Ketone Concentrations Research Articles

A Cross-Sectional Study of Capillary Blood Ketone Concentrations in Heart Failure Based on Sodium-Glucose Co-Transporter-2 Inhibitor Use and Heart Failure Type

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are standard-of-care treatment in heart failure (HF). The risk of ketosis in patients with HF is unclear, especially during hospitalisation. We aimed to evaluate the normal ketone concentration range in HF patients. We performed a cross-sectional study of inpatients with acutely decompensated HF and outpatients with stable HF. Ketone concentrations were measured and analysed based on SGLT2i use. Baseline demographic data (age, gender, body mass index [BMI]), time since last meal, HF type, type 2 diabetes status, insulin use, and blood parameters (creatinine, glycosylated haemoglobin A1c [HbA1c] and N-terminal pro-B-type natriuretic peptide) were collected from patients or medical records. The primary outcome was capillary blood ketone concentration in patients with acute decompensated HF and stable chronic HF stratified by SGLT2i use. Multivariate regression was also performed using ketones as the outcome variable, with age, gender, BMI, glucose levels, HbA1c, time since last meal and presence of insulin therapy as predictor variables. A total of 20 individuals with decompensated HF (n=5 SGLT2i treated) and 47 with stable chronic HF (n=22 SGLT2i treated) were recruited. Median ketone concentrations were similar in all groups irrespective of SGLT2i use and the presence of acute decompensation (0.1 mmol/L, biggest interquartile range 0.2 mmol/L, p=0.49). Apart from time from last meal, multivariate regression analysis showed no association of ketone concentration with SGLT2i use, age, gender, BMI, type 2 diabetes status, insulin use and blood glucose level. Ketone concentrations were low in individuals with HF regardless of SGLT2i use or the presence of acute decompensation.

Serum concentrations of lipids, ketones and acylcarnitines during the postprandial and fasting state: the Postprandial Metabolism (PoMet) study in healthy young adults.

To improve the interpretation and utilisation of blood lipids, ketones and acylcarnitine concentrations as biomarkers in clinical assessments, more information is needed on their dynamic alterations in response to dietary intake and fasting. The aim of this intervention study was to characterise the changes in serum lipid, ketone and acylcarnitine concentrations 24 h after a standardised breakfast meal. Thirty-four healthy subjects (eighteen males and sixteen females) aged 20-30 years were served a breakfast meal (∼500 kcal, 36 E% fat, 46 E% carbohydrates, 16 E% protein, 2E% fibre), after which they consumed only water for 24 h. Blood samples were drawn before and at thirteen standardised timepoints after the meal. Metabolite concentrations were plotted as a function of time since the completion of the breakfast meal. Results demonstrated that concentrations of HDL-cholesterol and LDL-cholesterol decreased until ∼2 h (-4 % for both), while TAG concentrations peaked at 3 h (+27 %). Acetoacetate and β-hydroxybutyrate were highest 24 h after the meal (+433 and +633 %, respectively). Acetylcarnitine, butyrylcarnitine, hexanoylcarnitine, octanoylcarnitine, decanoylcarnitine and dodecanoylcarnitine reached the lowest values at 60 min (decreases ranging from -47 to -70 %), before increasing and peaking at 24 h after the meal (increases ranging from +86 to +120 %). Our findings suggest that distinguishing between fasting and non-fasting blood samples falls short of capturing the dynamics in lipid, ketone, carnitine and acylcarnitine concentrations. To enhance the utility of serum acylcarnitine analyses, we strongly recommend accounting for the specific time since the last meal at the time of blood sampling.

