both groups demonstrated similar levels of sedation according to the Skeie scale and mean revised FLACC score. Although the occurrence rates of nausea and vomiting had no significant differences, the dextrose group had no cases of vomiting in children aged >24 months compared to the control group, which had three cases (30%). In conclusion, the addition of dextrose to chloral hydrate did not significantly affect sedation time, anxiety, pain reduction, or occurrence of gastrointestinal complications during sedation.

DETERMINATION OF THE OPTIMUM PLATELET-RICH PLASMA METHOD FOR THE ESSENTIAL AMOUNT OF PLATELETS

Objective: Platelet-rich plasma (PRP) is the cellular plasma component containing a higher platelet concentration obtained by centrifugation of autologous peripheral blood. PRP has an auxiliary role in regenerative medicine treatment. Current treatment protocols for tissue repair strategies may be globally insufficient. PRP treatment via Platelet-released growth factors (GF) supports inflammation, proliferation, and wound healing. PRP studies have progressed and have proposed different formulations in recent years. Although various methods and devices are used, there are few and different standardized protocols to obtain PRP with the highest platelet concentration. Although anticoagulants containing citrate are primarily preferred in PRP production To provide effective platelet concentration in PRP, we noticed differences in the literature regarding PRP tube volumes, anticoagulant-citrate, and blood amounts. We aimed to obtain the most appropriate platelet concentration in PRP treatment by using different concentration ratios of Acid Citrate dextrose (ACD) solution A and different blood amounts and introducing a new treatment method to the literature. Methods: The blood of 30 individuals aged between 30 and 75 was taken into 10cc laboratory tubes, and 15cc and 18cc hourglass-shaped PRP tubes containing 8% ACD-solution A. Blood fractions were separated by centrifugation, buffy coat area was collected, and count platelet amount by Hematology Analyzer. Results: The platelet amount per µl was statistically significantly higher in 18cc blood compared to 15cc and 10cc. Platelet amounts obtained from 15 and 18cc peripheral blood with 8% ACD-solution A were above the effective treatment amount recommended in the literature. Conclusion: It was observed that the amount of used blood volume was correlated with the amount of obtained platelets.

Corticosteroid Versus Dextrose Ultrasound-Guided Injection in the Treatment of Sacroiliac Joint Dysfunction: A Randomized Double-Blinded Clinical Trial

Background: Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.&#x0D; Methods: This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.&#x0D; Results: In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.&#x0D; Conclusion: Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Neural Prolotherapy in Persistent Post-Surgery Pain: A Case Report

Introduction: Persistent postoperative pain is a clinical condition of discomfort (pain) and lasts more than 2 months after surgery without other causes, such as chronic infection or pain due to chronic conditions that occurred before surgery. This study aims to describe PPSP management and its outcomes.&#x0D; Case presentation: A woman, 54 years old, a housewife, came to the hospital with complaints of persistent pain from a surgical scar in the abdominal area. The pain has gotten worse in the last 3 months and sometimes feels like it's spreading to the area around the surgical wound. The pain is felt sharp and hot, spreads to the area around it, and is felt when resting, aggravated by activity experienced 5 months ago since the operation to remove the uterus. The patient was diagnosed with persistent post-surgical pain. Neural prolotherapy is performed on patients with PPSP indications. The drugs used are 5% dextrose solution and 2% lidocaine. Injection of 0.5-1 ml of dextrose was carried out in the area along the surgical scar and its surroundings. After the injection, the patient felt that the pain was reduced (numeric rating scale 1/10).&#x0D; Conclusion: Neural prolotherapy can be used in the management of patients with PPSP complaints. Treatment with neural prolotherapy injection using a mixture of D5% solution and lidocaine has a good prognosis for symptom improvement and relatively minimal complications.

Effect of Perineural Dextrose Injection on Myofascial Pain Syndrome

Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs). Objectives: To assess the effectiveness of the perineural injection in patients with MFPS. Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment. Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years. Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site. Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.

