A nationwide questionnaire study evaluated kidney injury associated with Beni-koji tablets in Japan.

Red yeast rice, traditionally used in Asian cuisine and increasingly marketed as a dietary supplement for cholesterol management, has recently been linked to kidney dysfunction in Japan. In late 2023 to early 2024, multiple cases involving specific Beni-koji (red yeast rice) tablets from three different Beni-koji preparations, prompted a safety reevaluation. Although citrinin, a known nephrotoxin of red yeast rice, was not produced by the implicated strains, new safety concerns emerged.

Efficacy of melatonin for treatment and prevention of neonatal necrotizing enterocolitis: a systematic review.

The purpose of this study was to systematically review the available literature evaluating the use of melatonin for preventing and treating neonatal necrotizing enterocolitis (NEC). A systematic review of studies examining the effect of melatonin on neonatal NEC was conducted. The databases of Medline, Scopus, WOS, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant studies.

Metabolomic signature of pediatric diabetic ketoacidosis: key metabolites, pathways, and panels linked to clinical variables.

Background: Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes (T1D), arising from relative insulin deficiency and leading to hyperglycemia, ketonemia, and metabolic acidosis. Early detection and treatment are essential to prevent severe outcomes. This pediatric case-control study utilized plasma metabolomics to explore metabolic alterations associated with DKA and to identify predictive metabolite patterns.

Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus.

Background: Type 2 ketone-prone diabetes mellitus (T2KPDM) is thought to occur in men of African descent, with obesity who experienced prolonged hyperglycemia; the role of medication non-adherence as a contributing cause remains unstudied.

Research Design And Methods: This was a retrospective study of unique adults (>18 years) who sought emergency care one of four hospitals in the greater Detroit area. Patients were identified on the basis of a laboratory order for a ß-hydroxybutyrate concentration.

A fatal case of Vibrio cholerae-associated diarrhea and bacteremia in a 30-year-old carrier of beta-thalassemia.

Bacterial infections leading to bacteremia and septicemic shock constitute an emerging public health concern globally, especially in areas where sanitation is poor and safe drinking water is scarce. Enteric pathogens such as Vibrio cholerae are responsible for many deaths caused by contaminated food and water in these areas. While cholera is the prominent clinical threat posed by V.

Influences of fat-protein-ratio and udder health parameters on the milk urea content of dairy cows.

The milk urea content is influenced by a large variety of factors, including the quantity and quality of protein fed, its balance with energy, diurnal fluctuations, management, season, analysis method, and also individual cow factors which include the health status of the cow. Aim of this study was to investigate the effects of metabolic disorders (ketosis, ruminal acidosis; indicated by the fat-protein-content of the milk) as well as high somatic cell counts and udder diseases on the milk urea content of dairy cows from different regions and farms across Germany. For this purpose, 5 independent data sets which contain information derived from monthly milk recordings (data sets A (6,140,342 test-data in 2015), data set D (439,767 test-data in 2020-2023), data set E (399,279 test-data in 2019-2020)) in combination with the differential somatic cell count (DSCC) in data set D and E, or individual recordings of daily feed and energy intake and milk analysis (data set B (58,235 test-data in 2014-2017) and data set C (352,346 test-data in 2018-2021)), were analyzed.

Hyperventilation worsens inflammatory lung injury in spontaneously breathing rats.

Objectives: Here, we investigated the effects of hyperventilation on acute lung injury (ALI) in spontaneously breathing rats.

Methods: Wistar rats were randomized to receive either intraperitoneal lipopolysaccharides (LPS) or saline, and intravenous infusion of NH4Cl (to induce metabolic acidosis and hyperventilation) or saline. Four groups were established: control-control (C-C), control-hyperventilation (C-HV), LPS-control (LPS-C), and LPS-hyperventilation (LPS-HV).

Long-term prognostic factors and outcomes in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes: a clinical and biochemical marker analysis.