Comprehensive investigation on non-volatile and volatile flavor compounds in different varieties of rose tea by UPLC-Q-TOF-MS/MS-based metabolomics and GC-IMS, GC-MS

This study aimed to analyze the quality differences of different varieties of rose tea. Ultra-high-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS/MS) was used to detect the metabolites in different varieties of rose to find out the differential metabolites.Forty-four phenylpropionic acid and polyketone compounds were found to the main differential metabolites in 6 different varieties of roses. Gas chromatography ion mobility spectrometry (GC-IMS) results revealed the presence of 15 potential differential compounds among different varieties of roses, with 1-penten-3-one (monomer) and ethyl propionate being the two most significantly different substances among the six different varieties of roses. GC-MS analysis of volatile flavor compounds in different varieties of rose tea showed that the concentrations of aldehydes, alcohols, alkanes, and phenols in XS rose tea were the highest, being 4.133 µg/g, 14.873 µg/g, 3.039 µg/g, and 2.399 µg/g, respectively. The concentrations of ketones, heterocyclic compounds, and ethers in KS rose tea are the highest, being 4.344 µg/g, 0.752 µg/g, and 0.234 µg/g, respectively. Phenyl-ethanol, citronellol, octanoic acid ethyl ester, and decanoic acid ethyl ester are considered to be the main factors in the formation of characteristic aromas in different varieties of rose tea.

Combination of contact ultrasound and infrared radiation for improving the quality and flavor of air-dried beef during hot air drying

Air-dried beef, a traditional dry fermented meat product in China, whose quality is largely influenced by processing conditions. In this study, contact ultrasound (CU) and infrared radiation (IR) were employed to enhance hot air drying (HAD), with an investigation into the mechanisms underlying improvements in quality and flavor. Samples subjected to CU and IR treatments during HAD (CU-IRD) demonstrated superior color (L* = 42.68, a* = 5.05, b* = −3.86) and tenderness (140.59 N) than HAD group, primarily attributed to reduced drying times and alterations in ultrastructure. Analyses utilizing SDS-PAGE and total volatile basic nitrogen (TVB-N) revealed that HAD and CU-HAD resulted in significant protein oxidation (197.85 mg TVB-N/kg and 202.23 mg TVB-N/kg, respectively), while IR treatments were associated with increased thermal degradation of proteins, producing lower molecular weight peptides. Compared with HAD group, the activities of certain lipases and proteases were enhanced by ultrasound and infrared treatments, leading to the release of greater amounts of free fatty acids and flavor amino acids. Furthermore, the thermal effects of infrared and the cavitation effects of ultrasound contributed to increased fat oxidation, amino acid Strecker degradation, and esterification reactions, thereby augmenting the diversity and concentration of volatile flavor compounds, including alkanes, ketones, aldehydes, and esters. These findings indicate that the synergistic application of CU and IR represents a promising strategy for enhancing the quality of air-dried beef.

Feline acute patient physiologic and laboratory evaluation scores and other prognostic factors in cats with first-time diabetic ketoacidosis.

Acute Patient Physiologic and Laboratory Evaluation (APPLE) scores have not been reported in cats with diabetic ketoacidosis (DKA). In cats with DKA, APPLE scores will be significantly higher in non-survivors compared with survivors and these scores will predict mortality. Sixty-eight cats with DKA. Retrospective study. The APPLE scores, blood glucose concentration (BG), venous pH, and ketone concentrations were compared between survivors and non-survivors. Simple logistic regression was used to determine if these variables predict the binary variable of survival or non-survival, and if they did, an empirical optimal cut point for mortality prediction was calculated. The APPLEfast and APPLEfull scores were significantly higher in non-survivors (30 cats; and , respectively) compared with survivors (38 cats; and ; P = .01 and P = .02, respectively). The APPLEfast (P = .03) but not the APPLEfull scores (P = .06) predicted mortality. For every 1 unit increase in the APPLEfast score, the odds of death increased by 1.08 (95% confidence interval [CI], 1.006-1.17; P = .03). Median BG was significantly higher in non-survivors (431 mg/dL; range, 260-832 mg/dL) compared with survivors (343 mg/dL; range, 256-738 mg/dL; P = .01) and BG predicted mortality (P = .02). For every 1 mg/dL increase in BG, the odds of death increased by 1.004 (95% CI, 1.0006-1.008). Empirical optimal cut points for APPLEfast and BG mortality prediction were 24.5 and 358 mg/dL, respectively. The APPLEfast score and BG predict mortality in cats with DKA and can be used to stratify populations by risk of mortality in clinical trials of DKA in cats.

