Ketones In Presence Research Articles

6938 An Unusual Case of New-onset autoimmune insulin dependent Diabetes Mellitus Complicating Gestational Diabetes Mellitus in A Pregnant Female Diagnosed Early Postpartum - The Enigma of Autoimmunity and Diabetes During Pregnancy

Abstract Disclosure: R. Abdelmasih: None. W. Pan: None. Introduction: Gestation diabetes is the most common metabolic disorder in pregnancy affecting 25% of pregnancies. T1DM accounts for 0.2-0.5% of all pregnancies in the United States yearly. New-onset autoimmune insulin-dependent diabetes mellitus during pregnancy is very uncommon and it might be overlooked. Diabetes-related autoantibodies have been studied in women with GDM with prevalence of 0-10%. There is controversial data regarding the clinical significance of checking diabetes antibodies in pregnancy. Case Presentation: A 22-year-old G1P1 female with history of Hashimoto hypothyroidism presented during early second trimester for evaluation of GDM with serum glucose of 300s mg/dl in a random blood sample with multiple subsequent high values, hemoglobin A1C of 9.4% (prepartum value was 5.3%). Patient was started on insulin during pregnancy. Pregnancy was complicated with cesarian section and macrosomia. 1 week postpartum, A1c was 5.4%, Insulin was discontinued, and patient was continued on Metformin. 2 months Postpartum, patient presented with persistent high blood glucose values of 300-400 mg/dl with no signs of DKA. Glipizide and Glargine 15 units daily were added though patient continued to have hyperglycemia. Laboratory workup were remarkable for high blood glucose of 342 mg/dl, low C peptide of 0.6 ng/dl, and positive glutamic acid decarboxylase antibodies (GAD Ab) 38.8 U/ml. oral antidiabetics were discontinued and prandial insulin was added. Discussion: GDM is a risk factor for DMII after pregnancy given high insulin resistance postpartum, Data regarding new-onset DMI and diabetes autoimmunity during pregnancy is lacking. About 0-10% of women with gestational diabetes develop DM autoantibodies. GAD Ab exhibits the highest sensitivity of 63% for type 1 diabetes prediction compared to Islet cell antibodies (48%), and tyrosine phosphatase-related islet antigen 2 (34%). Pathophysiology of autoimmune DM during pregnancy is not quite understood; It is thought that when autoimmune tendency is present, GDM causes β-cells to deteriorate due to excessive insulin production in setting of insulin resistance, and the burden of third-trimester gestation may cause the insulin deficiency to be expressed sooner than non-pregnant female. So far, Literature about the predictive value or specific clinical features of checking diabetes autoantibodies is discordant and inconclusive. It is suggested to screen for autoantibodies only when array of clinical hallmarks suggestive of an autoimmune DM form of GDM present as young age, low BMI, need for insulin therapy early in pregnancy, presence of ketones, concurrent other autoimmune conditions (e.g., thyroiditis). This case is to shed light on autoimmunity in pregnancy. More data is needed with longer follow-up to better identify women at risk, their characteristics, indications for autoantibodies testing, follow and prognosis. Presentation: 6/2/2024

Skrining Pemeriksaan Badan Keton Pada Urin Individu Obesitas Dengan Menggunakan Metode Gerhardt

Obesity, or more commonly known as overweight, is an abnormal or excessive fat accumulation condition that can be harmful to health. This causes metabolic disorders such as insulin resistance, which causes carbohydrate metabolism to be disrupted, so the energy the body needs is produced by fatty acid metabolism. The fatty acid metabolism process produces the ketone body that occurs in the urine or ketonuria. This community dedication is aimed at screening ketone bodies tests in obese individuals in Puskesmas Antang, Kota Makassar. The respondents were 33 people with obesity who were willing to follow the activity. Based on the results of a study of 33 obese individuals, there were three positive urine ketones in comparison with 30 negative ones. Positive results indicate high levels of fatty acids that cause the presence of ketones in the urine. (Ketonuria).

