Introduction: Very low-calorie diets (VLCDs) are used preoperatively in bariatric-metabolic surgery; however, this can lead to physiological ketosis. Euglycemic ketoacidosis is an increasingly recognized complication in diabetic patients on sodium-glucose-cotransporter-2 inhibitors (SGLT2i) undergoing surgery and requires assessment of ketones for diagnosis and monitoring. VLCD induced ketosis may confound monitoring in this group. We aimed to evaluate the influence of VLCD, compared to standard fasting, on perioperative ketone levels and acid-base balance.
Materials And Methods: Twenty-seven patients were prospectively recruited to the intervention group and 26 to the control group from two tertiary referral centres in Melbourne, Australia. Intervention group patients were severely obese (body mass index) (BMI) (≥35), undergoing bariatric-metabolic surgery, and prescribed 2 wk of VLCD preoperatively. Control group patients underwent general surgical procedures and prescribed standard procedural fasting only. Patients were excluded if diabetic or prescribed SGLT2i. Ketone and acid-base measurements were taken at regular intervals. Univariate and multivariate regression was utilised with significance defined as P < 0.005.
Clinicaltrials: gov ID: NCT05442918.
Results: Patients on VLCD, compared to standard fasting, had an increased median preoperative (0.60 versus 0.21 mmol/L), immediate postoperative (0.99 versus 0.34 mmol/L) and day 1 postoperative (0.69 versus 0.21 mmol/L) ketone level (P < 0.001). Preoperative acid-base balance was normal in both groups, however VLCD patients were found to have a metabolic acidosis immediately postoperatively (pH 7.29 versus pH 7.35) (P = 0.019). Acid-base balance had normalized in VLCD patients on postoperative day 1.
Conclusions: Preoperative VLCD resulted in increased pre- and postoperative ketone levels with immediate postoperative values consistent with metabolic ketoacidosis. This should be considered particularly when monitoring diabetic patients prescribed SGLT2i.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jss.2023.05.001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
1,3-butanediol administration as an alternative strategy to calorie restriction for neuroprotection - Insights into modulation of stress response in hippocampus of healthy rats.
Biomed Pharmacother
January 2025
Institute for the Animal Production System in the Mediterranean Environment, National Research Council, Portici, 80055, Italy. Electronic address:
Ketogenic diet has a wide range of beneficial effects but presents practical limitations due to its low compliance, hence dietary supplements have been developed to induce ketosis without nutrient deprivation. The alcohol 1,3-butanediol (BD) is a promising molecule for its ability to induce ketosis, but its effects on brain have been investigated so far only in disease models, but never in physiological conditions. To support BD use to preserve brain health, the analysis of its activity is mandatory.
View Article and Find Full Text PDFPhenotypic variation of dairy cows' hematic metabolites and feasibility of non-invasive monitoring of the metabolic status in the transition period.
Front Vet Sci
November 2024
Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padova, Legnaro, Italy.
Article Synopsis
- The incidence of metabolic diseases in dairy cows peaks around parturition due to hormonal and physiological changes, making reliable monitoring essential.
- Blood tests are costly and stressful for cows, leading to the exploration of mid-infrared spectroscopy (MIR) as a non-invasive alternative to assess nutritional and metabolic health.
- The study conducted on 349 Holstein cows revealed that while MIR can predict certain blood traits like BHB and NEFA, its accuracy isn't perfect, yet it can still help identify cows at risk for negative energy balance and assist in herd management and decision-making.
[The technology of induction of physiological ketosis in asthenia of various origins and decreased resistance to cognitive and physical activity].
Zh Nevrol Psikhiatr Im S S Korsakova
November 2024
Speech Pathology and Neurorehabilitation Center of the Department of Health of Moscow, Moscow, Russia.
Objective: To assess the possibility of achieving physiological ketosis with oral administration of beta-hydroxybutyrate salts and, if ketosis is achieved, to assess its effect on cognitive functioning in patients with brain dysfunction during the recovery period after a somatic disease.
Material And Methods: The study included 86 patients with complaints of asthenic manifestations (ICD-10 diagnoses F06; F07; R53). Half of the patients were included in the study group taking beta-hydroxybutyrate salts, and the other half were included in the control group taking placebo.
Effect of Hyperketonemia on Myocardial Function in Patients With Heart Failure and Type 2 Diabetes.
Diabetes
January 2025
Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.
We examined the effect of increased levels of plasma ketones on left ventricular (LV) function, myocardial glucose uptake (MGU), and myocardial blood flow (MBF) in patients with type 2 diabetes (T2DM) with heart failure. Three groups of patients with T2DM (n = 12 per group) with an LV ejection fraction (EF) ≤50% received incremental infusions of β-hydroxybutyrate (β-OH-B) for 3-6 h to increase the plasma β-OH-B concentration throughout the physiologic (groups I and II) and pharmacologic (group III) range. Cardiac MRI was performed at baseline and after each β-OH-B infusion to provide measures of cardiac function.
View Article and Find Full Text PDF[Fulminant type 1 diabetes mellitus with acute pancreatitis: A case report and literature review].
Beijing Da Xue Xue Bao Yi Xue Ban
October 2024
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China.
The objective was to report a relatively rare case of fulminant type 1 diabetes (FT1DM) complicated with acute pancreatitis (AP), to summarize the characteristics as well as experience of diagnosis and treatment, and to explore its pathogenesis. Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively. A 66-year-old male presented with acute fever and abdominal pain, accompanying with the significantly elevated pancreatic enzymes, and his abdominal CT scan showed exudation around the pancreas.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!