1.
Lactation ketoacidosis: case presentation and literature review.
Al Alawi, AM, Falhammar, H
BMJ case reports. 2018
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Abstract
A 35-year-old woman presented to the emergency department with a 2 days history of malaise and headache. She was breastfeeding her 5-month old infant and had recently started an altered diet based on reducing carbohydrate amount. Moreover, she had also started exercising 2 weeks prior to her illness. Initial blood tests revealed high anion gap metabolic acidosis and hypoglycaemia (pH 7.13 (normal 7.30-7.40), bicarbonate 9.4 mmol/L (normal 21.0-28.0), anion gap 22.6 mmol/L (normal 8-12), glucose 2.9 mmol/L (normal fasting 3.9-5.8) and ketones 6.4 mmol/L (normal <0.6)). The patient was treated with intravenous dextrose and showed complete resolution of ketoacidosis and hypoglycaemia within 48 hours. She was discharged home and remained well with a balanced diet. After excluding all other the causes of hypoglycaemia and ketoacidosis, the diagnosis of lactation ketoacidosis was made and it was considered triggered by altered diet, exercise and skipping meals. All 11 cases of lactation ketoacidosis which has previously been published are reviewed as well.
2.
Training for a 78-km solo open water swim.
Piacentini, MF, DE Ioannon, G, Cibelli, G, Mignardi, S, Antonelli, A, Capranica, L
The Journal of sports medicine and physical fitness. 2017;(6):790-793
Abstract
The purpose of the present study was to report the training of a master athlete in preparation to an ultra-marathon swimming event. For 32 weeks prior to a 78-km "solo" open water swim from Italy to Albania, a male long distance master (48 years) swimmer was monitored. Training volume was recorded as total time and distance while intensities were recorded according to international classifications utilizing the primary goal of the session method. Thereafter, time spent in the three training zones: Z1 (low intensity training), Z2 (threshold training) and Z3 (high intensity training) was calculated. Weekly swimming volume ranged from 15 to 70 km.week-1 and training frequency ranged from 3 to 6 days.week-1. Total weekly training dedicated to swimming ranged from 270 to 1140 min. Training intensity comprised Z1=64%. Z2=28%, and Z3=8%, respectively. During the three-week taper period, total swimming volume decreased by 43% while intensity remained unchanged. The athlete succeeded in being the first swimmer to accomplish the event. These findings provide useful information for coaches on training regimens of master ultra-marathon swimmers. Compared to the literature, time spent at a Z1 training intensity was lower in favor of that spent in Z2. It could be speculated that master ultra-marathon athletes might benefit from training intensities at or above LT to counterbalance the age-related physiological decrease.
3.
Recurrent nightly ketosis after prolonged exercise in type 1 diabetes - the need for glycogen replacement strategies. Case report and review of literature.
van Albada, ME, Bakker-van Waarde, WM
Pediatric diabetes. 2016;(7):531-534
Abstract
Exercise in diabetes patients has many benefits but also several risks, of which hypoglycemia is most often discussed. We present a case with recurrent keto-acidosis post-exercise, in which we hypothesize that glycogen replacement strategies were insufficient. Our experience in this case and review of the literature emphasize the importance of discussing glycogen replacement strategies with your diabetic athletes.
4.
Cardiovascular considerations in middle-aged athletes at risk for coronary artery disease.
Reamy, BV, Ledford, CC
Current sports medicine reports. 2013;(2):70-6
Abstract
Cardiovascular disease remains the leading cause of death in the United States despite a 50% decrease in deaths from myocardial infarction and stroke in the past 30 years associated with improvements in blood pressure and lipid control. The National Health and Nutrition Evaluation Survey found that the least prevalent metrics of cardiovascular health in adults were healthy diets, normal weights, and optimal levels of exercise. A further reduction in rates of cardiovascular disease will require an increase in exercise. Clinicians who encourage exercise in middle-aged patients face several dilemmas. This article reviews exercise-related risks for sudden death and the performance of a global cardiovascular risk assessment. The need for additional preexercise risk stratification with electrocardiogram, graded exercise testing, or echocardiography is outlined. In addition, the optimum choice of medications for hypertension or dyslipidemia treatment and the effects of these medications and aspirin on endurance exercise are reviewed.
5.
Exercise-induced serum enzyme elevations confounding the evaluation of investigational drug toxicity. Report of two cases in a vaccine trial.
Johnson, C, Monath, TP, Kanesa-Thasan, N, Mathis, D, Miller, C, Shapiro, S, Nichols, R, McCarthy, K, Deary, A, Bedford, P
Human vaccines. 2005;(1):24-9
Abstract
Two subjects developed marked elevations in creatine kinase and other serum enzymes associated with mild myalgia during a randomized, double-blind, controlled Phase 1 clinical trial of an investigational live, attenuated vaccine against West Nile virus (ChimeriVax-WN02). One subject had received ChimeriVax-WN02 while the other subject was enrolled in an active control group and received licensed yellow fever 17D vaccine (YF-VAX). Subsequently, the clinical trial was interrupted, and an investigation was begun to evaluate the enzyme abnormalities. As daily serum samples were collected for determination of quantitative viremia, it was possible to define the enzyme elevations with precision and to relate these elevations to physical activity of the subjects, symptoms, and virological and serological measurements. Evaluation of both subjects clearly showed that skeletal muscle injury, and not cardiac or hepatic dysfunction, was responsible for the biochemical abnormalities. This investigation also implicated strenuous exercise as the cause of the apparent muscle injury rather than the study vaccines. As a result of this experience, subjects engaged in future early-stage trials of these live, attenuated viral vaccines will be advised not to engage in contact sports or new or enhanced exercise regimens for which they are not trained or conditioned. The inclusion of placebo control arm (in lieu of or addition to an active vaccine control) will also be useful in differentiating causally related serum enzyme elevations.