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JAAPA : Official Journal of the... Nov 2017
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Diagnosis, Differential; Humans; Symptom Assessment
PubMed: 29064939
DOI: 10.1097/01.JAA.0000525920.14882.60 -
Obstetrics and Gynecology Clinics of... Sep 2022The physiologic changes and common signs and symptoms of pregnancy can make the early recognition of endocrine emergencies more challenging. Diabetic ketoacidosis (DKA)... (Review)
Review
The physiologic changes and common signs and symptoms of pregnancy can make the early recognition of endocrine emergencies more challenging. Diabetic ketoacidosis (DKA) can occur at only modestly elevated glucose levels (euglycemic DKA), often accompanied by starvation ketosis due to substantial fetal-placental glucose demands and is associated with a high stillbirth rate. Thyroid storm is life threatening with a higher rate of heart failure and both require prompt and aggressive treatment to avoid maternal and fetal morbidity and mortality. Treatment of these disorders and the special considerations for recognition and management in the context of pregnancy are reviewed.
Topics: Diabetes Mellitus; Diabetic Ketoacidosis; Emergencies; Female; Glucose; Humans; Placenta; Pregnancy; Thyroid Crisis
PubMed: 36122980
DOI: 10.1016/j.ogc.2022.02.003 -
Current Neurology and Neuroscience... Mar 2021Endocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the... (Review)
Review
PURPOSE OF REVIEW
Endocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the systemic effect of hormones across many organs and systems including the nervous system. This is a narrative review of the recent evidence of the diagnosis and treatment approach of these medical and neurological emergencies.
RECENT FINDINGS
With the possible exception of diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia, endocrinological emergencies are complex, uncommon yet life-threatening conditions with protean and often nonspecific early clinical signs. They frequently are the first manifestation of the endocrine derangement. The systemic effects of hormones extend to the nervous system and as such, these conditions can present with neurological complications manifested, in most cases, by a diffuse dysfunction of the brain in the form of encephalopathy, delirium, seizures, and coma; or specific and peculiar syndromes such as hemichorea, hemiballism, and epilepsia partialis continua. The severity of these conditions often necessitates management in the intensive care unit requiring substantial supportive care in addition to specific targeted therapy to correct the hormonal metabolic abnormalities while at the same time blocking hormonal activity, in cases of excessive function, or supplementing hormonal deficiencies. Endocrine emergencies and their neurological complications are infrequent. The major challenge for most is early recognition. Their morbidity and mortality are high and their diagnosis requires high index of suspicion. The neurological complication most often improves with the correction of the metabolic derangement and their acuity and severity require admission to the intensive care unit.
Topics: Coma; Diabetic Ketoacidosis; Emergencies; Endocrine System Diseases; Female; Humans; Myxedema; Pregnancy
PubMed: 33709163
DOI: 10.1007/s11910-021-01105-2 -
The Western Journal of Emergency... Nov 2023Euglycemic diabetic ketoacidosis (DKA) (glucose <250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2...
INTRODUCTION
Euglycemic diabetic ketoacidosis (DKA) (glucose <250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period.
METHODS
This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18 years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18 millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250 milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250 mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group -tests for continuous variables and chi-squared tests for binary variables, with alpha 0.05.
RESULTS
We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; < 0.05) and lower initial glucose (195 vs 561 mg/dL, < 0.001) and potassium (4.3 vs 5.3 mmol/L, < 0.001). Etiologies of euglycemia were insulin use prior to arrival (57%), poor oral intake with baseline insulin use (29%), and SGLT2 inhibitor use (14%). Mean time on insulin infusion was shorter for those with euglycemic DKA: 13.5 vs 19.4 hours, = 0.003. Mean times to first bicarbonate >18 mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (<70 mg/dL) while on insulin infusion was significantly higher for those with euglycemic DKA (18.2 vs 4.8%, = 0.02); incidence of hypokalemia (<3.3 mmol/L) was 27.3 vs 19.1% ( = 0.23).