Background: MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes) is a common subtype of mitochondrial encephalomyopathy. However, few studies have explored the relationship between biochemical markers and prognosis. This study aimed to explore the relationship between clinical and biochemical markers and prognosis of patients with MELAS.

[Uncommon Yet Severe: Metabolic Acidosis from Concurrent Use of Paracetamol and Flucloxacillin].

A 60-year-old polymorbid patient developed severe metabolic acidosis during weeks of treatment with flucloxacillin and paracetamol. The acidosis was triggered by an accumulation of 5-oxoproline due to pre-existing risk factors for glutathione deficiency as well as a ketoacidosis due to starvation. After treatment with N-acetylcysteine and hemofiltration, the acidosis completely resolved.

Ischemic and Hemorrhagic Brain Damage in Methanol Poisoning: A Case of Rapid Deterioration.

BACKGROUND Methanol is a toxic alcohol that is often ingested accidentally or intentionally. Its metabolites can induce severe visual disturbances, metabolic acidosis, and neurological dysfunction, which can frequently become life-threatening. CASE REPORT A 44-year-old woman with a history of depression and alcohol use was hospitalized in the Intensive Care Unit after cardiopulmonary reanimation.

Management of diabetic keto-acidosis in adult patients admitted to intensive care unit: an ESICM-endorsed international survey.

Background: Guidelines for diabetic ketoacidosis (DKA) management are limited, resulting in varied practices. This study assessed Intensive Care Unit (ICU) admission criteria, fluid resuscitation, insulin therapy, and metabolic management in adult patients with DKA.

Methods: An international survey of ICU clinicians consisted of 39 items that focused on management of DKA and was endorsed by the European Society of the Intensive Care Medicine.

Methaemoglobinaemia in neonates with acute gastroenteritis: lethal, but curable.

Methaemoglobinaemia is a rare factor that can lead to cyanosis. The predominant cause of acquired methaemoglobinaemia is commonly attributed to anaesthetic agents. This case series presents three instances of acquired methaemoglobinaemia resulting from acute gastroenteritis caused by formula feeds.

Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial.

Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.

Materials And Methods: We performed a two-center, pilot, open-label, randomized trial.

Comparing survival and outcomes in isolated versus polytrauma-associated TBI: a retrospective cohort study.

Background: One in four patients with moderate to severe traumatic brain injury (TBI) also has other body district injuries (OBD). The impact of OBD on mortality and disability is debated. This study compared outcomes of TBI patients with polytrauma (p-TBI) versus isolated TBI (alone-TBI) and identified outcome determinants, focusing on survival time and prognosis.

Balanced Electrolyte Solutions Versus 0.9% Saline for Kidney Transplantation: An Updated Systematic Review and Meta-analysis.

Background: Perioperative intravenous fluids are administered to kidney transplant recipients to maintain hemodynamic stability and graft perfusion; however, the ideal fluid remains uncertain. Although 0.9% saline (saline) is commonly used, its high chloride content causes hyperchloremic metabolic acidosis and may increase the risks of delayed graft function (DGF) and hyperkalemia.

Simultaneous Treatment of Two Severe Acute Intoxication and Acute Kidney Injury.

Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban.

Exploring Hypoglycemic Ketoacidosis in Nondiabetic Patients on Tirzepatide: Is Starvation the Culprit?

BACKGROUND Tirzepatide is a long-acting glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist administered via subcutaneous injection for weight reduction and treating type 2 diabetes. CASE REPORT We report case series of hypoglycemic ketoacidosis after the use of tirzepatide to treat nondiabetic patients with obesity from Kuwait. The first case was a 29-year-old woman with a body mass index (BMI) of 32 kg/m² who developed abdominal pain and vomiting after increasing the dose to 5 mg subcutaneously in week 5 of treatment.

Pharmacological Nephroprotection in Chronic Kidney Disease Patients with Type 2 Diabetes Mellitus-Clinical Practice Position Statement of the Polish Society of Nephrology.

