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The Veterinary Clinics of North... Mar 2017Diabetic ketoacidosis is a dynamic disease that requires regular reassessment of an affected patient. Typical treatment regimens include crystalloid fluid therapy,... (Review)
Review
Diabetic ketoacidosis is a dynamic disease that requires regular reassessment of an affected patient. Typical treatment regimens include crystalloid fluid therapy, insulin, and supplementation of dextrose, phosphorus, and potassium. This article presents an approach to and considerations for treatment of a diabetic ketoacidotic dog or cat.
Topics: Animals; Cat Diseases; Cats; Diabetic Ketoacidosis; Dog Diseases; Dogs; Electrolytes; Fluid Therapy; Hypoglycemic Agents; Insulin; Water-Electrolyte Imbalance
PubMed: 28017407
DOI: 10.1016/j.cvsm.2016.09.012 -
BMJ (Clinical Research Ed.) Oct 2015
Review
Topics: Administration, Cutaneous; Adult; Bicarbonates; Blood Glucose; Diabetic Ketoacidosis; Fluid Therapy; Humans; Hypoglycemic Agents; Insulin; Ketones; Monitoring, Physiologic; Potassium; Practice Guidelines as Topic; Risk Factors
PubMed: 26510442
DOI: 10.1136/bmj.h5660 -
Heart Failure Clinics Oct 2022SGLT2 inhibitors (SGLT2i) are effective in the management of diabetes and in reducing adverse cardiovascular and renal outcomes. Randomized clinical trials demonstrated... (Review)
Review
SGLT2 inhibitors (SGLT2i) are effective in the management of diabetes and in reducing adverse cardiovascular and renal outcomes. Randomized clinical trials demonstrated safety and tolerability in older adults. Adverse effects associated with SGLT2i are impacted by patient frailty, comorbidities, and concomitant medication use and, therefore, must be thoroughly evaluated before initiating treatment. The risk of volume depletion, hypoglycemia, genital infections, and diabetic ketoacidosis can be minimized by appropriate patient selection, patient education, and early symptom recognition. Limited data exists regarding the risk of urinary tract infections, fractures, and amputations in the elderly treated with SGLT2i and routine monitoring is recommended.
Topics: Aged; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Humans; Hypoglycemia; Hypoglycemic Agents; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 36216492
DOI: 10.1016/j.hfc.2022.03.002 -
Medicina (Kaunas, Lithuania) Mar 2022Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a... (Review)
Review
Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a consequence of disease progression or its treatment, in particular potassium disorders. The prevalence of hypokalemia in diabetic individuals over 55 years of age is up to 1.2%. In patients with acute complications of diabetes, such as diabetic ketoacidosis, this prevalence is even higher. Potassium disorders, either hypokalemia or hyperkalemia, have been associated with increased all-cause mortality in diabetic individuals, especially in those with associated comorbidities, such as heart failure and chronic kidney disease. In this article, we discuss the main conditions for the onset of hypokalemia in diabetic individuals, briefly review the pathophysiology of acute complications of diabetes mellitus and their association with hypokalemia, the main signs, symptoms, and laboratory parameters for the diagnosis of hypokalemia, and the management of one of the most common electrolyte disturbances in clinical practice.
Topics: Diabetes Mellitus; Diabetic Ketoacidosis; Heart Failure; Humans; Hyperkalemia; Hypokalemia; Prevalence
PubMed: 35334607
DOI: 10.3390/medicina58030431 -
Annals of Emergency Medicine Sep 2021
Review
Topics: Adolescent; Brain Edema; Child; Diabetic Ketoacidosis; Female; Fluid Therapy; Humans; Hypoglycemia; Infusions, Intravenous; Insulin; Male
PubMed: 33966934
DOI: 10.1016/j.annemergmed.2021.02.028 -
The New England Journal of Medicine Feb 2015
Review
Topics: Acid-Base Equilibrium; Bicarbonates; Brain Edema; Child; Diabetic Ketoacidosis; Fatty Acids; Humans; Mitochondria; Osmolar Concentration; Oxidation-Reduction; Sodium Bicarbonate
PubMed: 25651248
DOI: 10.1056/NEJMra1207788 -
Journal of Osteopathic Medicine Sep 2023Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year.... (Review)
Review
CONTEXT
Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.
OBJECTIVES
The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to identify the frequency of endocrinology or diabetology consultation in the hospital setting.
METHODS
A retrospective chart review was conducted utilizing charts from three different hospitals within a hospital system. Charts were identified utilizing ICD-10 codes for admissions to the hospital for DKA. If the patient was over 18 and had one of the diagnostic codes of interest, the chart was reviewed for further details regarding the criteria for DKA diagnosis as well as admission and treatment details.
RESULTS
A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4 % of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. Most patients were admitted to the intensive care unit (ICU) and treated with IV insulin infusion (n=288). Consultation of endocrinology or diabetology occurred in 40.2 % (n=209) of all hospital admissions, and 128 of those consults occurred in ICU admissions. The diagnosis of DKA was incorrect in 92 of the patients admitted to the medical surgical unit (MSU) and in 49 of patients admitted to the ICU.
CONCLUSIONS
Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.