Oxone in microemulsion for diastereoselective epoxidation of R-limonene to trans-limonene dioxide

Some catalytic processes developed for the synthesis of epoxy resins, polycarbonates or even non-isocyanate polyurethanes from cis/trans-limonene dioxide exhibit low or complete absence of reactivity of cis-limonene dioxide (cis-LDO). This study focuses on the development of a process for exclusively producing trans-LDO. The technique involves uses a chiral ketone as a catalyst that reacts with oxone to form the corresponding chiral dioxirane which epoxidises R-limonene. The effect of various organic solvents and the importance of the surfactant (for micelle formation) were evaluated. It was found that when epoxidation is performed using a chiral ketone in presence of a microemulsion, high conversion and diastereoselectivity was reached. The chiral ketone catalyst tested in this way gave an LDO yield close to 100%, consisting almost exclusively of trans-LDO (97%). When acetone catalyst was employed instead of the chiral ketone, a mixture of cis and trans-LDO was obtained with a selectivity to trans diastereoisomers of only 39%. The diastereoselective epoxidation process developed is easy to reproduce and could be considered ready for industrial implementation.

Validation of the Diagnostic Accuracy Levels of International Classification of Diseases, 10th Revision Codes for Diabetic Ketoacidosis: A Multicentre, Cross-sectional Study of Adults

ObjectivesInternational Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA. MethodsWe conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA. ResultsWe identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%. ConclusionICD-10 codes can identify patients with DKA among those admitted to general internal medicine.

New insight into the role of the self-assembly of heteroatom compounds in heavy oil viscosity enhancement.

Unveiling the role of heteroatom compounds in heavy oil viscosity is pivotal for finding targeted viscosity reduction methods to improve oil recovery. This research investigates the impact of heteroatoms in asphaltene molecules by utilizing quantum chemical calculations and molecular dynamics simulations to analyze their electrostatic potential characteristics, pairwise interactions, and dynamic behavior within realistic reservoirs. Heteroatom compounds can influence the molecular-level properties of asphaltenes and thus impact the macroscopic behavior of heavy oils. Research results suggest that the presence of ketone and aromatic rings in asphaltene molecules leads to the unrestricted movement of pi electrons due to their collective electronegativity. Two distinct configurations of asphaltene dimers, face-to-face, and edge-to-face, were observed. Intermolecular interactions were predominantly governed by van der Waals forces, highlighting their significant role in stabilizing asphaltene aggregates. The distribution of asphaltene molecules in the oil phase can be summarized as the "rebar-cement" theory. In the heteroatom-free system, the face-to-face peaks in the radial distribution function exhibit significantly reduced magnitudes compared to those in the heteroatom-containing system. This emphasizes the pivotal function of heteroatoms in connecting molecular components to form a more compact asphaltene structure, which may result in a higher viscosity of heavy oil. These findings give insight into the significance of heteroatoms in bridging molecular components and shaping the intricate structure of asphaltene and advance our understanding of heavy oil viscosity properties.

Aerobic oxidation of alkyl aromatics to ketones catalyzed by biomimetic copper complex and N-hydroxyphthalimide (NHPI) under mild conditions

A galactose oxidase-like copper complex (CuIIL) (Ligand: N, N′-bis(2-hydroxy-3,5-di-tert-butylphenyl)-2,2′-diaminobiphenyl) was synthesized and used to catalyze the aerobic oxidation of alkyl aromatics to ketones in presence of N-hydroxyphthalimide (NHPI). The catalytic system exhibited excellent performance and tolerance under mild conditions. Mechanistic studies indicated that NHPI could be activated smoothly to generate phthalimide N-oxyl (PINO) radical in the presence of CuIIL. The kinetic isotope effect (KIE) studies showed that the generation of PINO radical was the rate-determining step.

