title: Pyruvate Dehydrogenase Activity Is Decreased in Emergency Department Patients With Diabetic Ketoacidosis.
abstract: The pyruvate dehydrogenase complex (PDH) is an essential enzyme in aerobic metabolism. Ketones are known to inhibit PDH activity, but the extent of this inhibition is unknown in patients with diabetic ketoacidosis (DKA).
  
  
  
  We enrolled adult patients presenting to the emergency department in hyperglycemic crisis. Patients were classified as DKA or hyperglycemia without ketoacidosis based on laboratory criteria. Healthy controls were also enrolled. PDH activity and quantity were measured in isolated peripheral blood mononuclear cells. We compared PDH values between groups and measured the relationship of PDH values to measures of acid-base status.
  
  
  
  Twenty-seven patients (17 with DKA) and 31 controls were enrolled. Patients with DKA had lower PDH activity and quantity compared to the two other groups. PDH activity was significantly correlated with serum bicarbonate and pH and inversely correlated with the anion gap.
  
  
  
  DKA is associated with greater suppression of PDH activity than hyperglycemia without ketoacidosis, and this is correlated with measures of acid-base status. Future studies may determine whether PDH depression plays a role in the pathophysiology of DKA and whether modification of PDH could decrease time to DKA resolution.
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.|The Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: The Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Berg
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Montissol
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sulmonte
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.|The Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Julia
authors.initials: J
authors.lastname: Balkema
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.|The Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wolfe
authors.affiliation: The Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX.|The Endocrine Service, Ben Taub General Hospital, Houston, TX.
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Liu
authors.affiliation: The Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.|The Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000328:Adult; D000368:Aged; D016883:Diabetic Ketoacidosis / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D007963:Leukocytes, Mononuclear / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D011768:Pyruvate Dehydrogenase Complex / Q000097:blood*
chemical_list: D011768:Pyruvate Dehydrogenase Complex