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P0621 EFFECTIVENESS OF INSULIN ASPART ON THE TREATMENT OF HYPERKALEMIA IN PATIENTS WITH DIABETIC RENAL FAILURE
S204
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Discussion & conclusion: Prevalence of DM in stroke patients in the literature varies between 2-7%, even though we found a higher prevalence (25%). Therefore we would like to emphasize the importance of the DM in this condition. Diabetic men are younger at the onset of the stroke, what suggests that women could preserve protective factors against the stroke despite of the age. Accordingly,cardiovascular risk factors must be strictly controlled in this patients. Furthermore,it is noticeable that the lipid profile appears worst controlled in the diabetic group. Therefore,clinicians must implement blood pressure and lipidic control,as dislipydemia is poorly controlled in diabetics in our population. Finally,this study illustrates how the diabetic patient must be managed in an integral way, not only in the glycemic control but in the assessment of all the cardiovascular risk factors. Keywords: Diabetes, Stroke
P0620 THYROID FUNCTION ABNORMALITIES IN PATIENTS WITH DIFFERENT SEVERITY OF LIVER CIRRHOSIS ACCORDING TO THE CHILD-PUGH CLASSIFICATION SYSTEM
Homayoun Sheikholeslami 1 , Farzaneh Minou 1 , Amir Ziaee 1 , Navid Mohammadi 2 , Camellia Kani 1 . 1 Department of Internal Medicine, Boali Sina Hospital, Qazvin University of Medical Sciences; 2 Department of Community Medicine, Faculty of Medicine, Qazvin University of Medical Sciences Introduction: The liver plays an important role in thyroid hormone metabolism being involved in their conjugation, excretion, peripheral T4 to T3 conversion via 5’-deiodination and in synthesis of thyroid hormone carrier protein (thyroxine-binding globulin, transthyretin and albumin). Abnormalities in thyroid function tests vary based on the type and severity of hepatic dysfunction. Objectives: The current study aimed to investigate changes in thyroid hormone metabolism in patients with different severity of liver cirrhosis according to the Child-Pugh classification system. Materials & methods: Seventy three consecutive patients (38 men, 35 women; mean age: 63.6±8.9, range: 31-80) with histologically diagnosed cirrhosis were enrolled in this study. Total and free T3 and T4, T3RU, and thyroid-stimulating hormone (TSH) levels were measured. Diagnosis of low T3 variant of sick euthyroid syndrome was established when there was only T3 decrease and normal serum T4, free T4 (fT4), and TSH levels. Results: Low T3 syndrome was identified in 67% of patients, 10 patients (47.6%) with Child grade A, 18 (62.1%) with Child grade B, and 21 patients (91.3%) with Child grade C (p=.007). The post hoc analysis of the patients revealed that those with Child grade C have significantly lower serum T3 levels than patients with Child grade B and A (.65±.29 versus 1.12±.54, and 1.17±.53, respectively, p=.001). Serum T3 levels positively correlated with serum albumin levels (r=0.25, p=.03). The progression of liver cirrhosis from Child grade A to Child grade C was accompanied by a significant increase in serum fT4 levels, but within normal ranges (14.8±3.66, 15.4±3.19, and 18.02±4.10, respectively, þ=.009. Discussion & conclusion: Although, there are several aberrations in thyroid function tests in liver cirrhosis, euthyroidism is maintained, presumably as a result of low-normal fT3 and high normal fT4. The reason for the disparity between normal total T4 and increased fT4 concentrations in liver cirrhosis is not clearly understood. Inclusion of fT3 and ft4 may improve the predictive power of the Child-Pugh score. A prospective validation of the newly defined scores needs to be performed in the future. Keywords: Thyroid function,Liver cirrhosis,Child-Pugh score
P0621 EFFECTIVENESS OF INSULIN ASPART ON THE TREATMENT OF HYPERKALEMIA IN PATIENTS WITH DIABETIC RENAL FAILURE
Refik Demirtunc, Gul Babacan Abanonu, Hilal Guner Upcin. Department of Internal Medicine, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Introduction: Hyperkalemia is a potentially life –threatening complication that can frequently be seen in chronic renal failure. The most effective treatment of severe hyperkalemia in patients with end-stage renal disease is removal of potassium from the body via hemodialysis. Since there may be 2-3 hours delay between detection of hyperkalemia and administration of hemodialysis; medical therapies that help transferring of K into the cells should be administered firstly. Among these medical therapies, regular insulin-dextrose infusion therapy is well-known and most used one. On the