Volatile organic compounds of camel milk and shubat across Kazakhstan's regions, seasons, and breeds

Despite extensive research in recent years on camel milk composition and health benefits, limited scientific data exists on the volatile organic compound profiles of camel milk and its fermented product, shubat. This study analyzed volatile organic compounds (VOCs) in raw camel milk and shubat from six Kazakh farms across all seasons. We found that camel milk displayed higher concentrations of aldehydes, ketones, and alcohols with the main two compounds in milk being acetone and (2-Aziridinylethyl) amine. Conversely, the majority of volatile organic compounds in shubat samples belonged to esters, but the predominant compounds by concentration were ethanol, dimethylamine, propanoic acid, and octanoic acid. Seasonality emerged as the primary driver of variation in milk, with heptanal being the most discriminative compound. Fermented milk showcased regional diversity likely driven by distinct microbial communities. Findings demonstrate the dynamic nature of camel milk's aromatic properties, which are influenced by multiple factors that contribute to its distinctive sensory characteristics.

Mononuclear Aluminum Complexes as Precursors for Cyanosilylation of Carbonyl Compounds

AbstractThe synthesis, structural characterization, and catalytic application of two novel aluminum complexes, [κ3ENSe−{Ph2P(E)N−C6H4−SePh}AlMe2] [E=S (1) and Se (2)] supported by new pincer‐type phenylselenium‐phosphanamidinate chalcogenide ligands are described. The molecular structures of both complexes in their solid states reveal a distorted trigonal bipyramidal geometry around the Al(III) ion, involving monoanionic ligand {Ph2P(E)N−C6H4−SePh}− bonded to the AlMe2‐motif in a tridentate manner. Complex 1 was found to be an effective pre‐catalyst for the cyanosilyation of aldehydes and ketones with TMSCN under solvent‐free conditions. The reaction protocol is simple, efficient, and has a diverse substrate scope of aldehydes and ketones, showing superior functional group tolerance. The kinetic study revealed that ketone reduction proceeded with first‐order dependence on ketone concentrations, TMSCN, and catalyst 1.

Characterization of aroma dynamic changes during six developing stages of yellow cultivar Flammulina filiformis based on E-Nose, GC×GC-TOF MS, GC-IMS, and GC-O-MS

The aroma volatiles of Flammulina filiformis (F. filiformis) had notably dynamic changes during various developing stages. However, the dynamic fingerprints of the overall aroma volatiles during mushroom development remained largely unknown in F. filiformis. The purpose of this study was to characterize the dynamic changes in the aroma volatiles of yellow cultivar F. filiformis using E-Nose, GC-MS/O, GC-IMS, and GC × GC-TOF MS. A total of 140 volatiles were characterized (about 59% by GC × GC-TOF MS). Phenylacetaldehyde, 2-octenal, hexanal, nonanal, 2,4-decadienal, β-citronellol, 3-octanone, 1-octen-3-one, 2-methylpropyl butanoate, limonene, and 2-pentyl-furan were identified as key aroma compounds. The richness of odorants (numbers and concentrations) was most abundant during the initial stage of fruiting (with a fruity note). The concentrations of C8 volatiles and ketones gradually decreased before the mature stage, followed by a slight increase (with mushroom and sweet notes). An excellent correlation was observed between the changes in aroma attributes corresponding to odorants. Furthermore, the correlation between the volatile contents could be well explained by metabolic pathways (unsaturated fatty acids, β-oxidation of saturated fatty acids, and Ehrlich pathways for amino acids). Overall, this study provides insights into the metabolic pathways of volatiles potential for aroma quality enhancement in F. filiformis.

