Acidosis: The Prime Determinant of Depressed Sensorium in Diabetic Ketoacidosis

OBJECTIVE — The etiology of altered sensorium in diabetic ketoacidosis (DKA) remains unclear. Therefore, we sought to determine the origin of depressed consciousness in DKA. RESEARCH DESIGN AND METHODS — We analyzed retrospectively clinical and biochemical data of DKA patients admitted in a community teaching hospital. RESULTS — We recorded 216 cases, 21 % of which occurred in subjects with type 2 diabetes. Mean serum osmolality and pH were 304 31.6 mOsm/kg and 7.14 0.15, respectively. Acidosis emerged as the prime determinant of altered sensorium, but hyperosmolarity played a synergistic role in patients with severe acidosis to precipitate depressed sensorium (odds ratio 2.87). Combination of severe acidosis and hyperosmolarity predicted altered consciousness with 61 % sensitivity and 87 % specificity. Mortality occurred in 0.9 % of the cases. CONCLUSIONS — Acidosis was independently associated with altered sensorium, but hy-perosmolarity and serum “ketone ” levels were not. Combination of hyperosmolarity and acidosis predicted altered sensorium with good sensitivity and specificity. Diabetes Care 33:1837–1839, 2010 D iabetic ketoacidosis (DKA) is fre-quently associated with alteredmental status, which is correlated with the severity of the disease and prog-nosis (1). However, the etiology of de-pressed sensorium in DKA remains uncertain and controversial (2,3). Puta-tive factors in the pathogenesis of diabetic ketoacidotic coma include cerebral hypo-perfusion due to circulatory collapse and cerebral thrombosis (4), reduced cerebral glucose and oxygen utilization (1,5), aci-dosis (6,7), hyperosmolarity (8,9), and direct toxic effect of ketone bodies (2). Cerebral edema remains an important precipitant of altered consciousness in DKA, especially in children. Different studies have yielded con-flicting results regarding the role of these etiologic factors in the pathogenesis of al-tered mentation in patients with DKA. Hence, the origin of clouded sensorium in DKA remains to be fully elucidated. We undertook to study the etiology of de-pressed consciousness in patients admit-ted with DKA at the Regional Medica

IS THE CURRENT SYSTEM OF SCIENTIFIC COMMUNICATION ADEQUATE TO THE AGE OF PLASMID ENGINEERING?

In order to deal with both the general problem of scientific information, as well as the specific problem of information on Recombinant DNA, we have divided our paper into two parts. The first part will deal with the problem of information retrieval and the second will outline some of the special sources on plasmids not published in available journals. In order for scientists to function effectively today, they must have the asstirance that they are aware of all research which may have some bearing on their activities. Whether the topic is antibiotic resistance in bacteria, cloning of unnatural molecules, recombinant DNA or any other aspect of science, we must insure that maximum advantage is taken of the new methods that have been developed in the past decade for general and selective dissemination of information. Undoubtedly, the import of this assertion is of greatest significance to our scientific colleagues throughout the underdeveloped world. For a variety of reasons, many of them may not have been exposed to many of these more modern methods. The reasons why scientists in many countries have not had the benefits of these new services are fundamentally economic and political. Scientific information disseminatio

Nutritional Efficiency of Forest Species in Natural Regeneration of Tropical Forest in Brazil

The knowledge of the nutritional aspects of native species, mainly in natural regeneration, may be important for understanding their establishment, particularly in areas with low nutrient availability soils, such as tropical soils. This study aimed to determine the biological utilization efficiency (BUE) of the nutrients N, P, K, Ca, and Mg of forest species of natural regeneration in a Lowlands Dense Ombrophilous forest fragment in Pernambuco, Brazil. A phytosociological study of the fragment was carried out and were defined the ten species with the highest absolute density (AD). Three individuals per species were selected. The N, P, K, Ca, and Mg contents were determined in the sample leaves of the species, and the foliar biomass was determined “in loco”. Nine individuals of each species were collected according to the following diameter intervals at the base (DBs): DBsMg>K>Ca>N. The highest BUE of nutrients was of the species Protium heptaphyllum. In tropical soils of low natural fertility, the use of these species can be recommended in environmental reforestation projects. The difference in the nutritional demand of the forest species can indicate the planting of those with greater capacity of absorption and BUE of nutrients, being more efficient in areas of soils with low natural fertility like in the tropical forests