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Severe acidosis caused by starvation and stress. Am J Kidney Dis 2003 Nov;42(5):E16-9

Date

10/29/2003

Pubmed ID

14582074

DOI

10.1016/j.ajkd.2003.07.012

Scopus ID

2-s2.0-2142704233   22 Citations

Abstract

A 1-year-old boy had severe anoxic brain injury owing to a cardiorespiratory arrest. He had an initial metabolic acidosis, but this largely resolved by hospital day 2. He then had a persistent, profound metabolic acidosis. Evaluation on hospital day 6 found that the patient had ketonemia, ketonuria, and a normal serum glucose level; he had received no intravenous dextrose during his hospitalization. The dextrose-free fluids were given initially to protect his brain from the deleterious effects of hyperglycemia after brain injury. Continuation beyond 24 hours was inadvertent. The initiation of dextrose-containing intravenous fluids produced a rapid resolution of his metabolic acidosis. Starvation usually produces a mild metabolic acidosis, but when combined with physiologic stress, starvation may cause a severe metabolic acidosis. Among the few reports of severe starvation ketoacidosis, our case is unique because the patient was monitored closely in an intensive care unit, allowing us to describe the time course of the acidosis in detail.

Author List

Toth HL, Greenbaum LA

Author

Heather Toth MD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Fatal Outcome
Glucose
Heart Arrest
Humans
Hypoxia, Brain
Infant
Ketosis
Male
Starvation
Stress, Physiological