Exploring the Impact of Extended Maceration on the Volatile Compounds and Sensory Profile of Monastrell Red Wine

Volatile organic compounds (VOCs) are crucial to the wine’s overall quality since they define the aromatic profile. The aim of this study was to investigate whether a 146-day extended maceration (EM) treatment positively affects the aromatic and sensory properties of Monastrell red wine. A total of 43 aromatic compounds belonging to different chemical classes were identified using solid-phase microextraction combined with gas chromatography–mass spectrometry (SPME/GC-MS). In general, EM treatment decreased both the number and total relative concentration of VOCs. Specifically, EM decreased the concentration of alcohols, terpenes and sulphur compounds compared to control wines. However certain compounds such as 2-ethyl-1-hexanol, phenylethyl and ethyl decanoate significantly increased with prolonged maceration. Conversely, EM treatment did not significantly affect the total relative concentrations of esters and ketones. From sensorial point of view, the triangular test showed a positive identification of wines (10/18) with a significant preference for EM wines. Moreover, descriptive analysis revealed that EM wines scored lower values in appearance, aroma and taste. Future research should aim to optimize maceration time to enhance the content of VOCs without compromising the sensory quality of the wine.

Milk productivity and the concentration of ketones in the blood of Kostroma cows of different LEP genotypes

Relevance. Currently, scientists are searching for genes associated not only with an increased level of dairy productivity, but also with the preservation of functional longevity and health of cows, with a high level of realization of their genetic potential, as well as with the distinctive quality of dairy products. The available data allow us to consider the leptin gene (LEP) as one of the candidate genes of milk productivity.Methods. The research was conducted in 2022–2023 on cows of the Kostroma breed (n = 107) bred in the Kostroma region. In cows in the postpartum period, the content of ketone bodies in the blood and genotypes were determined by the R25C locus of the LEP gene. The animals were divided into groups depending on the concentration of ketone bodies in the blood: 1st – 0–1.2 mmol/l, 2nd – above 1.2 mmol/l.Results. The presence of a predisposition of highly productive cows to ketosis (р < 0.05) was established. The largest number of ketone bodies in the blood was determined in animals of the 2nd group with the LEPCT genotype. However, despite such a small difference, the difference in the frequency distribution of LEP alleles in groups 1 and 2 turned out to be statistically significant (χ2 = 63.48, р < 0.001). When testing the hypothesis of a significant dependence of the level of milk productivity on the concentration of ketone bodies in the blood of carriers of the CC genotype, a statistically significant rho value was obtained among cows with the CC genotype, at the level of 0.37 (р = 0.038). The rank correlation between milk yield and ketone body content in carriers of LEPCT and LEPTT genotypes was low and unreliable (р > 0.05). The tendency towards a close relationship between the level of ketone bodies and the fat content in the milk of cows of the TT genotype due to its low concentration in the sample requires further confirmation in a larger sample of cows with this genotype of the leptin gene.

#976 Empagliflozin limits AKI incidence and severity following cardiac surgery: an open-label phase IV randomized pilot study