other hand rapid-acting insulin analogues are begining to be used routinely in diabetes treatment since they have a shorter time for onset of action, have less hypoglycemic effect and more physiological action. At present there is no clinical study that demonstrates the effect of insulin analogues to the plasma potassium level. Objectives: In this study we investigated the effect of insulin aspart (a rapid acting insulin analogue) on plasma potassium level by comparing with regular insulin. Materials & methods: A prospective, double blind, randomized, caseelective, single-center study. Thirty seven patients, who have diabetic chronic renal failure, a plasma potassium level between 5,0 mEq/L and 7,0 mEq/L, age between 38 and 75 years were randomized into two groups. First group (Group I; n:19; women:11 men:8; age between 43-75; mean age: 63.7) was given insulin aspart and 10% dextrose 50cc; whereas the second group (Group II; n:18; women: 11 men:7; age between 38-75; mean age: 61.5) was given regular insulin and 10% dextrose 50cc. Plasma potassium and glucose levels were measured at 0th-5th-15th-30th-60th-120th minutes for both groups. There was no statistically significant difference between two groups according to the baseline plasma potassium, glucose and sodium levels. Results: In Group I, a significant decreases in potassium levels was observed at 5th-15th-30th-60th and 120th minutes with respect to baseline. In Group II there were significant decreases in potassium levels at 15th-30th-60th and 120th minutes too. At 5th minute there was still a decrease in potassium level in Group II but it was not statistically significant (p:0,172). Discussion & conclusion: In this study, we demonstrated that insulin aspart could decrease potassium level as well as regular insulin in diabetic end- stage renal patients. The action of insulin aspart started much earlier than regular insulin. We are considering that this early action is very essential for urgent treatment of life threatening hyperkalemia. Further studies will be necessary to extend our result to a larger population. Keywords: hyperkalemia, rapid-acting insulin analogues, insulin aspart, endstage renal disease
P0622 SERUM RESISTIN AND ADIPONECTIN LEVELS IN YOUNG NON-OBESE WOMEN WITH PCOS
Senay Arikan 1 , Mithat Bahceci 1 , Alpaslan Tuzcu 1 , Ebru Kale 2 , Deniz Gokalp 1 . 1 Department of Endocrinology and Metabolism, Dicle University, Faculty of Medicine, Diyarbakir, Turkey; 2 Department of Biochemistry, Dicle University, Faculty of Medicine, Diyarbakir, Turkey Introduction: Although polycystic ovary syndrome (PCOS) was described more than half a century ago, the underlying cause of PCOS is still unknown. Objectives: The aim of our study to evaluate whether serum resistin and adipoytokine levels alter and its changes relate with low grade inflammation in non-obese young PCOS women. Materials & methods: Newly diagnosed thirty-one young non-obese women with PCOS (mean age 21.8±5.4 yr; body mass index (BMI): 23.8±6.6 kg/m2 ) and 25 BMI- and age matched, regular-cycling, healthy women (mean age 24.9±5.7 yr; BMI: 24.6±5.8 kg/m2 ) were included the study. Anthropometric measurements were evaluated. Resistine, adiponectin, glucose, insulin, hormone profiles, Lp (a), hs-CRP, and homocysteine levels were measured in the beginning of OGTT. HOMA-IR was calculated. Results: Non-obese young women with PCOS had high adiponectin levels (28.01±6.47 ng/mL in PCOS vs. 23.89±7.70 ng/mL in control subjects, p=0.034), whereas serum resistin levels were not significantly different compared with health controls (14.14±6.6 ng/mL in PCOS vs. 13.78±4.26 ng/mL in control subject). There were no significant differences between two groups in terms of fasting insulin, Lp(a), homocysteine and hs-CRP levels. Mean HOMA-IR value of PCOS patients were similar with control subjects (1.93±0.73 in PCOS; 1.15±0.54 in control group). Discussion & conclusion: Resistin levels did not change in non-obese young women with PCOS whereas adiponectin level in non-obese young women with PCOS was significantly higher than control subjects, perhaps, because of no insulin resistance. Circulating resistin levels may not be candidate to play a role in pathogenesis of PCOS without insulin resistance or obesity. Keywords: Polycystic ovary syndrome, adiponectin, resistin
