| Chapter title |
Defect of Cobalamin Intracellular Metabolism Presenting as Diabetic Ketoacidosis: A Rare Manifestation.
|
|---|---|
| Chapter number | 220 |
| Book title |
JIMD Reports - Volume 11
|
| Published in |
JIMD Reports, April 2013
|
| DOI | 10.1007/8904_2013_220 |
| Pubmed ID | |
| Book ISBNs |
978-3-64-237327-5, 978-3-64-237328-2
|
| Authors |
Sheetal Sharda, Suresh Kumar Angurana, Mandeep Walia, Savita Attri |
| Editors |
Johannes Zschocke, K Michael Gibson, Garry Brown, Eva Morava, Verena Peters |
| Abstract |
Hypoglycemia is the usual feature of commonly occurring organic acidemias. Organic acidemias manifesting as hyperglycemia or diabetic ketoacidosis are rare and only a few cases have been reported. We report a 13-month-old boy who presented with vomiting, dehydration, coma, hyperglycemia, high anion gap metabolic acidosis and ketosis, mimicking diabetic ketoacidosis (DKA). Treatment with parenteral fluid, electrolytes, and insulin infusion resulted in an improvement in hyperglycemia, but persistence of metabolic acidosis and lack of improvement of neurologic status led us to suspect an organic acidemia. Urinary organic acid analysis revealed increased methylmalonic acid levels. In addition, hyperhomocysteinemia and homocystinuria were also noted in presence of normal vitamin B12 levels. This confirmed the diagnosis of cobalamin metabolism defect leading to combined methylmalonic aciduria and homocystinuria. There was some improvement in neurologic status and metabolic parameters after treatment with low-protein diet, vitamin B12, folic acid, and L-carnitine, but he ultimately succumbed to polymicrobial nosocomial sepsis. The entire MMACHC gene of the patient was sequenced and no mutations were identified. This is probably the first case report of cobalamin intracellular metabolism defect (CblC/CblD/CblF/CblJ or ABCD4) presenting as diabetic ketoacidosis. |
X Demographics
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| Country | Count | As % |
|---|---|---|
| Hungary | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 19 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 4 | 21% |
| Student > Ph. D. Student | 3 | 16% |
| Researcher | 3 | 16% |
| Student > Master | 3 | 16% |
| Student > Doctoral Student | 1 | 5% |
| Other | 3 | 16% |
| Unknown | 2 | 11% |
| Readers by discipline | Count | As % |
|---|---|---|
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| Agricultural and Biological Sciences | 3 | 16% |
| Nursing and Health Professions | 2 | 11% |
| Arts and Humanities | 1 | 5% |
| Other | 3 | 16% |
| Unknown | 1 | 5% |