CONCLUSION
Compared to hyperglycemic DKA patients managed in the same protocolized fashion, euglycemic DKA patients were on insulin infusions 5.9 hours less, yet experienced hypoglycemia over three times more frequently. Future work can investigate treatment strategies for euglycemic DKA to minimize adverse events, especially iatrogenic hypoglycemia.
Topics: Adult; Humans; Adolescent; Diabetic Ketoacidosis; Bicarbonates; Insulin; Hypoglycemia; Glucose; Diabetes Mellitus
PubMed: 38165186
DOI: 10.5811/westjem.60361 -
Der Internist Oct 2017
Topics: Diabetic Ketoacidosis; Diagnosis, Differential; Emergencies; Endocrine System Diseases; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Hypoglycemia
PubMed: 28865008
DOI: 10.1007/s00108-017-0319-8 -
Journal of Diabetes and Its... Jan 2021"Brittle diabetes" was first used to describe a life "disrupted by episodes of hypoglycemia or hyperglycemia." Early descriptions focused on small case reports of mostly... (Review)
Review
"Brittle diabetes" was first used to describe a life "disrupted by episodes of hypoglycemia or hyperglycemia." Early descriptions focused on small case reports of mostly young women with psycho-social instability, recurrent diabetic ketoacidosis, poor patient compliance or maladaptation. We redefine "brittle diabetes" as occurring in four specific life stages each with distinct characteristics and associated conditions resulting in severely erratic glycemic control and poor outcomes. Once identified however these factors can often be reversed or significantly mitigated. The first group includes younger patients with associated psychiatric diseases such as bulimia and depression which require specific therapy and are treatable. A second group includes individuals who have another underlying medical condition resulting in disruption of insulin sensitivity or glucose utilization which must be sought. A third group, the largest we believe, has "geriatric type 1 diabetes" and develops severe glycemic instability due to frailty, chronic renal failure, dementia, vision loss, loss of counterregulation and other diseases of aging which lead to unintentional omission of insulin, insulin dosing errors and increasing insulin sensitivity. The fourth group, now seen around the world, suffers lack of insulin access and associated food insecurity. All four of these groups are described.
Topics: Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; Humans; Hypoglycemia; Insulin; Insulin Resistance; Insulin, Regular, Human
PubMed: 32620472
DOI: 10.1016/j.jdiacomp.2020.107646 -
The Journal of the Association of... Apr 2022Diabetic ketoacidosis is one of the hyperglycemic emergencies, there is insulin deficiency coupled with concomitant elevation of counter regulatory hormones. This...
UNLABELLED
Diabetic ketoacidosis is one of the hyperglycemic emergencies, there is insulin deficiency coupled with concomitant elevation of counter regulatory hormones. This hormonal imbalance promotes gluconeogenesis, glycolysis, glycogenolysis, protein breakdown and lipolysis.The symptoms of DKA like nausea, vomiting, epigastric pain can be present in acute pancreatitis also. From various studies it has been identified that in DKA, non specific elevation of serum amylase and lipase levels occurs in 16-25% of cases. Elevation of serum amylase, and lipase levels in association with severe abdominal pain often trigger the initial diagnosis of acute pancreatitis. So this study was carried out to study the elevation of serum amylase and lipase levels in patients with DKA.
MATERIAL
This cross sectional study was conducted in department of medicine KR Hospital,Mysore medical college and research institute, mysore during the study period of six months from June 2021 to november 2021. A total of 50 patients were included in the study after fulfilling the inclusion and exclusion criteria.
OBSERVATION
Among 50 cases studied, 9 cases (18%) with DKA are showing elevation of serum amylase levels and 13 cases(26%) of cases are showing elevation of serum lipase,34 cases(68%) were males and 16 cases(32%) were female. Among the 50 cases studied,infection is the most precipitating factor seen in 34cases (68%),followed by omission of insulin in 12 cases(24%), unidentified cause in 4 cases(8%).
CONCLUSION
significant elevation of serum amylase and serum lipase which are more specific for diagnosis of acute pancreatitis can also be seen in patients with diabetic ketoacidosis. Elevated serum amylase and lipase can occur in patients with DKA probably due to metabolic derangements,decreased clearance of enzymes and not due to acute pancreatitis The clinician must take these data into account when evaluating abdominal symptoms in DKA patients.