Abstract Background and Aims Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication of cardiac surgery assisted by cardiopulmonary bypass (CPB). Currently, no effective preventative strategies exist to reduce the incidence of acute kidney injury (AKI). Sodium-glucose transport protein 2 (SGLT2) inhibitors are effective in reducing the incidence of AKI in studies conducted in patients with chronic kidney disease. Therefore, we hypothesized that perioperative SGLT2 inhibition could reduce the incidence of CSA-AKI. Method In this open-label phase IV, randomized, parallel-group, balanced (1:1), pilot study, adult patients undergoing elective cardiac surgery with CPB were randomized to receive 10 mg empagliflozin per os once daily three days before surgery until two days after surgery, or standard care. The primary outcome was AKI incidence according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Other outcomes included hypoxia-inducible factor 1 alpha (HIF1A) and urinary Kidney Injury Molecule (KIM-1), urinary neutrophil gelatinase associated lipocalin (NGAL) and metabolic parameters such as plasma ketone and glucose concentrations. Results Between March 2022 and April 2023, 60 patients were randomized to empagliflozin (n = 29) or control (n = 31). All patients who underwent cardiac surgery with CPB were included in the intention-to-treat analysis (n = 25; empagliflozin group, n = 30; control group). SGLT2 inhibition significantly reduced the incidence of all stages of AKI (20% vs 66.7%; absolute difference 46%, 95% CI .13 to .63, P < .001). This decline in AKI incidence was reflected in the kidney biomarkers. SGLT2 inhibition also significantly reduced the number of patients with postoperative hyperglycemia (28% vs 60%; absolute difference 32%, 95% CI −56.8 to −7.2, P = .029). We observed no differences in the incidence of neither ketoacidosis nor hypoglycemic events. Conclusion Perioperative SGLT2 inhibition, compared with standard of care, demonstrated a significant reduction in AKI incidence rates. These findings merit validation in a larger placebo-controlled trial which is currently ongoing. Supplementary figures:

Ketoacidosis and SGLT2 Inhibitors: A Narrative Review.

An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors.

Tracking the therapeutic efficacy of a ketone mono ester and β-hydroxybutyrate for ulcerative colitis in rats: New perspectives

Ulcerative colitis (UC) is an inflammatory condition that affects the colon's lining and increases the risk of colon cancer. Despite ongoing research, there is no identified cure for UC. The recognition of NLRP3 inflammasome activation in the pathogenesis of UC has gained widespread acceptance. Notably, the ketone body β-hydroxybutyrate inhibits NLRP3 demonstrating its anti-inflammatory properties. Additionally, BD-AcAc 2 is ketone mono ester that increases β-hydroxybutyrate blood levels. It has the potential to address the constraints associated with exogenous β-hydroxybutyrate as a therapeutic agent, including issues related to stability and short duration of action. However, the effects of β-hydroxybutyrate and BD-AcAc 2 on colitis have not been fully investigated. This study found that while both exogenous β-hydroxybutyrate and BD-AcAc 2 produced the same levels of plasma β-hydroxybutyrate, BD-AcAc 2 demonstrated superior effectiveness in mitigating dextran sodium sulfate-induced UC in rats. The mechanism of action involves modulating the NF-κB signaling, inhibiting the NLRP3 inflammasome, regulating antioxidant capacity, controlling tight junction protein expression and a potential to inhibit apoptosis and pyroptosis. Certainly, BD-AcAc 2's anti-inflammatory effects require more than just increasing plasma β-hydroxybutyrate levels and other factors contribute to its efficacy. Local ketone concentrations in the gastrointestinal tract, as well as the combined effect of specific ketone bodies, are likely to have contributed to the stronger protective effect observed with ketone mono ester ingestion in our experiment. As a result, further investigations are necessary to fully understand the mechanisms of BD-AcAc 2 and optimize its use.

The Effect of Acute Ketone Supplementation on Time to Fatigue in NCAA Division I Cross-Country Athletes

This study investigated the effect of a commercially available ketone supplement on heart rate (HR), perceived exertion (RPE), blood lactate, glucose, and ketone concentrations, along with time to fatigue (TTF) during a running task to voluntary fatigue. Twelve NCAA Division I cross-country athletes took part in this randomized, double-blind, placebo-controlled cross-over study. Bayesian methodologies were employed for all statistical analyses, and point estimates were determined to be statistically significant if the 95% highest-density intervals (HDI) excluded zero. TTF was not significantly different between conditions with a Meandiff = 48.7 ± 6.3 s (95% HDI: −335, 424) and a 0.39 probability derived from the posterior distribution, indicating the likelihood that the supplement would increase TTF compared to the placebo control. Lactate concentrations immediately post-exercise were significantly lower in the supplement trial relative to placebo with an estimated Meandiff = −4.6 ± 1.9 mmol; 95% HDI: −8.3, −0.9. There were no significant interaction effects observed for either blood glucose or ketone concentrations nor HR or RPE. These findings imply that the acute ingestion of ketones before running at lactate threshold pace has a low probability of increasing TTF in highly trained Division I runners.