Solvothermal liquefaction of orange peels into biocrude: An experimental investigation of biocrude yield and energy compositional dependency on process variables

The efficient valorization of biomass for energy-derived biocrudes is essential for effective waste management. However, the production of biocrudes with high energy and reduced oxygen contents during the liquefaction process requires further insight. Therefore, the impact of reaction temperature, residence time, and ethanol: acetone on the energy compositions and bioproduct’s yield enhancement were investigated. The biocrudes obtained were characterized using elemental analysis, GC–MS, FTIR, GPC and TGA to understand the effects of process parameters on the biocrudes’ compositions. An improved HHV (38.18 MJ/kg) and lower O/C ratio (0.11) were obtained at 430 °C, 35 min and 50% ethanol with a significant improvement in the enhancement factor, deoxygenation, and percentage hydrogenation of 2.63, 36.88%, and 77.87%, respectively. The presence of ketones, hydrocarbons, phenolics and aromatics of 23.74, 4.28, 37.20 and 17.81% respectively indicate the potential of the obtained biocrude as renewable energy sources upon further upgrading.

THU310 A Presentation Of Diabetic Ketoacidosis In Gestational Diabetes

Abstract Disclosure: C. Yim: None. S.L. Liu: None. T. Spaic: None. Diabetic ketoacidosis (DKA) is a diabetic emergency characterized by wide anion gap acidosis, presence of ketones (in serum and/or urine) and, frequently, uncontrolled hyperglycemia. In pregnancy, DKA more commonly occurs in women with pre-existing diabetes, usually type 1 diabetes, and is exceptionally rare in women with gestational diabetes mellitus (GDM). We report a case of a 37-year-old woman in her second pregnancy who presented to hospital with DKA at 29+3 weeks gestation shortly after diagnosis of GDM 4 days earlier. In her first pregnancy, she was diagnosed with GDM at 28 weeks, required treatment with metformin at 35 weeks, which she stopped postpartum. She conceived her second pregnancy 3 months postpartum so was not screened for diabetes postpartum. In her second pregnancy, there was no evidence of diabetes on early antenatal labwork at 7 weeks: Hemoglobin A1c (HbA1c) 5.6%, random glucose 3.6 mmol/L. Early GDM screening at 21+1 weeks with 75 gram oral glucose tolerance test (OGTT) was normal: fasting glucose 4.4 mmol/L 1-hour glucose 9.0 mmol/L, 2-hour glucose 6.5 mmol/L. She presented to hospital at 29+3 weeks gestation with a 2-day history of polyuria, polydipsia, dizziness, and decreased oral intake without nausea or vomiting. Four days prior to presentation, she was diagnosed with GDM on a 75g OGTT (fasting glucose 6.2 mmol/L, 1-hour glucose 15.1 mmol/L, 2-hour glucose 11.9mmol/L). Admission labwork showed serum glucose 34.8 mmol/L, anion gap 18, pH 7.29, bicarbonate 17 and beta-hydroxybutyrate 2.97. She was treated with IV fluids and insulin and initiated on multiple daily injections of insulin. Other than pregnancy, no clear precipitating factor was found. HbA1C was 6.4%, serum insulin and C-peptide levels were inappropriately low at 22 pmol/L and 296 pmol/L respectively. Her anti-glutamic acid decarboxylase and anti-islet cell antibodies were negative. Lipase was mildly elevated at 226U/L but improved to 144U/L with treatment. Abdominal ultrasound did not demonstrate any findings suggestive of acute pancreatitis. Her 24-hour urinary free cortisol was 366 nmol and 442 nmol, both within normal trimester-specific range. Her salivary cortisol was in the normal range (10.5nmol and 10.9nmol). Following discharge, she remained significantly insulin resistant with suboptimal glycemic control (total daily insulin requirements ∼3.5 units/kg/day, HbA1C 7.9% at 35+6 weeks). Due to increased insulin resistance in pregnancy, DKA can progress more rapidly compared to nonpregnancy. Given increased rates of perinatal morbidity and mortality associated with DKA, treatment and monitoring should be promptly initiated. A high index of suspicion is especially important given that DKA is a rare presentation in GDM. Other precipitating factors of newly decompensated diabetes should also be ruled out. Presentation: Thursday, June 15, 2023