Topics: Abdominal Pain; Acute Disease; Amylases; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Ketoacidosis; Female; Humans; Insulin; Lipase; Male; Pancreatitis
PubMed: 35443366
DOI: No ID Found -
Medicine, Science, and the Law Jan 2022Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and...
Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. There were 94 cases with 11 diabetics ( = 6 type 1 and = 5 type 2). Four of the six decedents with type 1 diabetes had lethal DKA (66.7%; age range 30-54 years; average age 44.6 ± 10.5 years; M:F ratio 1:1). This incidence of DKA was higher than that of the general insulin-dependent diabetic population (6%) and also significantly higher than in medico-legal cases (13%; < 0.05). The clinical and autopsy assessment of insulin-dependent diabetics presenting with DKA should therefore include specific screening for methamphetamine. The increase in both insulin-dependent diabetes and methamphetamine abuse in the community may lead to increases in such cases in medico-legal and health contexts.
Topics: Adult; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Humans; Incidence; Insulin; Methamphetamine; Middle Aged
PubMed: 34102917
DOI: 10.1177/00258024211020936 -
BMJ Case Reports Feb 2023The clinical presentation of diabetic ketoacidosis (DKA) includes nausea, vomiting, thirst, polyuria, polydipsia, abdominal pain, tachypnoea, and change in mental status...
The clinical presentation of diabetic ketoacidosis (DKA) includes nausea, vomiting, thirst, polyuria, polydipsia, abdominal pain, tachypnoea, and change in mental status in cases of severe DKA. DKA is similar in pregnant and non-pregnant women, but in pregnant women it can be seen at lower serum glucose levels and symptoms may develop more rapidly. Most, but not all, cases occur in the second or third trimester.DKA results in reduction in uteroplacental blood flow due to osmotic diuresis, and also in metabolic abnormalities (maternal acidosis, hyperglycaemia, electrolyte imbalance), resulting in fetal hypoxaemia and acidosis. In fetuses with mature cardiac activity, the fetal heart rate may show minimal or absent variability, repetitive deceleration and absence of acceleration. These abnormalities in heart rate usually resolve with resolution of the DKA, which may last for several hours before normalisation.For the patient reported on here, immediate delivery based on pathological fetal heart rate would have resulted in preterm delivery and jeopardised the maternal clinical condition. However, a holistic clinical approach by the multidisciplinary team to management of the patient led to normal term delivery 5 weeks after presentation with DKA; fetal and maternal outcome were good.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Diabetic Ketoacidosis; Pregnancy in Diabetics; Fetus; Polydipsia; Pregnancy Trimester, Third; Diabetes Mellitus
PubMed: 36792143
DOI: 10.1136/bcr-2022-253198 -
Acta Clinica Croatica Apr 2023The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender...
The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender and severity of diabetic ketoacidosis. Medical records from January 1, 2017 until December 31, 2019 were reviewed and patients diagnosed with diabetic ketoacidosis were selected. The study included 52 patients, median age 34 (interquartile range 21-56) years. There was no statistically significant difference between male and female gender. The severity of diabetic ketoacidosis was moderate in the majority of cases (65.4%; p=0.005). The most common precipitating factor was infection (61.7%). In patients with moderate diabetic ketoacidosis, respiratory infections were more common, while gastrointestinal infections were more common in severe diabetic ketoacidosis (33% and 25%, respectively; p=0.03). Nausea (median age 32 years; p=0.004) and vomiting (median age 31 years; p=0.01) were more common in younger age groups, while altered mental status was more common in the older age group (median age 61 years; p=0.001). Infection was the most common precipitating factor. The most common symptoms in younger age groups were nausea and vomiting, and altered mental status in the older age group.
Topics: Humans; Male; Female; Aged; Young Adult; Adult; Middle Aged; Diabetic Ketoacidosis; Diabetes Mellitus, Type 1; Precipitating Factors; Vomiting; Nausea
PubMed: 38304369
DOI: 10.20471/acc.2023.62.01.08