The interaction between lipid oxidation and the Maillard reaction model of lysine-glucose on aroma formation in fragrant sesame oil

The formation mechanism behind the sophisticated aromas of sesame oil (SO) has not been elucidated. The interaction effects of the Maillard reaction (MR) and lipid oxidation on the aroma formation of fragrant sesame oil were investigated in model reaction systems made of l-lysine (Lys) and d-glucose (Glc) with or without fresh SO (FSO) or oxidized SO (OSO). The addition of OSO to the Lys-Glc model increased the MR browning at 294 nm and 420 nm and enhanced the DPPH radical scavenging activity greater than the addition of FSO (p < 0.05). The presence of lysine and glucose inhibited the oxidation of sesame oil, reduced the loss of γ-tocopherol, and facilitated the formation of sesamol (p < 0.05). The Maillard-lipid interaction led to the increased concentrations of some of the alkylpyrazines, alkylfurans, and MR-derived ketones and acids (p < 0.05) while reducing the concentrations of other pyrazines, lipid-derived furans, aliphatic aldehydes, ketones, alcohols, and acids (p < 0.05). The addition of FSO to the MR model enhanced the characteristic roasted, nutty, sweet, and fatty aromas in sesame oil (p < 0.05), while excessive lipid oxidation (OSO) brought about an unpleasant oxidized odor and reduced the characteristic aromas. This study helps to understand the sophisticated aroma formation mechanism in sesame oil and provides scientific instruction for precise flavor control in the production of sesame oil.

The role of &lt;i&gt;LEP&lt;/i&gt; R25C polymorphism in the predisposition of cows to ketosis

In conditions of intensification of the dairy cattle industry, persistent stress of metabolic processes in the cow's body can lead to metabolic disorders and the development of ketosis. Scientists have established the genetic susceptibility of cows to ketosis. The available data allow us to consider the leptin gene (LEP) as one of the candidate genes. The purpose of the study is to carry out an associative analysis of the predisposition to ketosis of Kostroma cows of different genotypes according to the leptin gene. The research was carried out in 2022-2023 yy on clinically healthy and highly productive fresh cows of third lactation and higher of the kostroma breed (n=167) in pedigree farms of the Kostroma region. In animals in the postpartum period, the content of ketone bodies in the blood was determined by express method and the RT-PCR genotypes were determined by the R25C locus of the LEP gene. Groups of cows were formed depending on the content of ketone bodies in the blood: 1st – 0-1.2 mmol/l (healthy), 2nd – above 1.2 mmol/l (subclinical ketosis). It was found out that among the experimental cows of the Kostroma breed, the CT genotype is characterized by the highest frequency. The almost complete absence of differences in the concentration of ketone bodies in the blood between carriers of different LEP genotypes from group 1 was determined. At the same time, among the animals of the 2nd group, the highest level of ketone bodies in the blood was observed in heterozygous animals, whereas carriers of the CC and TT genotypes did not differ from each other in this indicator. Heterozygous animals classified as subclinical ketosis had the highest average ketone concentration in the blood with the highest coefficient of variation (Cv=51.6%), which indicates a pronounced influence of other genetic factors. Thus, the role of LEP R25C polymorphism in the predisposition of cows to ketosis disease has not been established in this sample of animals, but may be supplemented by the influence of other factors, these hypotheses need to be tested in a larger sample and in other breeds of cattle. These data can be used to conduct such exploratory studies, such as the research of complex genotypes of genes that cause predisposition of cattle to ketosis.