Postpartum intrauterine dextrose infusion: Effects on uterine health, metabolic stress, systemic inflammation, and daily milk yield in clinically healthy dairy cows

The objective of this study was to assess the effect of intrauterine dextrose infusion at 4 ± 1 d in milk (DIM) on the incidence of clinical metritis (CM), metabolic stress [i.e., body condition score (BCS), β-hydroxybutyrate (BHB) concentration, and subclinical ketosis incidence], systemic inflammation (i.e., haptoglobin concentration), and daily milk yield in clinically healthy postpartum dairy cows. Cows (n = 245) from a dairy farm located in southwest Pennsylvania were screened at 4 ± 1 DIM using a Metricheck (Simcro Tech Ltd.) device to assess vaginal discharge. In addition, overall cow health (e.g., lameness, abnormal breathing) and rectal temperature were assessed at this time. Cows (n = 134) that presented a clear dense vaginal discharge, were in clinically good health status, and had a normal rectal temperature (i.e., <39.7°C) were blocked by parity (primiparous = 64; multiparous = 70) and randomly assigned to 1 of 3 groups: (1) SAL (n = 45): 1 intrauterine infusion of isotonic saline solution (1 L/cow); (2) DEX (n = 44): 1 intrauterine infusion of a 50% dextrose solution (1 L/cow), or (3) CON (n = 45): cows remained untreated. Cows were re-screened at 7 d after enrollment (11 ± 1 DIM) using the Metricheck device to assess CM incidence (research clinical metritis incidence; RCMI). On-farm computer records (i.e., Dairycomp 305) were also used to collect clinical metritis incidence (farm clinical metritis incidence; FCMI). In addition, BCS was assessed and blood samples were collected at enrollment and at study d 7, 14, and 21. Furthermore, daily milk yield and clinical disease events for the first 60 DIM were collected from on-farm computer records. The data were analyzed using the MIXED and GLIMMIX procedures of SAS (SAS Institute Inc.) as a randomized complete block design. Although not significant, the RCMI and FCMI in DEX and SAL cows were on average 14.5 and 18.1 percentage points higher, respectively, compared with CON cows. The SAL cows had higher BHB and haptoglobin concentrations and higher incidence of subclinical ketosis compared with CON cows on study d 7. With regard to daily milk yield, there was a day by treatment interaction, where CON cows produced more milk on certain days compared with DEX and SAL cows. Based on these findings, authors conclude that intrauterine dextrose infusion in clinically healthy postpartum cows with normal vaginal discharge may be prejudicial for cow health and performance.

Plasma Exchange for Immune-Related Adverse Events Due to Immune Checkpoint Inhibitor Therapy: Implications for Clinical Care and Clinical Trial Design

