South Beach Diet associated ketoacidosis: a case report

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South Beach Diet associated ketoacidosis: a case report

Abstract Introduction It has been previously unclear whether a "mild" degree of low carbohydrate or "starvation" ketonemia and acidosis induced by a low carbohydrate diet is clinically relevant to a patient. Case presentation A 30-year-old Caucasian male on a low carbohydrate diet presented with nausea, vomiting and abdominal pain. The patient's bicarbonate level was 12 and he had hyperglycemia and ketonemia. He was felt to be in diabetic ketoacidosis and was started on intravenous insulin and isotonic saline infusions and responded well. Following cessation of insulin therapy, the patient remained normoglycemic for the remainder of his hospital stay. He later admitted to having been on the South Beach Diet, which is a low carbohydrate diet, for the three weeks prior to his presentation and during which time he had lost 16 pounds. On admission his BMI was 27.1. On presentation, the patient was felt to be in diabetic ketoacidosis but, interestingly, he was subsequently euglycemic without therapy. Following discharge, the patient discontinued the diet plan and he has remained asymptomatic and euglycemic over the following two years. Conclusion The hyperglycemic ketoacidosis in this patient may have been caused by increased concentrations of free fatty acids in the absence of carbohydrate-induced inhibition of beta-oxidation of fatty acids and in the presence of an abnormally high ratio of glucagons to insulin. Given the present day popularity of low-carbohydrate diet plans, healthcare providers should be aware of the apparent association between such diets and symptomatic ketoacidosis. In a patient with ketoacidosis suspected to be secondary to a low carbohydrate diet, all other causes of high anion gap acidosis should be ruled out before attributing the acidosis to the low carbohydrate diet.</p

Degradation and Metabolite Profiling of Benz (a) Anthracene, Dibenz (a, h) Anthracene and Indeno [1, 2, 3-cd] Pyrene by <i>Aspergillus terricola</i>

<p>Mycoremediation of low molecular weight polycyclic aromatic hydrocarbons (PAH) is well studied. This study highlights the degradation of high molecular weight PAH (HMW-PAHs): Benz (a) anthracene (BAA), Dibenz (a, h) anthracene (DBA), and Indeno pyrene (IND) by <i>Aspergillus terricola var americanus.</i> The metabolism of the HMW-PAHs by this fungus was investigated in liquid submerged culture added with 60 mg/L of each compound. Depletion of BAA, DBA, and IND was 94.80, 90.16, and 93.80%, respectively, after 10 days of culture. Fungal broth solvent extracts were analyzed for the presence of metabolites by gas chromatography mass spectrometry and the extracellular enzymes produced were also assayed. The coexistence of two metabolic pathways, cytochrome P450 monooxygenase and ligninolytic pathway were identified. A high laccase activity was observed in BAA cultures on day 4 when compared to other PAH's studied. In conclusion, <i>A. terricola</i> might be a promising fungus for bioremediation of HMW-PAH mixtures co-metabolically.</p