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Indian Journal of Pediatrics Jun 2021
Topics: Acute Kidney Injury; Child; Diabetic Ketoacidosis; Humans; Risk Factors
PubMed: 33860885
DOI: 10.1007/s12098-021-03762-0 -
Diabetes Research and Clinical Practice Apr 2021Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that can be associated with increased morbidity and mortality, particularly if it is diagnosed... (Review)
Review
Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that can be associated with increased morbidity and mortality, particularly if it is diagnosed late and not treated appropriately. The management of DKA includes careful clinical evaluation, correction of metabolic abnormalities with intravenous fluids, insulin and electrolyte replacement with frequent monitoring of the patients' clinical and laboratory findings and also identification and treatment of the precipitating condition. There are special populations where features, management and outcome may differ from the usual patient with diabetes. Data on management of DKA in such special populations such as chronic kidney disease and pregnancy are sparse and recommendations are based mainly on small case series and expert opinion. Clinicians need to recognize and manage euglycaemic DKA in patients prescribed sodium-glucose cotransporter inhibitors. DKA is particularly a major health concern due to high rates of hospital admissions and mortality in resource-limited settings due to financial constraints, limiting the adequate provision of insulin and access to health care systems, and dysfunctional health systems. We review the challenges of diagnosis and management of DKA in these specific groups and provide recommendations on optimal patient care.
Topics: Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Female; Fluid Therapy; Humans; Hypoglycemic Agents; Pregnancy; Renal Insufficiency, Chronic
PubMed: 33713717
DOI: 10.1016/j.diabres.2021.108744 -
Pediatrics in Review Jun 2023
Topics: Humans; Diabetic Ketoacidosis; Respiratory Insufficiency; Diabetes Mellitus, Type 1
PubMed: 37258885
DOI: 10.1542/pir.2021-005186 -
BMJ Open Diabetes Research & Care Feb 2021Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) characterized by hyperglycemia and metabolic acidosis. Hypophosphatemia... (Observational Study)
Observational Study
INTRODUCTION
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) characterized by hyperglycemia and metabolic acidosis. Hypophosphatemia in DKA often occurs during hospital admittance for DKA. Literature on the magnitude, determinants and consequences of hypophosphatemia in DKA is scarce. Primary aim of this study was to investigate the incidence and consequences of hypophosphatemia during hospitalisation for DKA.
RESEARCH DESIGN AND METHODS
Cohort study among individuals with T1DM who were admitted for DKA between 2005 and 2020 in an academic and a non-academic hospital. Multivariate regression models were performed to investigate determinants of the lowest phosphate during the treatment of DKA.
RESULTS
A total of 127 episodes of DKA among 80 individuals were identified. Age at DKA presentation was 28 (22-46) years, 45% of the cases was female, diabetes duration was 13.2 (8.9-25.5) years with glycosylated hemoglobin levels of 91.9±26.2 mmol/mol. In 9% of all cases, DKA was the first presentation of T1DM. Lowest phosphate levelss reported during the treatment phase were 0.54 (0.32-0.83) mmol/L and hypophosphatemia was present in 74% (62/84). The time to lowest phosphate was 16 (8-23) hours. In multivariate analysis, baseline bicarbonate and hemoglobin at admission were significantly associated with the lowest phosphate level reported. No adverse effects of hypophosphatemia on hospital stay duration, morbidity or mortality were found, even if left untreated.
CONCLUSIONS
Hypophosphatemia during DKA is common and increases with severe acidosis. However, in this study it was not related to adverse outcomes. Although limitations of this retrospective study should be taken into account, the routine and repeated measurement of phosphate levels in DKA could be reconsidered, provided that possible symptoms related to hypophosphatemia are monitored.
Topics: Cohort Studies; Diabetic Ketoacidosis; Female; Humans; Hypophosphatemia; Incidence; Retrospective Studies
PubMed: 33597187
DOI: 10.1136/bmjdrc-2020-002018 -
Reviews on Recent Clinical Trials 2020Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of... (Review)
Review
BACKGROUND
Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon.
METHODS
Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter-regulatory hormones.
RESULTS
Goals of therapy are to correct dehydration, acidosis, and to reverse ketosis, gradually restoring blood glucose concentration to near normal.
CONCLUSION
It is essential to monitor potential complications of DKA and, if necessary, to treat them and any precipitating events.
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Emergencies; Humans; Insulin
PubMed: 32646361
DOI: 10.2174/1574887115666200709172402 -
Annals of Saudi Medicine 2022Diabetic ketoacidosis (DKA) is one of the complications of diabetes mellitus (DM), primarily type 1 DM. To our knowledge, only one study explored DKA readmission rates...
BACKGROUND
Diabetic ketoacidosis (DKA) is one of the complications of diabetes mellitus (DM), primarily type 1 DM. To our knowledge, only one study explored DKA readmission rates in Saudi Arabia.