Therapeutic plasma exchange (TPE) is increasingly utilized for Grade 3-4 immunotherapy adverse events (irAEs) to accelerate elimination of drug, autoantibodies, and cytokines. Immune checkpoint inhibitors (ICI) are IgG1 or IgG4 constructs with long half-lives (t1/2) and volume of distributions (Vd) favorable for clearance by apheresis. As drug levels are not readily available, the number of sessions needed to eliminate ICIs is estimated based on the interval from last drug dose, drug Vd, and drug t1/2. Increased use of TPE is anticipated as ICIs are now given despite preexisting autoimmunity, prior organ transplantation, and/or prior irAEs. TPE protocols are well established for the management of diseases that can also present as irAEs [e.g. thrombotic thrombocytopenic purpura (TTP), chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis (MG), hemophagocytic lymphohistiocytosis (HLH)] and for drug removal (e.g. natalizumab). While TPE is included in irAE management guidelines as second line therapy or later (Brahmer JR, et al, J Immunother Cancer, 2021 PMID: 34172516), no randomized controlled trial (RCT) data are available. TPE can reduce the level of clinical biomarkers for irAE monitoring: creatinine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT),fibrinogen, platelet count, ferritin. We treated 4 adults (median age 66 years, range 65-77 years) with TPE for steroid-refractory irAEs [myositis (2), myocarditis (1)] and, as part of initial therapy, in combination with dexamethasone and anakinra, for ICI-associated HLH. ICI constructs were IgG1 anti-PD-L1 (envafolimab, durvalumab) and IgG4 anti-PD-1 (nivolumab, cemiplimab). Data collection was IRB approved and with patient written consent. ICI indications were sarcoma, thymic carcinoma, cutaneous squamous cell carcinoma (SCC), and lung SCC. Only one patient (HLH irAE) had preexisting autoimmunity (thyroiditis). Median time from last ICI dose to first irAE symptoms or signs was 16 days (range 5-29 days). Three of 4 patients developed irAE after the first ICI dose. One patient (myocarditis) required full systemic anticoagulation (heparin, then enoxaparin) for atrial fibrillation and deep venous thrombosis, and dual antiplatelet therapy (DAPT) for a new coronary stent. The two myositis patients received prophylactic enoxaparin. All TPE sessions were one plasma volume exchange through central venous access, utilized Anticoagulant Citrate Dextrose Solution A (ACDA), and scheduled daily or every other day. Number of sessions ranged from 2-4. Except for the patient with HLH, TPE was initiated with 5% albumin replacement. Fibrinogen levels and estimated bleeding risk guided the need for fresh frozen plasma (FFP) replacement. Session intervals, exchange fluid, transfusion, biomarkers, changes in fibrinogen and platelet count, anticoagulation, and functional response are detailed in Table 1. Three of 4 patients, who had normal baseline fibrinogen and platelet counts, experienced clinically significant hypofibrinogenemia resulting in discontinuation of chemical DVT prophylaxis and/or cryoprecipitate transfusion, but did not have clinically significant thrombocytopenia. The fourth patient (HLH) required ongoing transfusion support due to pre-TPE hypofibrinogenemia and thrombocytopenia. TPE confounded interpretation of biomarkers in all. All irAEs demonstrated prompt clinical improvement, however, due to rapid corticosteroid tapers, 2 patients (myositis, HLH) relapsed within 1 month from last TPE. Both responded to additional immunosuppression. One patient (myositis) did not relapse. Grade 4 bleeding occurred in the patient receiving enoxaparin and DAPT and led to discontinuation of TPE after 2 sessions. Our experience supports the following when considering TPE for irAEs: 1) exclusion of patients with high bleeding risk, or use of 100% FFP replacement and every other day TPE; 2) meticulous non-biomarker irAE assessment during and after TPE; 3) RCT design includes irAE relapse timing and rates and long term follow-up to assess cumulative immunosuppression and tumor outcome; 4) serial drug levels and correlative studies (e.g. cytokines, autoantibodies) to better understand TPE mechanisms, persistence of irAEs, and long term ICI anti-tumor benefit. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Moderate intensity continuous and interval training affect visceral fat and insulin resistance model in female rat exposed high calorie diet