Growth promotion traits and emission of volatile organic compounds of two bacterial strains stimulate growth of maize exposed to heavy metals

Stress alleviation of plants grown in heavy metal contaminated soil has been observed after inoculation with plant growth-promoting bacteria. Here we analyzed individual and combined effects of Pseudomonas fluorescens UM270 and Bacillus paralicheniformis ZAP17 on plant growth of maize (Zea mays L.) subjected to stress through arsenic and mercury exposure. Both strains showed high and regular levels of tolerance to arsenic and mercury metals, respectively. Interestingly, plant growth promoter mechanisms, such as the production of 3-indolacetic acid, solubilization of phosphates, secretion of siderophores and biofilm formation, were maintained under the presence of the two metals, except for phosphate solubilization and the production of siderophores that were inhibited at certain concentrations. The metallic salts modified the mix of volatiles produced by UM270 and ZAP17, with the presence of ketones and aldehydes predominating. We also found compounds like 2-butanone, 2,3-butanediol and dimethyl disulfide, nonanal, hexadecanal, 2-tetradecanon and 2-tridecanone, which have been reported as plant growth promoters. Finally, the co-inoculation of the strains UM270 and ZAP17 in maize plants grown with different concentrations of metallic salts, showed that the presence of HAsNa2O4 stimulated shoot length and plant biomass, the trials with HgCl2 in the presence of the consortium presented a greater development of plant biomass, root and shoot length, while the combination of AsNaO2 and the bacterial consortium allowed to stimulate all the evaluated parameters, as compared with the control plants (without inoculation). These results demonstrate the importance of phytoremediation processes assisted by beneficial microorganisms, further is one of the first that has tried to link the emission of volatile organic compounds with a possible growth promotion effect in conditions of stress caused by heavy metals. In conclusion, the PGPB P. fluorescens UM270 and B. paralicheniformis ZAP17 exert multiple mechanisms of growth promotion, and they represent an excellent option as biopromoters in soils contaminated with heavy metals.

Cationic Divalent Metal Sites (M = Mn, Fe, Co) Operating as Both Nitrene-Transfer Agents and Lewis Acids toward Mediating the Synthesis of Three- and Five-Membered N-Heterocycles.

The tripodal compounds [(TMG3trphen)MII-solv](PF6)2 (M = Mn, Fe, Co; solv = MeCN, DMF) and bipodal analogues [(TMG2biphen)MII(NCMe)x](PF6)2 (x = 3 for Mn, Fe; x = 2 for Co) and [(TMG2biphen)MIICl2] have been synthesized with ligands that feature a triaryl- or diarylmethyl-amine framework and superbasic tetramethylguanidinyl residues (TMG). The dicationic M(II) sites mediate catalytic nitrene-transfer reactions between the imidoiodinane PhI═NTs (Ts = tosyl) and a panel of styrenes in MeCN to afford aziridines and low yields of imidazolines (upon MeCN insertion) with an order of productivity that favors the bipodal over the tripodal reagents and a metal preference of Fe > Co ≥ Mn. In CH2Cl2, the more acidic Fe(II) sites favor formation of 2,4-diaryl-N-tosylpyrrolidines by means of an in situ (3 + 2) cycloaddition of the initially generated 2-aryl-N-tosylaziridine with residual styrene. In the presence of ketone, 1,3-oxazolidines can be formed in practicable yields, involving a single-pot cycloaddition reaction of alkene, nitrene, and ketone (2 + 1 + 2). Mechanistic studies indicate that the most productive bipodal Fe(II) site mediates stepwise addition of nitrene to olefins to generate aziridines with good retention of stereochemistry and further enables aziridine ring opening to unmask a 1,3-zwitterion that can undergo cycloaddition with dipolarophiles (MeCN, alkene, ketone) to afford five-membered N-heterocycles.