OBJECTIVES
Identify and analyze precipitating factors for DKA admission and readmission.
DESIGN
Medical record review.
SETTING
Tertiary care center.
PATIENTS AND METHODS
We identified all patients aged 15 years and older admitted with DKA from 2018 to 2020. Descriptive factors and uni-and multivariate analyses are presented for associations with initial admission and readmission.
MAIN OUTCOME MEASURES
Relationships between precipitating factors and initial admission and readmission.
SAMPLE SIZE
176 patients.
RESULTS
Most of the patients had type 1 DM (n=157). The median (interquartile percentiles) for duration of DM was 6.0 (1.0-12.0) years. The mean (SD) HbA1C (%) was 11.8 (2.6). The factors that precipitated DKA were most commonly treatment nonadherence (55.1%), followed by infections (31.8%) and nonadherence to diet (25.6%). The most common symptoms were nausea and vomiting (87.5%), followed by abdominal pain (72.7%). During the study period, 32.4% of the sample were read-mitted with DKA. The median (interquartile range) duration between the first and second admission was 12 (4-25) weeks. In the multivariate analysis, increased odds of readmission for DKA were associated with type 1 DM and medication nonadherence (=.038, =.013, respectively). The severity of the initial DKA and the control of DM were not associated with the readmission rate.
CONCLUSION
Treatment nonadherence is the leading precipitating factor of DKA in our region. Patient education and counseling play a major role in addressing this preventable complication and its medical and financial burden. We advocate more efforts dedicated toward patient education and logistic support.
LIMITATIONS
Retrospective-single center.
CONFLICT OF INTEREST
None.
Topics: Adolescent; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Humans; Patient Readmission; Retrospective Studies; Saudi Arabia
PubMed: 35380064
DOI: 10.5144/0256-4947.2022.119 -
Pediatric Diabetes Aug 2015
Topics: Brain Edema; Diabetic Ketoacidosis; Female; Fluid Therapy; Humans; Male
PubMed: 25832987
DOI: 10.1111/pedi.12274 -
Expert Opinion on Drug Safety Jun 2020Sodium-glucose co-transporters 2 (SGLT-2) inhibitors are a relatively novel class of oral medications for the treatment of Type 2 Diabetes Mellitus, which lower plasma... (Review)
Review
INTRODUCTION
Sodium-glucose co-transporters 2 (SGLT-2) inhibitors are a relatively novel class of oral medications for the treatment of Type 2 Diabetes Mellitus, which lower plasma glucose by inhibiting glucose reabsorption in the proximal renal tubule. Apart from their hypoglycemic action, recent data suggest these agents have additional major cardioprotective and nephroprotective properties.
AREAS COVERED
This review summarizes the existing data on epidemiology, pathophysiology, and treatment of euglycaemic ketoacidosis (euDKA) as a complication of SGLT-2 inhibitor use.
EXPERT OPINION
Although SGLT-2 inhibitors have a relatively good adverse event profile, they have been associated with the serious and potentially life-threatening metabolic complication of euDKA. Data from major outcome trials suggest that the rate of DKA is quite low. However, the rate of DKA could be generally underestimated in clinical trials due to the atypical presentation of ketoacidosis, and even more so in real-life conditions. Management of this serious metabolic complication requires a proper understanding of its pathophysiology as well as increased awareness and early recognition of the potential risk factors involved. Following this, the institution of an array of simple supportive measures, could safely restore normal acid-base balance in most patients.
Topics: Animals; Blood Glucose; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Humans; Hypoglycemic Agents; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 32521174
DOI: 10.1080/14740338.2020.1764532 -
Medicina 2024Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that are increasingly used in cancer treatments. As experience in the use of immunotherapy increases, more... (Review)
Review
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that are increasingly used in cancer treatments. As experience in the use of immunotherapy increases, more is known about its safety profile and immune-mediated adverse effects. Among them is diabetic ketoacidosis (DKA), a rare but serious fatal complication of treatment. In this paper we describe the cases of three patients who presented with episodes of DKA during treatment with ICIs, two of which manifested with fulminant forms, leading to an acute course with initially normal glycosylated hemoglobin values. In addition, we conducted a review of the literature on DKA associated with ICIs in order to highlight the importance of noticing these potentially fatal complications and promptly establishing appropriate therapy.
Topics: Humans; Diabetic Ketoacidosis; Antibodies, Monoclonal; Immunotherapy; Drug-Related Side Effects and Adverse Reactions; Diabetes Mellitus
PubMed: 38271940
DOI: No ID Found -
The Journal of Pediatrics Apr 2016
Topics: Diabetic Ketoacidosis; Female; Humans; Male; Patient Admission
PubMed: 26879811
DOI: 10.1016/j.jpeds.2016.01.057