Chronic high-calorie diet (HCD) combined with physical inactivity promotes obesity and insulin resistance (IR). This study aimed to analyse the comparable effect of moderate-intensity continuous training (MICT) and moderate-intensity interval training (MIIT) on visceral fat weight and IR in subjects exposed to HCD. This randomised post-test research used only a control group design with female rats (Wistar norvegicus), 8 weeks old and 100-200 g of bodyweight. They were randomly divided into four groups: standard diet group (C), HCD group (C1), HCD combined with MICT group (C2) and HCD combined with MIIT group (C3). Each group consisted of six rats. HCD consisted ofad libitumstandard diet plus dextrose solution by oral gavage for 4 weeks. The MICT was conducted by swimming plus 6% load of body weight for 10 min in the first week, for 20 min in the second week and 30 min in the third and fourth week. The MIIT was conducted by swimming in a ratio between swimming and rest time at 2:1 plus 6% load of BW, performed 5×/week for 4 weeks, and increased progressively. The mean body weight pre-intervention was 152.79±13.280 g and 150.12±9.195 g post-intervention (P=0.115). The mean fasting blood glucose pre-intervention was 79±8.668 mg/dl, and post-intervention 86.29±12.142 mg/dl (P=0.142). The mean visceral fat weight between C (1.94±0.66 g), C1(1.45±0.47 g), C2(1.41±0.44 g), and C3(1.22±0.59 g) was not significant (P=0.179). The mean triglyceride level for C (173.33±30.30 mg/dl), C1(157.16±47.32 mg/dl), C2(112.83±25.49 mg/dl), and C3(80.33±23.47 mg/dl) was significant (P=0.000). The mean IR model for C (4.796±0.070), C1(4.728±0.125), C2(4.620±0.123), C3(4.360±0.143) was significant (P=0.000). In conclusion, both MICT and MIIT have an effect to improve IR and TG. The MIIT was more effective to improve IR compared to MICT in the female rats exposed to an HCD.

PMON257 Oral Ingestion of Macronutrients Selectively and Variably Decrease Circulating Testosterone Concentration in Healthy Men

Abstract We have previously reported acute suppression of testosterone in men after oral ingestion of dextrose. In the present study, we aimed to explore a potentially similar effect in response to other macronutrients. Eleven healthy men (age: 33-70 yrs, BMI 20.4-31.5 kg/m2) were studied in random order after an overnight fast on 4 separate days, involving oral ingestion of 300 ml of either water (control), dextrose, protein, or lipid solutions. Sessions were 6.5 h long, starting at 0800-0900 hrs. Test meals were isocaloric (400 kcal) and were ingested after the 4th blood draw (30 min point). Blood was collected at 10-min intervals for testosterone (ng/dL), and LH (IU/L) measurements. Means of the 1st 4 pre-intervention measures were used as the first value in all the time series. Mean delta-serum (macronutrients-water) testosterone and LH concentrations sampled at 10-minute intervals over 6 hour period were adjusted to the corresponding 1st value to correct for among the sessions inconsistent baseline testosterone and LH measures. Compared to the water day (control), mean (± SE) serum testosterone concentrations (ng/dL) in 11 subjects decreased from 415 ± 36 (control) to 370 ± 31 (dextrose: P=0.009), 340 ± 28 (protein: p=0.002), and 355 ± 30 (lipid: p=0.01). Corresponding LH (IU/L) values for dextrose (3.16 ± 0.29), protein (3.17 ± 0.39), and lipid (3.07 ± 0.29) were not significantly different from the control day (3.3 ± 0.29). Mean delta-testosterone time series revealed decreased testosterone of 63 ng/dL at 130 min after dextrose, 80 ng/dL at 200 min after protein, and 10 ng/dL at 70 min after lipid ingestion. Duration of suppression was variable among the 3 macronutrients, but most prolonged for protein lasting for 320 min. As oppose to testosterone, delta-LH concentrations were more positive rather than negative, suggestive of a potential testicular insult. In conclusion, oral ingestion of all macronutrients decrease circulating testosterone concentration, which appear to be independent of LH secretion. The effect is more intense and prolonged after protein intake, and minimal with lipid ingestion. Future studies are required to define the etiology, and the macronutrient effect on more prolonged basis. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP244 SGLT2 Inhibitor-Induced Euglycemic DKA and its Challenges

