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We report a case of lactation ketoacidosis in a 22-year-old female who was breastfeeding two infants while dieting. She appeared non-toxic, but had a serum bicarbonate of 7meq/L, a pH of 7.07, and moderate serum ketones. She responded well to simple carbohydrate replenishment and brief cessation of breastfeeding. Emergency Physicians should be aware of this entity so as to avoid unnecessary morbidity and to begin prompt treatment.

Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.

Serum ketone and total protein concentrations of 966 cattle slaughtered at the metropolitan abattoir, Maiduguri, Nigera, were estimated durng the dry and rainy months of the year. None of the sera had a titrable ketone concentration. Serum total protein (STP) concentration of Keywords : Nigeria, Sahel region, Cattle, Serum ketones, Serum total protein, Undernutrition

Objective To describe two patients with diabetic ketoacidosis and positive ethylene glycol levels and to call attention to the possibility of a false-positive ethylene glycol determination in patients with ketoacidosis. Methods Clinical manifestations and laboratory tests in the two patients were summarized. Serum specimens for both patients were analyzed for ethylene glycol, serum ketones, glucose, osmolality, pH, and electrolytes. Results Respective laboratory findings in our two patients were as follows: serum glucose levels, 56.4 and 45.7 mmol/L; serum acetone, positive in 1:80 and 1:128 dilution; serum osmolality, 366 and 377 mmol/kg; pH, 6.9 and 7.2; and ethylene glycol, 3.46 and 2.45 mmol/L. Conclusion Neither of these two elderly women had ingested ethylene glycol; nevertheless, both had positive results for ethylene glycol on a blood toxicology screen. Review of the literature demonstrates that false-positive ethylene glycol levels can be detected in patients with ketoacidosis. This information is documented in this report and should alert practicing physicians to such a possibility. (Endocr Pract. 1998;4:272-273)

10 g of guar was added to a test meal given to 11 subjects, six of whom had insulin-dependent diabetes, after an overnight fast. The addition of guar to the meal produced an overall decrease in the blood glucose concentrations after the meal in both normal and diabetic subjects. The insulin secretory response in the normal subjects was less when guar was included in the meal than when it was not. In normal subjects, but not in diabetic subjects, the addition of guar also resulted in a diminished response of lactate, pyruvate, and alanine to the test meal and a blunting of the fall in serum ketones. This is likely related to the fact that the same dose of insulin was given in the diabetic subjects with both test meals. Thus, in the normal circumstances, the diminished glycemic response to the guar-containing meal resulted in diminished insulin secretion, which was not the case with the diabetic subjects.

Intermittent total fasts of 10 to 12 days in obese diabetic patients exerted beneficial effects on the results of the glucose tolerance tests. This improvement is attributed to (1) the fasting hyperketonemia, known to occur during total fasts in obese subjects, and which is believed to increase production of insulin plus (2) optimal sensitivity of the insulin probably due to low concentrations of growth hormone. The obese nondiabetic and obese patient with borderline or latent diabetes experienced a deterioration of the glucose tolerance by the end of the fast, presumably caused by decreased insulin sensitivity from increasing amounts of growth hormone. Premature feeding of obese diabetic persons decreased the serum ketones and decreased sugar tolerance.

The utility of a new urine dipstick, Chemstrip uK, was evaluated using serum in place of urine to quantify serum ketones in 29 acutely ill patients with suspected ketosis treated in the emergency department. The serum Chemstrip uK method accurately predicted the level of ketonemia as assessed by the Acetest tablet method (r = .94; P less than .0001). There were no false-negative and no false-positive results. The use of this strip is recommended for evaluating subjects with suspected ketosis.