Frequency of Common Risk Factors of Recurrent Diabetic Diabetic Metabolic Acidosis among Children

Background: Diabetic metabolic acidosis (DKA) is a serious dilemma for diabetics that arises when the body cannot create sufficient insulin. associated withboth the main subtypes of diabetes. It is characterized by an elevation in blood glucose concentrations, combined with the presence of ketones and acidosis symptoms. The frequency of DKA episodes among children with T1DM can vary widely depending on several factors, such as age and duration of the disease, adherence to treatment regimens, frequency of medical visits, and access to health care. The frequency of common risk factors for recurrent DKA has not been well studied. Objective: To estimate the prevalence/frequency of common risk factors of recurrent Diabetic metabolic acidosis in infancy,toddlers,preschoolers and teenaged with diabetes. Method: This epidemiological study explored the relationship between Type 1 Diabetes Mellitus (T1DM) and risk factors associated with life-threatening recurrent diabetic metabolic acidosis. Careful examination of medical records, laboratory results, physical exams and more were conducted on 0-18 year old children admitted to a public reference/tertiary care hospital in Pakistan over one year's time.Through bivariate and multivariate Poisson regression analysis, researchers sought to uncover patterns in age groups as well as doctor visits frequencies rate and treatment plans related to T1DM development among infancy, toddler hood through preteen years. Results: Our study of 456 patients uncovered a connection between infections, consistent healthcare visits, following prescribed medication instructions, and DKA episodes. Significantly higher rates of multiple DKA incidents were observed among those who had missed one or more medical appointments compared to regular attendees. Of the participants surveyed 63% reported taking their medication as instructed while 24% admitted to missing doses or not heeding dosage directions correctly. These results emphasize that proper management is key in preventing severe health complications such as diabetes-related acidosis attacks for diabetes sufferers worldwide Conclusion: Our data suggest that recurrent DKA in children with T1DM can vary significantly based on numerous factors, including age, disease duration, medical visit frequency, and medication adherence. Therapies may be able to alleviate this. To understand the impact of recurrent DKA rates in T1DM children, additional research is required. Keywords: Frequency of common risk factors; recurrent diabetic diabetic metabolic acidosis; children with type 1 diabetes mellitus

Subarachnoid Hemorrhage as a Complication of Diabetic Ketoacidosis in Early Onset Type 1 Diabetes Melitus in Limited Resource Settings

Background: Diabetic ketoacidosis (DKA) is one of the most frequent causes of morbidity and mortality in type 1 diabetes mellitus (T1DM). Neurological complications that can occur in DKA patients are cerebral edema followed by ischemic and hemorrhagic strokes. Hemorrhagic strokes have higher mortality than ischemic strokes in T1DM patients. Case: An 11-year-old patient came to the emergency room with complaints of decreased consciousness since morning. During the previous 2 days the patient had nausea and vomiting. There was no history of trauma or fever. About 2 days before admission patient showed decrease of consciousness. On physical examination, he was found to be in a coma, kussmaul breathing, mydriatic pupil, and with kussmaul breathing. Laboratory examination showed hyperglycemia, leukocytosis, hyponatremia, ketonuria, and C-peptide of 0,560 ng/ml. Head CT-Scan showed subarachnoid hemorrhage and cerebral edema. The patient showed a positive response after rehydration, administration of mannitol, and blood sugar regulation with an insulin pump. Discussion: DKA is one of the manifestations of T1DM. DKA is confirmed by hyperglycemia, blood pH below 7.3 manifesting with kussmaul breathing and the presence of ketones in blood and urine tests. DKA is treated with rehydration and insulin administration. SAH is a rare manifestation of DKA. The diagnosis of SAH can be confirmed by neuroimaging examination. Management of SAH could be done through close monitoring of blood pressure, prevention of increased intracranial pressure, and surgical approach. Conclusion: Subarachnoid hemorrhage is a neurological complication that rarely happens in DKA and could be caused by several factors such as hypotensive episode, hyperketonemic state, arteriovenosus malformation rupture, and endothelial perturbation. Neuroimaging could detect early neurological complication in DKA.