Abstract Introduction Sodium-glucose cotransporter type 2 inhibitors (SGLT2-i) have proven to be a gamechanger for patients with diabetes, cardiovascular, and renal disease. However, this class of medications confers an increased risk for adverse side effects such as genitourinary infections and, rarely, euglycemic diabetic ketoacidosis (EDKA). Studies have shown that the risk of euglycemic DKA from SGLT2 inhibitors increase sevenfold in patients with type 2 diabetes mellitus (T2DM) with an overall incidence of approximately 0.1%. These side effects need to be taken into consideration when prescribing this type of therapy. Case Description Case of a 61-year-old male, with hypertension, type 2 diabetes mellitus on glargine, insulin lispro and empagliflozin, adherent to his regimen. Also, patient had a history of CAD s/p PCI (2015), and urethral stricture with self-catheterization who presented to the ED complaining of genital pain of 4 days evolution. Patient had been treated at home with clindamycin without improvement of symptoms. Upon evaluation at ED, laboratories were remarkable for WBC: 25.90, glucose: 144mg/dL, sodium: 134mmol/L, potassium: 5.3mmol/L, CO2: 10mmol/L, ketones: large. Arterial blood gases with metabolic acidosis and anion gap: 26.3. [LAG1] Glycated hemoglobin was 6.8%. Urinalysis was significant for glucosuria 1000 mg/dL, SG 1. 036, 30 mg/dL of protein, negative for nitrites and leukocyte esterase, and few bacteria. Blood glucose levels remained between 145-194 the first 24 hours after admission. Urology service performed a penile exploration with the finding of bilateral corpus cavernosum abscesses that were drained and cultured. Patient was diagnosed with EDKA and started therapy with IV insulin infusion as per DKA protocol, however 10% dextrose infusion was required to continue insulin IV infusion until ketoacidosis resolution. Broad spectrum IV antibiotics were initiated. However, his clinical condition deteriorated and developed respiratory failure requiring mechanical ventilation. After 36 hours of insulin infusion, IV antibiotics and fluids, his anion gap normalized. Abscess and blood cultures reported Candida Glabrata. Antifungal therapy was started and after seven days, the patient's clinical condition improved with resolution of his sepsis and DKA, and was successfully extubated. Patient was discharged to a rehabilitation facility. Conclusion EDKA presents a diagnostic and treatment challenge. It should be suspected in patients with metabolic acidosis, ketonemia and under treatment with a SGLT2-i, even in the absence of hyperglycemia. Prompt treatment initiation with IV insulin infusion along with IV dextrose is important for resolution of DKA. Five-percent dextrose solution should be started and titrated as needed, but if ketoacidosis does not resolve, 10% dextrose can be considered to maintain the insulin infusion. Prescribing this class of hypoglycemic medication should be avoided in those who are clearly at high risk of this well-known complications. Patient education regarding early recognition and to seek early medical evaluation are essential. [LAG1]Anadir unidades Presentation: No date and time listed

Infusion of an acidified ethanolic-dextrose solution enhances urinary ammonium excretion and increases acid resilience in non-mechanically ventilated acidotic rabbits.

Hitherto, the rabbit has long been known to have a very poor tolerance to non—volatile acid. In this study, we tested the hypothesis that acid resilience in the acidotic rabbit can be increased by enhancing the plasma availability of a naturally occurring volatile fatty acid, namely acetate. To ascertain the relative merits of the respiratory and renal systems in contributing to that resilience, we conducted our studies in non—ventilated and mechanically ventilated acidotic animals. Using ethanol as a feeder of acetate, and to counteract the antidiuretic effects of surgical interventions, we induced acidosis in anaesthetised rabbits, by intravenously infusing an acidified ethanolic dextrose solution. We observed very potent respiratory regulation of arterial blood pH coupled with a notable renal response by way of a 25-fold increase in urinary ammonium excretion in the non—ventilated group. In contrast, arterial blood pH plummeted much more rapidly in the mechanically—ventilated animals, but the compensated renal response was enormous, in the form of an 85 -fold increase in urinary ammonium output. Despite this significant adaptive renal response, the non -mechanically ventilated group of rabbits showed the greater acid resilience. This was attributed to an acetate stimulated flux through a series of metabolic pathways, generating supplementary buffer in the form of bicarbonate and ammonia, complemented by a robust respiratory response.

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES