The Journal of Internal Korean Medicine (대한한방내과학회지)

The Society of Internal Korean Medicine (대한한방내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case Report of a Patient Diagnosed with Diabetic Ketoacidosis Accompanied by Hyperammonemia from Systemic Inflammation

고암모니아혈증을 동반한 전신성 염증으로 인한 당뇨병성 케톤산증 환자 치험 1례

  • Jang, Hansol (Dept. of Korean Internal Medicine, Dongguk University Bundang Korean Medicine Hospital) ;
  • Chung, U-ryeong (Dept. of Korean Internal Medicine, Dongguk University Bundang Korean Medicine Hospital) ;
  • Jung, Seung-hyun (Dept. of Korean Internal Medicine, Dongguk University Bundang Korean Medicine Hospital)
  • 장한솔 (동국대학교 분당한방병원 한방내과) ;
  • 정우령 (동국대학교 분당한방병원 한방내과) ;
  • 정승현 (동국대학교 분당한방병원 한방내과)
  • Received : 2022.04.08
  • Accepted : 2022.05.09
  • Published : 2022.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

A 42-year-old male patient with prolonged throat pain and discomfort, dry mouth, and general weakness and recently diagnosed with tonsillitis, pulmonary embolism, and venous thrombosis was admitted to the internal Korean medicine department. A sudden onset of diabetic ketoacidosis with hyperammonemia was diagnosed on the second day of treatment. During admission, the patient received insulin therapy, hydration, and traditional Korean medicine treatment, including herbal medicine. Subjective symptom change was evaluated daily and blood glucose level checked five times per day. At discharge, the patient's fasting and postprandial blood sugar levels were adequate. After an additional two weeks of herbal treatment, the symptoms were significantly ameliorated. Thus, having been admitted with dysregulated glucose metabolism leading to a hyperglycemic crisis after a series of inflammatory events, the patient showed symptomatic improvements and decreased blood glucose after 18 days of hospitalization and treatment.

