Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética
Objective: To communicate a case of glucocorticoid and gatifloxacin induced ketoacidosis and to discuss the mecanisms of this unusual and severe complication. Case: A 32 years old woman, was admitted for community acquired pneumonia of 5 days of evolution. History: previous diagnosis of probable...
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| Publicado en: | Revista Médica Universitaria |
|---|---|
| Autores principales: | , , , , |
| Materias: | |
| Acceso en línea: | https://bdigital.uncu.edu.ar/fichas.php?idobjeto=2750 |
| descriptores_str_mv |
Cetoacidosis diabética Corticoides Gatifloxacina Glucocorticoides Hiperglucemia Neumonía Pacientes hospitalizados Pacientes no diabéticos |
|---|---|
| todos_str_mv |
1221 2735 HospLagClinMed HospLagClinMed HospLagClinMed spa UNCuyo FCM Dto. Medicina Interna UNCuyo FCM Dto. Medicina Interna |
| autor_str_mv |
Carena, José Alberto Carminati, Gustavo Lavandaio, Hugo Marcucci, Guillermo Salomón, Susana Elsa |
| titulo_str_mv |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| disciplina_str_mv |
Ciencias médicas |
| description_str_mv |
Objective: To communicate a case of glucocorticoid and gatifloxacin induced
ketoacidosis and to discuss the mecanisms of this unusual and severe complication.
Case: A 32 years old woman, was admitted for community acquired pneumonia of 5
days of evolution. History: previous diagnosis of probable AR 4 months before
treated with intermittent methotrexate and glucocorticoids. Physical examination:
regular status, BMI 21, Tº 38ºC, RR 32/min, right pleural effusion, HR 96/min, BP
110/70, polyarthralgia without arthritis. Blood test: HCT 23%, WBC 16300/mm3, ESR
96mm/1ºh, glycemia 0.90mg/dl, liver function and amylase normal, uremia 1.19g/l,
creatinine 19mg/l. Blood cultures (2) and sputum positives for Streptococcus
pneumoniae penicillin susceptible. Pneumonia respond to gatifloxacin. She
developed renal failure becoming anuric with metabolic acidosis. Assuming this
findings as lupic rapidly progressive glomerulonephritis because of proteinuria of
2g/24hs, RF (+) 1/1280, homogeneous ANA (+) 1/320, Anti DNA (+), reduced
complement: C3 29.4mg/dl and C4 10mg/dl, Anti-Ro, Anti-La, Scl70, RNP and Anticardiolipin
positives. Therapy was initiated with IV methylprednisolone bolus
(1g/day/3 days), complicating with hyperglycemia of >6 g/l and ketoacidosis with
ketonuria (+); Anti-ICA and Anti-GAD negatives, and HbA1C 5.2%. She was
admitted to ICU and managed with insulin and hemodialysis. The patient improves,
glucocorticoids were tapered and was dismissed without insulin.
Commentary
1) The presence of normal HbA1C, negative Anti-ICA and Anti-GAD, allows us to rule
out a Tipe 1 Diabetes associated to lupus. 2) The development of ketoacidosis
during glucocorticoid and gatifloxacin therapy and the later resolution support the
etiologic rol of them. 3) Ketoacidosis can be explained by enhanced gluconeogenesis
and insulin resistance with impaired peripheral glucose uptake at receptor and postreceptor
level induced by implicated drugs associated to inflammatory state related
with lupus and sepsis which increase those effects.
Objetivo: Comunicar un caso de cetoacidosis inducida por corticoides y gatifloxacina y discutir los mecanismos de esta inusual y seria complicación. Caso clínico: Mujer de 32 años, ingresa por neumonía adquirida en la comunidad de 5 días de evolución. Antecedentes: AR probable diagnosticada 4 meses antes tratada con metotrexate y corticoides intermitente. Examen físico: regular estado general, IMC 21, Tº 38ºC, FR 32/min, derrame pleural derecho, FC 96/min, PA 110/70, artralgias sin artritis. Exámenes complementarios: Hto 23%, GB 16300/mm3, VSG 96mm/1ºh, glucemia 0.90mg/dl, función hepática y amilasa normales, uremia 1.19g/l, creatinina 19mg/l. Hemocultivos (2) y esputo positivos para Neumococo penicilina-sensible. La neumonía responde a gatifloxacina. Deteriora la función renal hasta la anuria con acidosis metabólica. Se interpreta como glomerulonefritis lúpica rápidamente progresiva por proteinuria de 2g/24hs, FR (+) 1/1280, FAN (+) 1/320 homogéneo, Anti ADN (+) , complemento bajo: C3 29.4mg/dl y C4 10mg/dl, Ac anti Ro, La, Scl70, RNP y anticardiolipinas positivos. Se indica metilprednisolona EV (3 bolos 1g), complicándose con hiperglucemias de >6 g/l y cetoacidosis con cetonuria (+); Ac anti ICA y antiGAD negativos con HbA1C 5.2%. Es tratada en UTI (insulina y hemodiálisis). La paciente mejora, se desciende la dosis de corticoides, con normalización de la glucemia sin tratamiento hipoglucemiante. Comentarios 1) La presencia de HbA1C nomal, Ac anti ICA y GAD negativos permite descartar con razonable grado de certeza una diabetes tipo1 asociada al lupus. 2) El desarrollo de la cetoacidosis durante el tratamiento con corticoides y gatifloxacina y su resolución posterior avalan el rol etiológico de los mismos. 3) La cetoacidosis puede explicarse por estimulación de la gluconeogénesis y la insulinoresistencia a nivel de receptor y post-receptor generada por los fármacos potenciado por el estado inflamatorio relacionado con el lupus y la sepsis. |
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Revista Médica Universitaria |
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Revista Médica Universitaria |
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Revista Médica Universitaria |
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Vol. 4, no. 3 |
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Vol. 4, no. 3 |
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textuales |
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Articulos |
| title_full |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| title_fullStr |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| title_full_unstemmed |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| description |
Objective: To communicate a case of glucocorticoid and gatifloxacin induced
ketoacidosis and to discuss the mecanisms of this unusual and severe complication.