Both chronic kidney disease (CKD) and type 2 diabetes (T2D) are modern epidemics worldwide and have become a severe public health problem. Chronic kidney disease progression in T2D patients is linked to the need for dialysis or kidney transplantation and represents the risk factor predisposing to serious cardiovascular complications. In recent years, important progress has occurred in nephroprotective pharmacotherapy in CKD patients with T2D.

The Cardioprotective Effects of Nutritional Ketosis: Mechanisms and Clinical Implications.

Cardiovascular diseases (CVDs) persist as the primary cause of death worldwide, accounting for roughly 17.9 million fatalities each year. The prevalence of obesity, metabolic syndrome, and type 2 diabetes (key risk factors for CVD) continues to escalate at an alarming rate, necessitating novel therapeutic strategies to address this global health crisis.

Hepatic parenchymal hypoattenuation in dogs with diabetes mellitus on computed tomography consistent with hepatic steatosis.

Hypoattenuation of the liver, consistent with hepatic steatosis or lipidosis, has been reported in veterinary patients. In people, measuring CT hepatic attenuation is diagnostic for hepatic steatosis, and hypoattenuation of the liver is defined as absolute if less than 40 HU or relative if the liver is 10 HU less than the spleen. The purpose of this study is to describe hepatic parenchymal attenuation in dogs with diabetes mellitus with or without diabetic ketosis (DK) or diabetic ketoacidosis (DKA), using the above categorization for absolute and relative hypoattenuation, as with humans.

Clinical examination for identifying low-risk pregnancies suitable for expectant management beyond 40-41 gestational weeks: maternal and fetal outcomes.

Purpose: There is an ongoing discussion on whether the benefits of term elective labor induction outweigh its potential risks. This study evaluated the utility of a comprehensive clinical examination in identifying low-risk pregnancies suitable for expectant management beyond gestational age 40‒41 weeks and compared their outcomes with earlier labor induction by indication.

Methods: Pregnant women (n = 722) with ≥ 40 + 0 gestational weeks referred to a tertiary hospital were included in this prospective cohort.

Correction of hypoxic effects on target organs in pneumonia with phytotherapy.

Objectives: This study aims to investigate the molecular mechanisms of the combination of stellasterin, quercetin, and kaempferol - components of the phytopreparation ginseng (trade name Panax) - in the treatment of tissue hypoxia occurring in patients with viral and bacterial pneumoni.

Methods: An analytical single-center method of network pharmacology was utilized, involving 110 individuals divided into two subgroups: placebo and Panax phytopreparation. The therapy course lasted 2 months, after which physical (forced vital capacity, respiratory volume, oxygen saturation) and laboratory (total ATPase, Na+/K+-ATPase, glucose, leukocytes) parameters were evaluated.

Beyond ketosis: the search for the mechanism underlying SGLT2-inhibitor benefit continues.

Despite the impressive clinical benefits and widespread adoption of sodium glucose cotransporter 2 inhibitors (SGLT2i) to treat all classes of heart failure, their cardiovascular mechanisms of action are poorly understood. Proposed mechanisms range broadly and include enhanced ketogenesis, where the mild ketosis associated with SGLT2i use is presumed to be beneficial. However, in this issue of the JCI, carefully conducted metabolic flux studies by Goedeke et al.

Factors associated with intensive care unit admission due to diabetic ketoacidosis in adults: a validated predictive model.

Objective: The objective of this study was to develop a predictive model capable of determining the need for intensive care unit (ICU) admission of patients with diabetic ketoacidosis (DKA) during their assessment in the Emergency Department.

Methods: This is an observational study of consecutive cases including all adult patients diagnosed with DKA at a tertiary hospital between 2010 and 2024. Variables from medical history, physical examination, and laboratory tests at admission were collected and studied for their association with ICU admission.