Isolated cerebral mucormycosis: A case discussion

We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial headaches, neck pain, confusion, and generalized tonic-clonic seizures. The patient initially presented at a rural community hospital with a fever and was found to be in diabetic ketoacidosis (DKA). He was also hemodynamically stable but stuporous, prompting intubation to protect his airway. Despite initial treatment measures, his neurological condition worsened and he remained ventilator-dependent. Key findings include a high glucose level, presence of ketones, and evidence of drug use. Blood cultures showed no growth, but his febrile state persisted. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, hyperglycorrhachia but normal protein, with no growth. Neuroimaging showed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI. The patient's neurological status worsened on the second day of admission, manifesting as sluggish pupillary reflexes, right third nerve palsy, and decerebrate posturing. Emergent MRI suggested cerebral edema, leading to initiation of hypertonic saline. This case highlights the diagnostic challenges and critical management considerations in a patient with multiple comorbidities presenting with unexplained neurological deterioration, emphasizing the importance of a comprehensive and timely approach to diagnosis and treatment.

Saccharomyces cerevisiae (Baker’s Yeast) catalyzed efficient and facile chemo-selective synthesis of aldimines

An efficient and reliable method has been developed for chemo-selective synthesis of Schiff bases (SB) (3a–n) by using Baker’s yeast (BY) as biocatalyst. The reaction is highly chemo-selective as only benzaldehydes take part in the reaction, whereas acetophenones fail to take part in this reaction. Furthermore, it was observed that amino acids (glycine, phenylalanine & tryptophan) and aliphatic amines (isopropyl amine and 1-amino butane) did not take part in the reaction. The present method is very efficient as it involves simple work up and gives the products in good to excellent yield. The reaction is totally carried out under eco- friendly and environmentally begin conditions by using ethanol (EtOH) as a green solvent. Thus it is anticipated that the present newly developed method will open a gateway for the chemist to prepare the selective SB (Aldimines) in the presence of ketones in facile and eco-friendly conditions.

Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process

Sick day medication guidance (SDMG) involves withholding or adjusting specific medications in the setting of acute illnesses that could contribute to complications such as hypotension, acute kidney injury (AKI), or hypoglycemia. We sought to achieve consensus among clinical experts on recommendations for SDMG that could be studied in future intervention studies. A modified Delphi process following guidelines for conducting and reporting Delphi studies. An international group of clinicians with expertise relevant to SDMG was recruited through purposive and snowball sampling. A scoping review of the literature was presented, followed by 3 sequential rounds of development, refinement, and voting on recommendations. Meetings were held virtually and structured to allow the participants to provide their input and rapidly prioritize and refine ideas. Opinions of participants were measured as the percentage who agreed with each recommendation, whereas consensus was defined as >75% agreement. Quantitative data were summarized using counts and percentages. A qualitative content analysis was performed to capture the context of the discussion around recommendations and any additional considerations brought forward by participants. The final panel included 26 clinician participants from 4 countries and 10 clinical disciplines. Participants reached a consensus on 42 specific recommendations: 5 regarding the signs and symptoms accompanying volumedepletion that should trigger SDMG; 6 regarding signs that should prompt urgent contact with a health care provider (including a reduced level of consciousness, severe vomiting, low blood pressure, presence of ketones, tachycardia, and fever); and 14 related to scenarios and strategies for patient self-management (including frequent glucose monitoring, checking ketones, fluid intake, and consumption of food to prevent hypoglycemia). There was consensus that renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, sodium/glucose cotransporter 2 inhibitors, and metformin should be temporarily stopped. Participants recommended that insulin, sulfonylureas, and meglitinides be held only if blood glucose was low and that basal and bolus insulin be increased by 10%-20% if blood glucose was elevated. There was consensus on 6 recommendations related to the resumption of medications within 24-48 hours of the resolution of symptoms and the presence of normal patterns of eating and drinking. Participants were from high-income countries, predominantly Canada. Findings may not be generalizable to implementation in other settings. A multidisciplinary panel of clinicians reached a consensus on recommendations for SDMG in the presence of signs and symptoms of volume depletion, as well as self-management strategies and medication instructions in this setting. These recommendations may inform the design of future trials of SDMG strategies.