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Discussion & conclusion: Prevalence of DM in stroke patients in the literature varies between 2-7%, even though we found a higher prevalence (25%). Therefore we would like to emphasize the importance of the DM in this condition. Diabetic men are younger at the onset of the stroke, what suggests that women could preserve protective factors against the stroke despite of the age. Accordingly,cardiovascular risk factors must be strictly controlled in this patients. Furthermore,it is noticeable that the lipid profile appears worst controlled in the diabetic group. Therefore,clinicians must implement blood pressure and lipidic control,as dislipydemia is poorly controlled in diabetics in our population. Finally,this study illustrates how the diabetic patient must be managed in an integral way, not only in the glycemic control but in the assessment of all the cardiovascular risk factors. Keywords: Diabetes, Stroke
P0620 THYROID FUNCTION ABNORMALITIES IN PATIENTS WITH DIFFERENT SEVERITY OF LIVER CIRRHOSIS ACCORDING TO THE CHILD-PUGH CLASSIFICATION SYSTEM
Homayoun Sheikholeslami 1 , Farzaneh Minou 1 , Amir Ziaee 1 , Navid Mohammadi 2 , Camellia Kani 1 . 1 Department of Internal Medicine, Boali Sina Hospital, Qazvin University of Medical Sciences; 2 Department of Community Medicine, Faculty of Medicine, Qazvin University of Medical Sciences Introduction: The liver plays an important role in thyroid hormone metabolism being involved in their conjugation, excretion, peripheral T4 to T3 conversion via 5’-deiodination and in synthesis of thyroid hormone carrier protein (thyroxine-binding globulin, transthyretin and albumin). Abnormalities in thyroid function tests vary based on the type and severity of hepatic dysfunction. Objectives: The current study aimed to investigate changes in thyroid hormone metabolism in patients with different severity of liver cirrhosis according to the Child-Pugh classification system. Materials & methods: Seventy three consecutive patients (38 men, 35 women; mean age: 63.6±8.9, range: 31-80) with histologically diagnosed cirrhosis were enrolled in this study. Total and free T3 and T4, T3RU, and thyroid-stimulating hormone (TSH) levels were measured. Diagnosis of low T3 variant of sick euthyroid syndrome was established when there was only T3 decrease and normal serum T4, free T4 (fT4), and TSH levels. Results: Low T3 syndrome was identified in 67% of patients, 10 patients (47.6%) with Child grade A, 18 (62.1%) with Child grade B, and 21 patients (91.3%) with Child grade C (p=.007). The post hoc analysis of the patients revealed that those with Child grade C have significantly lower serum T3 levels than patients with Child grade B and A (.65±.29 versus 1.12±.54, and 1.17±.53, respectively, p=.001). Serum T3 levels positively correlated with serum albumin levels (r=0.25, p=.03). The progression of liver cirrhosis from Child grade A to Child grade C was accompanied by a significant increase in serum fT4 levels, but within normal ranges (14.8±3.66, 15.4±3.19, and 18.02±4.10, respectively, þ=.009. Discussion & conclusion: Although, there are several aberrations in thyroid function tests in liver cirrhosis, euthyroidism is maintained, presumably as a result of low-normal fT3 and high normal fT4. The reason for the disparity between normal total T4 and increased fT4 concentrations in liver cirrhosis is not clearly understood. Inclusion of fT3 and ft4 may improve the predictive power of the Child-Pugh score. A prospective validation of the newly defined scores needs to be performed in the future. Keywords: Thyroid function,Liver cirrhosis,Child-Pugh score
P0621 EFFECTIVENESS OF INSULIN ASPART ON THE TREATMENT OF HYPERKALEMIA IN PATIENTS WITH DIABETIC RENAL FAILURE
Refik Demirtunc, Gul Babacan Abanonu, Hilal Guner Upcin. Department of Internal Medicine, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Introduction: Hyperkalemia is a potentially life –threatening complication that can frequently be seen in chronic renal failure. The most effective treatment of severe hyperkalemia in patients with end-stage renal disease is removal of potassium from the body via hemodialysis. Since there may be 2-3 hours delay between detection of hyperkalemia and administration of hemodialysis; medical therapies that help transferring of K into the cells should be administered firstly. Among these medical therapies, regular insulin-dextrose infusion therapy is well-known and most used one. On the