Topics: Humans; Diabetic Ketoacidosis; Retrospective Studies; Emergencies; Blood Glucose Self-Monitoring; Blood Glucose; Hospitals; Insulins; Diabetes Mellitus
PubMed: 37406169
DOI: 10.1515/jom-2023-0019 -
The Journal of Emergency Medicine Sep 2020Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that presents commonly to the emergency department. Severe DKA has the potential for significant morbidity and... (Review)
Review
BACKGROUND
Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that presents commonly to the emergency department. Severe DKA has the potential for significant morbidity and mortality if not recognized early and treated appropriately. It is incumbent on the emergency clinician to be vigilant in the management of these critically ill patients.
OBJECTIVE
This narrative review evaluates the emergency medicine management of the adult patient with severe DKA.
DISCUSSION
DKA is a condition found most commonly in patients with insulin-dependent diabetes, often due to nonadherence with diabetic medications or an inciting event, such as infection or ischemia. The severity of DKA is classified based on the level of acidosis present rather than absolute glucose level. The management of severe DKA involves assessing and treating the inciting event, fluid hydration, insulin, and potassium repletion. Close monitoring is necessary to prevent the complications that can occur.
CONCLUSIONS
DKA is a medical condition that has the potential for significant morbidity and mortality if not recognized and managed appropriately.
Topics: Acidosis; Adult; Critical Illness; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Humans; Insulin
PubMed: 32763063
DOI: 10.1016/j.jemermed.2020.06.059 -
Diabetes Care Dec 2021Certain chronic comorbidities, including diabetes, are highly prevalent in people with coronavirus disease 2019 (COVID-19) and are associated with an increased risk of... (Review)
Review
Certain chronic comorbidities, including diabetes, are highly prevalent in people with coronavirus disease 2019 (COVID-19) and are associated with an increased risk of severe COVID-19 and mortality. Mild glucose elevations are also common in COVID-19 patients and associated with worse outcomes even in people without diabetes. Several studies have recently reported new-onset diabetes associated with COVID-19. The phenomenon of new-onset diabetes following admission to the hospital has been observed previously with other viral infections and acute illnesses. The precise mechanisms for new-onset diabetes in people with COVID-19 are not known, but it is likely that a number of complex interrelated processes are involved, including previously undiagnosed diabetes, stress hyperglycemia, steroid-induced hyperglycemia, and direct or indirect effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the β-cell. There is an urgent need for research to help guide management pathways for these patients. In view of increased mortality in people with new-onset diabetes, hospital protocols should include efforts to recognize and manage acute hyperglycemia, including diabetic ketoacidosis, in people admitted to the hospital. Whether new-onset diabetes is likely to remain permanent is not known, as the long-term follow-up of these patients is limited. Prospective studies of metabolism in the setting of postacute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.
Topics: COVID-19; Diabetes Mellitus; Diabetic Ketoacidosis; Humans; Hyperglycemia; Prospective Studies; SARS-CoV-2
PubMed: 34625431
DOI: 10.2337/dc21-1318 -
Acta Diabetologica Mar 2023To investigate the main feature and the association between euglycemic diabetic ketoacidosis (euDKA) /diabetic ketoacidosis (DKA) and sodium-dependent glucose...
AIMS
To investigate the main feature and the association between euglycemic diabetic ketoacidosis (euDKA) /diabetic ketoacidosis (DKA) and sodium-dependent glucose transporters 2 inhibitors (SGLT-2i) from the FDA adverse event reporting system (FAERS).
METHODS
Cases of SGLT-2i-associated with euDKA/DKA were extracted from the FAERS database and compared with the reports for other hypoglycemia agents (ATC10 class). Disproportionality analyses used the reporting odds ratio (ROR) and information components (IC). The lower limit of the IC 95% credibility interval for IC > 0 is considered a reported signal, with at least 3 cases.
RESULTS
A total of 10,195 cases of euDKA (n = 1680) and DKA (n = 8515) associated with SGLT-2i were identified from the FAERS. The SGLT-2i was associated with higher reporting of euDKA and DKA compared to other hypoglycemia agents (ROR = 16.69 [95% CI 14.89-18.70], IC = 3.27 [95% CI 2.91-3.66] for euDKA; ROR = 16.44 [95% CI 15.72-17.20], IC = 3.19 [95% CI 3.05-3.34] for DKA). In available data, the median onset time of euDKA/DKA was 31 days, and canagliflozin had the longest onset time (96.5 days for euDKA and 75 days for DKA) compared with dapagliflozin and empagliflozin (p < 0.05). Male patients predominate in euDKA (51.9%), and female patients predominate in DKA (53.7%). Most patients discontinue the treatment (95.5% for euDKA, 93.9% for DKA), and approximately 49.0% (n = 3658) of patients had symptomatic remission after discontinuation of SGLT-2i, and 2.3% (n = 173) of patients had no remission. About 75.6% (n = 6126) of patients need hospitalization after euDKA/DKA.
CONCLUSIONS
Post-marketing data showed that SGLT-2i was significantly associated with higher reporting of euDKA/DKA. Although euDKA/DKA is rare, clinicians should be aware of SGLT-2i-associated euDKA/DKA events.
Topics: Humans; Male; Female; Sodium-Glucose Transporter 2 Inhibitors; Diabetic Ketoacidosis; Diabetes Mellitus, Type 2; Pharmacovigilance; Hypoglycemic Agents; Hypoglycemia
PubMed: 36576563
DOI: 10.1007/s00592-022-02015-6