Keywords

References

  1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32(7):1335-43. https://doi.org/10.2337/dc09-9032
  2. Cho DH. Effective Management of Diabetic Ketoacidosis. J Korean Diabetes 2018;19(4):208-13. https://doi.org/10.4093/jkd.2018.19.4.208
  3. Ohara N, Kaneko M, Yano T, Sato N, Usuda H, Miyakoshi M, et al. Type 1 Diabetes Mellitus and Pernicious Anemia in an Elderly Japanese Patient: A Case Report and Literature Review. Intern Med 2015;54(18):2361-5. https://doi.org/10.2169/internalmedicine.54.4621
  4. Musey VC, Lee JK, Crawford R, Klatka MA, McAdams D, Phillips LS. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis. Diabetes Care 1995;18(4):483-9. https://doi.org/10.2337/diacare.18.4.483
  5. Shin YJ, Kim DI, Lee DW, Jeon BK, Ji JG, Lim JA, et al. Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution. Ann Geriatr Med Res 2016;20(4):185-9. https://doi.org/10.4235/agmr.2016.20.4.185
  6. Manappallil RG, Kumar P, Josephine B. Noncirrhotic hyperammonemia in a newly diagnosed diabetic patient presenting in diabetic ketoacidosis. Ind J Case Reports 2019;5(3):217-8.
  7. Hawkes ND, Thomas GA, Jurewicz A, Williams OM, Hillier CE, McQueen IN, et al. Non-hepatic hyperammonaemia: an important, potentially reversible cause of encephalopathy. Postgrad Med J 2001;77(913):717-22. https://doi.org/10.1136/pmj.77.913.717
  8. Clay AS, Hainline BE. Hyperammonemia in the ICU. Chest 2007;132(4):1368-78. https://doi.org/10.1378/chest.06-2940
  9. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes 2017;10(1):12. https://doi.org/10.1186/s13104-016-2335-5
  10. Lee HJ, Sajan A, Tomer Y. Hyperglycemic emergencies associated with COVID-19 vaccination: a case series and discussion. J Endocr Soc 2021;5(11):bvab141. https://doi.org/10.1210/jendso/bvab141
  11. Samuel SM, Varghese E, Triggle CR, Bus elberg D. COVID-19 Vaccines and Hyperglycemia-Is There a Need for Postvaccination Surveillance?. Vaccines (Basel) 2022;10(3):454. https://doi.org/10.3390/vaccines10030454
  12. Dula SB, Jecmenica M, Wu R, Jahanshahi P, Verrilli GM, Carter JD, et al. Evidence that low-grade systemic inflammation can induce islet dysfunction as measured by impaired calcium handling. Cell Calcium 2010;48(2-3):133-42. https://doi.org/10.1016/j.ceca.2010.07.007
  13. Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes 2004;53(8):2079-86. https://doi.org/10.2337/diabetes.53.8.2079
  14. Khodabandehloo H, Gorgani-Firuzjaee S, Panahi G, Meshkani R. Molecular and cellular mechanisms linking inflammation to insulin resistance and β-cell dysfunction. Transl Res 2016;167(1):228-56. https://doi.org/10.1016/j.trsl.2015.08.011
  15. Wang Y, Zhu Y, Gao L, Yin H, Xie Z, Wang D, et al. Formononetin attenuates IL-1β-induced apoptosis and NF-κB activation in INS-1 cells. Molecules 2012;17(9):10052-64. https://doi.org/10.3390/molecules170910052
  16. Chaudhuri A, Umpierrez GE. Oxidative stress and inflammation in hyperglycemic crises and resolution with insulin: implications for 2he acute and chronic complications of hyperglycemia. J Diabetes Complications 2012;26(4):257-58. https://doi.org/10.1016/j.jdiacomp.2012.04.016
  17. Ghanim H, Mohanty P, Deopurkar R, Sia CL, Korzeniewski K, Abuaysheh S, et al. Acute modulation of toll-like receptors by insulin. Diabetes Care 2008;31(9):1827-31. https://doi.org/10.2337/dc08-0561
  18. Pribiag H, Stellwagen D. TNF-α downregulates inhibitory neurotransmission through protein phosphatase 1-dependent trafficking of GABA (A) receptors. J Neurosci 2013;33(40):15879-93. https://doi.org/10.1523/JNEUROSCI.0530-13.2013
  19. Xu E, Kumar M, Zhang Y, Ju W, Obata T, Zhang N, et al. Intra-islet insulin suppresses glucagon release via GABA-GABAA receptor system. Cell Metab 2006;3(1):47-58. https://doi.org/10.1016/j.cmet.2005.11.015
  20. Soltani N, Qiu H, Aleksic M, Glinka Y, Zhao F, Liu R, et al. GABA exerts protective and regenerative effects on islet beta cells and reverses diabetes. Proc Natl Acad Sci U S A 2011;108(28):11692-7. https://doi.org/10.1073/pnas.1102715108
  21. Lee JM. Donguisusebowon. Seoul: Yeokang Publishing; 1992, p. 74-164.
  22. Huang GS. Boncho Gujin. Seoul: Tree and Soil Publising; 1999, p. 391-404, 897-962.
  23. Heo J. Donguibogam. Seoul: Namsandang; 1996, p. 74, 506-7.
  24. Nationwide College of Korean Medicine Department of Sasang Constitution. Revised and Enlarged Sasang Constitutional Medicine. 2nd edition. Seoul: Jipmoondang; 2016, p. 292-4.
  25. Won DP. Dongui Sasang Sinpyeon. Seoul: Jeongdam; 2002, p. 188.
  26. Hwang SH, Wang Z, Yoon HN, Lim SS. Xanthium strumarium as an Inhibitor of α-Glucosidase, Protein Tyrosine Phosphatase 1β, Protein Glycation and ABTS+ for Diabetic and Its Complication. Molecules 2016;21(9):1241. https://doi.org/10.3390/molecules21091241
  27. Yoon HN, Lee MY, Kim JK, Suh HW, Lim SS. Aldose reductase inhibitory compounds from Xanthium strumarium. Arch Pharm Res 2013;36(9):1090-5. https://doi.org/10.1007/s12272-013-0123-5
  28. Banin RM, Hirata BK, Andrade IS, Zemdegs JC, Clemente AP, Dornellas AP, et al. Beneficial effects of Ginkgo biloba extract on insulin signaling cascade, dyslipidemia, and body adiposity of diet-induced obese rats. Braz J Med Biol Res 2014;47(9):780-8. https://doi.org/10.1590/1414-431X20142983
  29. Chen JS, Chen YH, Huang PH, Tsai HY, Chen YL, Lin SJ, et al. Ginkgo biloba extract reduces high-glucose-induced endothelial adhesion by inhibiting the redox-dependent interleukin-6 pathways. Cardiovasc Diabetol 2012;11(1):49. https://doi.org/10.1186/1475-2840-11-49
  30. Ha JH, Lee DU, Lee JT, Kim JS, Yong CS, Kim JA, et al. 4-Hydroxybenzaldehyde from Gastrodiaelata B1. is active in the antioxidation and GABAergic neuromodulation of the rat brain. J Ethnopharmacol 2000;73(1-2):329-33. https://doi.org/10.1016/S0378-8741(00)00313-5
  31. Liu HJ, Lai X, Xu Y, Miao JK, Li C, Liu JY, et al. α-Asarone Attenuates Cognitive Deficit in a Pilocarpine-Induced Status Epilepticus Rat Model via a Decrease in the Nuclear Factor-κB Activation and Reduction in Microglia Neuroinflammation. Front Neurol 2017;8:661. https://doi.org/10.3389/fneur.2017.00661
  32. Ahn YK. Meridian Study Series (Gyeonghyeolhak-Chongseo). 6th edition. Seoul: Seongbo-sa; 2006, p. 281-98, 392-432.
  33. Yang JZ. Complete Compendium of Acupuncture and Moxibustion (Chimgudaeseong). Seoul: Daeseongmunhwa-sa; 1996, p. 809-57.
  34. Kim DH, Baik Y. A Study on the Clinical Application of Five-Transport-Points in Huangdineijing - Focused on Frequency of Application and Selection. Korean J Acupunct 2020;37(4):276-83. https://doi.org/10.14406/acu.2020.035