other hand rapid-acting insulin analogues are begining to be used routinely in diabetes treatment since they have a shorter time for onset of action, have less hypoglycemic effect and more physiological action. At present there is no clinical study that demonstrates the effect of insulin analogues to the plasma potassium level. Objectives: In this study we investigated the effect of insulin aspart (a rapid acting insulin analogue) on plasma potassium level by comparing with regular insulin. Materials & methods: A prospective, double blind, randomized, caseelective, single-center study. Thirty seven patients, who have diabetic chronic renal failure, a plasma potassium level between 5,0 mEq/L and 7,0 mEq/L, age between 38 and 75 years were randomized into two groups. First group (Group I; n:19; women:11 men:8; age between 43-75; mean age: 63.7) was given insulin aspart and 10% dextrose 50cc; whereas the second group (Group II; n:18; women: 11 men:7; age between 38-75; mean age: 61.5) was given regular insulin and 10% dextrose 50cc. Plasma potassium and glucose levels were measured at 0th-5th-15th-30th-60th-120th minutes for both groups. There was no statistically significant difference between two groups according to the baseline plasma potassium, glucose and sodium levels. Results: In Group I, a significant decreases in potassium levels was observed at 5th-15th-30th-60th and 120th minutes with respect to baseline. In Group II there were significant decreases in potassium levels at 15th-30th-60th and 120th minutes too. At 5th minute there was still a decrease in potassium level in Group II but it was not statistically significant (p:0,172). Discussion & conclusion: In this study, we demonstrated that insulin aspart could decrease potassium level as well as regular insulin in diabetic end- stage renal patients. The action of insulin aspart started much earlier than regular insulin. We are considering that this early action is very essential for urgent treatment of life threatening hyperkalemia. Further studies will be necessary to extend our result to a larger population. Keywords: hyperkalemia, rapid-acting insulin analogues, insulin aspart, endstage renal disease
P0622 SERUM RESISTIN AND ADIPONECTIN LEVELS IN YOUNG NON-OBESE WOMEN WITH PCOS
Senay Arikan 1 , Mithat Bahceci 1 , Alpaslan Tuzcu 1 , Ebru Kale 2 , Deniz Gokalp 1 . 1 Department of Endocrinology and Metabolism, Dicle University, Faculty of Medicine, Diyarbakir, Turkey; 2 Department of Biochemistry, Dicle University, Faculty of Medicine, Diyarbakir, Turkey Introduction: Although polycystic ovary syndrome (PCOS) was described more than half a century ago, the underlying cause of PCOS is still unknown. Objectives: The aim of our study to evaluate whether serum resistin and adipoytokine levels alter and its changes relate with low grade inflammation in non-obese young PCOS women. Materials & methods: Newly diagnosed thirty-one young non-obese women with PCOS (mean age 21.8±5.4 yr; body mass index (BMI): 23.8±6.6 kg/m2 ) and 25 BMI- and age matched, regular-cycling, healthy women (mean age 24.9±5.7 yr; BMI: 24.6±5.8 kg/m2 ) were included the study. Anthropometric measurements were evaluated. Resistine, adiponectin, glucose, insulin, hormone profiles, Lp (a), hs-CRP, and homocysteine levels were measured in the beginning of OGTT. HOMA-IR was calculated. Results: Non-obese young women with PCOS had high adiponectin levels (28.01±6.47 ng/mL in PCOS vs. 23.89±7.70 ng/mL in control subjects, p=0.034), whereas serum resistin levels were not significantly different compared with health controls (14.14±6.6 ng/mL in PCOS vs. 13.78±4.26 ng/mL in control subject). There were no significant differences between two groups in terms of fasting insulin, Lp(a), homocysteine and hs-CRP levels. Mean HOMA-IR value of PCOS patients were similar with control subjects (1.93±0.73 in PCOS; 1.15±0.54 in control group). Discussion & conclusion: Resistin levels did not change in non-obese young women with PCOS whereas adiponectin level in non-obese young women with PCOS was significantly higher than control subjects, perhaps, because of no insulin resistance. Circulating resistin levels may not be candidate to play a role in pathogenesis of PCOS without insulin resistance or obesity. Keywords: Polycystic ovary syndrome, adiponectin, resistin