Discerning Comparison of 1 and 0.5% Ethylene Glycol in Sprague-Dawley Rats with Modeled Urolithiasis.

A common method of modeling urolithiasis is the use of 1 and 0.75% ethylene glycol, or a combination of ethylene glycol with other lithogens, but too rapid progression of the disease and multiple organ toxicity have been reported. We developed a urolithiasis model in Sprague-Dawley rats, in which the animals received a relatively low concentration of ethylene glycol (0.5%), but for a long-term period (6 weeks) followed by animal observation during the 6-week recovery period. In urine samples, signs of the urolithiasis development were observed starting from the sixth week: the presence of ketones, decrease in diuresis and urine pH; in the blood, urea, protein, and hematocrit were elevated. However, no leukocytes were detected in the urine; in the blood, no shifts in differential leukocyte count and no elevation in ALT, creatinine, cholesterol, and triglycerides were observed, which indicates the absence of multiple organ failure while using 1% ethylene glycol. In addition, the animals receiving 0.5% ethylene glycol were followed up to 12 weeks in contrast to animals receiving 1% ethylene glycol (the experiment in this case was stopped during the third week for ethical reasons).

Abstract P3056: Influence Of Maternal Diabetes And High Fat Diet On Myocardial Ketone Body Metabolism In The Offspring

Alteration in myocardial substrate utilization and energy metabolism is a well-known contributor to the pathogenesis of heart disease. Recent studies suggest the failing heart may benefit from ketone bodies as an energy source. Infants exposed to diabetic pregnancy are at higher risk of cardiomyopathy at birth and early onset cardiovascular disease (CVD) as adults. We showed fetal exposure to excess circulating fuels, especially to the combination of maternal high fat diet (HFD) and diabetes, exaggerates CVD risk through fuel-mediated mitochondrial dysfunction including complex I dysfunction. Diabetic pregnancy increases ketone body exposure in utero, but whether prenatal exposures impair myocardial metabolism of ketones postnatally remains unknown. The objective of this study was to determine whether neonatal rat cardiomyocytes (NRCM) exposed to maternal diabetes and HFD in utero can increase ketone oxidation as a preferred fuel source over glycolysis. To test our hypothesis, we developed a ketone stress test (KST) or modified extracellular flux analyses to compare real-time ß-hydroxy butyrate (ßOHB) metabolism in NRCM and myocardial expression of genes responsible for ketone and lipid metabolism. While control and combination exposed NRCM had similar basal respiration, the presence of ketone (4.5 mM) increased maximal respiration, spare respiratory capacity, and ATP-limited glycolytic rate in the combination exposed group. Interestingly, baseline proton efflux rate (PER) from lactate (anaerobic glycolysis) decreased while PER from CO 2 (aerobic glycolysis) increased in response to ketones in the combination exposed group. Expression of genes responsible for ketone body metabolism ( Hmgcs2 and Bdh1 ) was not different. The study uses a novel KST to analyze real-time ketone body metabolism and demonstrates myocardial ketone body metabolism is preserved and may be protective in the NRCM exposed to maternal overnutrition.

Comparing Finger-stick Βeta-hydroxybutyrate with Dipstick Urine Tests in the Detection of Ketone Bodies in the Diagnosis of Children with Diabetic Ketoacidosis.