Case: A 32 years old woman, was admitted for community acquired pneumonia of 5
days of evolution. History: previous diagnosis of probable AR 4 months before
treated with intermittent methotrexate and glucocorticoids. Physical examination:
regular status, BMI 21, Tº 38ºC, RR 32/min, right pleural effusion, HR 96/min, BP
110/70, polyarthralgia without arthritis. Blood test: HCT 23%, WBC 16300/mm3, ESR
96mm/1ºh, glycemia 0.90mg/dl, liver function and amylase normal, uremia 1.19g/l,
creatinine 19mg/l. Blood cultures (2) and sputum positives for Streptococcus
pneumoniae penicillin susceptible. Pneumonia respond to gatifloxacin. She
developed renal failure becoming anuric with metabolic acidosis. Assuming this
findings as lupic rapidly progressive glomerulonephritis because of proteinuria of
2g/24hs, RF (+) 1/1280, homogeneous ANA (+) 1/320, Anti DNA (+), reduced
complement: C3 29.4mg/dl and C4 10mg/dl, Anti-Ro, Anti-La, Scl70, RNP and Anticardiolipin
positives. Therapy was initiated with IV methylprednisolone bolus
(1g/day/3 days), complicating with hyperglycemia of >6 g/l and ketoacidosis with
ketonuria (+); Anti-ICA and Anti-GAD negatives, and HbA1C 5.2%. She was
admitted to ICU and managed with insulin and hemodialysis. The patient improves,
glucocorticoids were tapered and was dismissed without insulin.
Commentary
1) The presence of normal HbA1C, negative Anti-ICA and Anti-GAD, allows us to rule
out a Tipe 1 Diabetes associated to lupus. 2) The development of ketoacidosis
during glucocorticoid and gatifloxacin therapy and the later resolution support the
etiologic rol of them. 3) Ketoacidosis can be explained by enhanced gluconeogenesis
and insulin resistance with impaired peripheral glucose uptake at receptor and postreceptor
level induced by implicated drugs associated to inflammatory state related
with lupus and sepsis which increase those effects.
|
| dependencia_str_mv |
Facultad de Ciencias Médicas |
| title |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| spellingShingle |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética Cetoacidosis diabética Corticoides Gatifloxacina Glucocorticoides Hiperglucemia Neumonía Pacientes hospitalizados Pacientes no diabéticos Carena, José Alberto Carminati, Gustavo Lavandaio, Hugo Marcucci, Guillermo Salomón, Susana Elsa |
| topic |
Cetoacidosis diabética Corticoides Gatifloxacina Glucocorticoides Hiperglucemia Neumonía Pacientes hospitalizados Pacientes no diabéticos |
| topic_facet |
Cetoacidosis diabética Corticoides Gatifloxacina Glucocorticoides Hiperglucemia Neumonía Pacientes hospitalizados Pacientes no diabéticos |
| author |
Carena, José Alberto Carminati, Gustavo Lavandaio, Hugo Marcucci, Guillermo Salomón, Susana Elsa |
| author_facet |
Carena, José Alberto Carminati, Gustavo Lavandaio, Hugo Marcucci, Guillermo Salomón, Susana Elsa |
| title_sort |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| title_short |
Cetoacidosis inducida por corticoides y gatifloxacina en una mujer joven no diabética |
| url |
https://bdigital.uncu.edu.ar/fichas.php?idobjeto=2750 |
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3 |
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Biblioteca Digital |
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Biblioteca Digital |
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Artículo de Revista |
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Sistema Integrado de Documentación |
| indexed_str |
2023-04-25 00:38 |
| _version_ |
1764120344519507968 |
