Insulin Resistance and Portal Vein Thrombosis
Article Figures & Tables
Figures
- FIGURE 1.
Management of DKA with IV insulin during first 24 hours after admission. The patient presented with DKA, which was managed with IV insulin using the DKA Endotool software protocol (Monarch Medical Technologies, Charlotte, N.C.). Anion gap was closed within a few hours after IV insulin was started and remained normal throughout the course. IV dextrose saline was started when blood glucose dropped to <250 mg/dL, according to protocol. Dextrose saline was continued for ∼12 hours at a rate of 75 mL/hour and discontinued 2 hours before discontinuation of IV insulin.
- FIGURE 2.
CT scan of the abdomen with contrast. Complete thrombosis of main portal vein and right and left portal vein and hepatic branches. There were no abnormalities in liver or ascites. There was no mass or suspicion of malignancy.
- FIGURE 3.
Insulin requirement over time. The patient initially needed IV insulin at a high dose and was transitioned to a much lower dose of subcutaneous insulin after resolution of DKA. However, due to his high blood glucose level, IV insulin was started again for a few hours and then transitioned to a relatively higher dose of subcutaneous insulin.
- FIGURE 4.
CT scan of the abdomen with contrast. Although BMI is only in overweight range, CT showed visceral adiposity with relatively low subcutaneous adiposity. These findings are consistent with insulin resistance.
- FIGURE 5.
Prothrombotic risk in diabetes. IL-1, interleukin-1.
Tables
- TABLE 1.
Admission Laboratory Values
Test (Reference Range) Result White blood count, K/μL (4.5–11.0) 24.10 Neutrophil, % (NA) 91 Glucose, mg/dL (70–108) 418 Sodium, mg/dL (136–145) 127 Potassium, mEq/L (3.5–5.0) 4.7 Chloride, mEq/L (98–107) 89 Bicarbonate, mEq/L (23–31) 20 Blood urea nitrogen, mg/dL (8–36) 30 Creatinine, mg/dL (0.72–1.25) 1.83 Anion gap, mEq/L (4–12) 18 Calcium, mg/dL (8.4–10.2) 10.5 Phosphorus, mg/dL (2.3–4.7) 3.7 Beta-hydroxybutyrate, mg/dL (0.00–2.81) 25.14 PCO2, venous, mmHg (38–50) 33 PO2, venous, mmHg (30–50) 30 pH, venous (7.33–7.43) 7.43 Bicarbonate, venous, mEq/L (24–28) 22 - TABLE 2.
Liver Function Profile
Test (Reference Range) Result on Admission Result 3 Days Later Bilirubin, mg/dL (0.22–1.2) 2.4 1.3 Alkaline phosphatase, units/L (40–150) 174 148 Aspartate aminotransferase, units/L (5–34) 37 48 Alanine aminotransferase, units/L (0–55) 34 47 Protein, total, units/L (6.2–8.1) 10.4 8 Albumin, g/dL (3.2–4.6) 3.5 2.6 - TABLE 3.
Coagulopathy Profile, Autoimmune Profile, and Tumor Markers
Test Result Coagulopathy profile test (reference range) International normalized ratio 1.0 Prothrombin time, seconds (9.5–10.9) 10.7 Partial thromboplastin time, seconds (21.5–26.2) 22.8 Antithrombin III, % normal human pooled plasma (75–125) 89 Homocysteine, μmol/L (<11.4) 10.9 Protein C, % (70–180) 83 Protein S, total, % (70–140) 143 Protein S, free, % (57–171) 101 Dilute Russell’s viper venom time screen, seconds (≤45) 29 Autoimmune profile test (reference range) Antinuclear antibodies (<40) <40 IgA, mg/dL (101–645) 567 IgG, mg/dL (540–1,822) 1,884 IgM, mg/dL (22–240) 639 Tumor markers test (reference range) Carcinoembryonic antigen, ng/mL (<5.0) 2.6 Carbohydrate antigen 19-9, units/mL (<34) 6 Alpha-fetoprotein, ng/mL (<6.1) 1.2