To compare the finger-stick β-hydroxybutyrate (β-OHB) method accuracy with dipstick urine test for the detection of ketone bodies to diagnose diabetic ketoacidosis in children. Cross-sectional study. Department of Pediatrics, National Institute of Child Health, Karachi, from March to August 2021. Ninety-six known or newly diagnosed diabetic patients aged 2-15 years with suboptimal glycemic control and diabetic ketoacidosis were included in the study. A urine dipstick test was utilised to evaluate the absence or presence of ketones in the urine. In point-of-care, blood β-OHB levels were recorded. Among 96 children, with median age of 10 years (IQR=6-11), 11 (11.5%) children had traces of urine ketones, 7 (7.3%) had + urine ketones, 19 (19.8%) had ++ urine ketones, 26 (27.1%) had +++ ketones and 19 (19.8%) had ++++ ketones. In 66 patients (68.75%), capillary blood ketone was observed to be positive by a finger-stick β-OHB method. The finger-stick β-OHB method had a higher sensitivity (90.4% vs. 84.9%), specificity (100% vs. 91.3%), and accuracy (92.7% vs. 86.5%) than the dipstick urine test. Finger-stick β-OHB method can serve as a more accurate alternative to the urinary dipstick method for the measurement of ketones and to exclude ketosis and diagnosis of diabetic ketoacidosis (DKA) in hyperglycemic children. Diabetes mellitus, Hyperglycemia, Diabetic ketoacidosis, Point-of-care testing, Ketosis, Urine ketones, Acetoacetates.

The incidence of biliary sludge in first trimester pregnancies with hyperemesis gravidarum and its effect on the course of hyperemesis gravidarum

Pregnancy is one of the risk factors for biliary sludge (BS) formation. In this cross-sectional study, a total of 959 pregnant women were included. Serum aspartate aminotransferase, alanine aminotransferase, sodium, potassium, triglycerides, cholesterol levels and the presence of ketones in urine were determined. The presence of BS was investigated using maternal abdominal ultrasound. The incidence of BS in pregnancies complicated by hyperemesis gravidarum (HG) was 14%. The degree of ketonuria and low birth weight were statistically higher in pregnancies with maternal BS than women without sludge. Total weight gain during pregnancies with BS was statistically lower than controls. The incidence of BS in pregnancies with HG does not appear to increase due to HG-related complications, such as dehydration, starvation and weight loss. However, the severity of HG may be worse when HG is associated with sludge. Impact Statement What is already known on this subject? The incidence of biliary sludge (BS) in pregnant women ranges between 10.9% and 36%. Some clinical conditions, such as pregnancy, prolonged fasting, total parenteral nutrition, rapid weight loss and ceftriaxone treatment can play a role in the formation of gallbladder sludge. What do the results of this study add? This is the first study to investigate the incidence of BS in hyperemesis gravidarum (HG) pregnancies. Results show that HG may transiently be associated with BS. HG is more likely to cause a transient increase in new sludge formation. The symptoms and complications related to HG may be more severe when HG is associated with BS. What are the implications of these findings for clinical practice and/or further research? Our study showed that BS can be found in HG patients, and HG can be a predisposing factor for new sludge formation, although this association is generally driven by advanced maternal age and increased baseline serum lipid and alanine aminotransferase levels. BS may also be independently associated with an increased risk of subsequent preterm delivery in women with HG.

A General Way to Spiro-Annulated 2-Benzoxepines via Rh2(esp)2-Catalyzed [5+2] Cycloaddition of Diazo Arylidene Succinimides to Ketones

AbstractThe formation of spirocyclic 2-benzoxepines by Rh2(esp)2-catalyzed decomposition of diazo arylidene succinimides in the presence of ketones was investigated. This transformation, which is a formal [5+2] cycloaddition of styryl rhodium carbenes to the carbonyl group, occurs in high yields under mild conditions, with high carbonyl substrate tolerance and diastereoselectivity. The developed general method opens access to rare spiro (hetero)cyclic scaffolds with great potential in drug discovery.