A case report on diabetic ketoacidosis in 5 years old female child

Diabetic ketoacidosis is characterised by an insulin deficiency, metabolic acidosis and increased ketone concentration in the body which can be normalised by insulin replacement and electrolyte replacement therapy. One in three children suffers with type 1 diabetes (T1D), across the US and globally, the incidence of the disease is rising among the paediatrics by over 3% annually. The diagnosis of diabetic ketoacidosis (DKA) was based on the presence of hyperglycaemia (blood glucose &amp;#62; 11 mmol/L), acidosis (serum bicarbonate &amp;#60; 15 mmol/L) and ketonuria (urine ketone ≥1+). Gestational diabetes is a common abnormality of glucose metabolism during pregnancy which affects foetal development and an alteration in the balance of glucagon and insulin is affected due to an overproduction of glucose and ketones in the liver, with free release of fatty acids from adipose tissue. A case of 5 years old female child presented with increased urination, increased appetite and sudden weight loss since 1 month and her RBS range was found to be 426mg/dl. Child underwent laboratory investigations, GRBS monitoring every 3 and assessed as Diabetic ketoacidosis with uncontrolled sugars. The child was treated with insulin supplementation for 3 days, recovered and child was hemodynamically stable and got discharged.

Role of beta-hydroxybutyrate measurement in the evaluation of plasma glucose concentrations in newborn infants

ObjectiveThe Glucose in Well Babies (GLOW) Study showed that there are two phases of low glucose concentrations in healthy newborn infants: an initial phase in which plasma concentrations of ketones...

Ketones provide an extra source of fuel for the failing heart without impairing glucose oxidation

BackgroundCardiac glucose oxidation is decreased in heart failure with reduced ejection fraction (HFrEF), contributing to a decrease in myocardial ATP production. In contrast, circulating ketones and cardiac ketone oxidation are increased in HFrEF. Since ketones compete with glucose as a fuel source, we aimed to determine whether increasing ketone concentration both chronically with the SGLT2 inhibitor, dapagliflozin, or acutely in the perfusate has detrimental effects on cardiac glucose oxidation in HFrEF, and what effect this has on cardiac ATP production. Methods8-week-old male C57BL6/N mice underwent sham or transverse aortic constriction (TAC) surgery to induce HFrEF over 3 weeks, after which TAC mice were randomized to treatment with either vehicle or the SGLT2 inhibitor, dapagliflozin (DAPA), for 4 weeks (raises blood ketones). Cardiac function was assessed by echocardiography. Cardiac energy metabolism was measured in isolated working hearts perfused with 5 mM glucose, 0.8 mM palmitate, and either 0.2 mM or 0.6 mM β-hydroxybutyrate (βOHB). ResultsTAC hearts had significantly decreased %EF compared to sham hearts, with no effect of DAPA. Glucose oxidation was significantly decreased in TAC hearts compared to sham hearts and did not decrease further in TAC hearts treated with high βOHB or in TAC DAPA hearts, despite βOHB oxidation rates increasing in both TAC vehicle and TAC DAPA hearts at high βOHB concentrations. Rather, increasing βOHB supply to the heart selectively decreased fatty acid oxidation rates. DAPA significantly increased ATP production at both βOHB concentrations by increasing the contribution of glucose oxidation to ATP production. ConclusionTherefore, increasing ketone concentration increases energy supply and ATP production in HFrEF without further impairing glucose oxidation.

Invasive Candidiasis Causing Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a common yet fatal complication of diabetes mellitus which is characterised by uncontrolled hyperglycaemia, metabolic acidosis, and increased body ketone concentration. This preventable hyperglycaemic emergency accounts for more than 50,000 hospital days per year [1]. Infections, non-compliance to medication are the main precipitating factors for DKA, although myocardial infarction, stroke, trauma, and substance abuse may result in DKA. Clinical features of the same include nausea, vomiting, dehydration, pain abdomen, Kussmaul breathing pattern or even altered mental sensorium. Different types of infections can precipitate DKA, commonly of which are pneumonia, urinary tract infection, Oro-mucosal and aural infections. Careful evaluation and identification of precipitating factor should be made earlier for prompt treatment The aim of this case report is to review knowledge gaps in precipitating factors of DKA.