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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 -
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 -
Diabetes, Obesity & Metabolism Jul 2023SARS-CoV-2 infection could disrupt the endocrine system directly or indirectly, which could result in endocrine dysfunction and glycaemic dysregulation, triggering... (Review)
Review
SARS-CoV-2 infection could disrupt the endocrine system directly or indirectly, which could result in endocrine dysfunction and glycaemic dysregulation, triggering transient or persistent diabetes mellitus. The literature on the complex relationship between COVID-19 and endocrine dysfunctions is still evolving and remains incompletely understood. Thus, we conducted a review on all literature to date involving COVID-19 associated ketosis or diabetic ketoacidosis (DKA). In total, 27 publications were included and analysed quantitatively and qualitatively. Studies included patients with DKA with existing or new onset diabetes. While the number of case and cohort studies was limited, DKA in the setting of COVID-19 seemed to increase risk of death, particularly in patients with new onset diabetes. Future studies with more specific variables and larger sample sizes are needed to draw better conclusions.
Topics: Humans; Diabetic Ketoacidosis; COVID-19; SARS-CoV-2; Ketosis; Cohort Studies; Diabetes Mellitus, Type 1
PubMed: 36855317
DOI: 10.1111/dom.15036 -
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 -
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 -
MMW Fortschritte Der Medizin Jun 2024
Topics: Humans; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Hypoglycemic Agents; Ketosis; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 38806910
DOI: 10.1007/s15006-024-3985-1 -
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 -
Pediatrics in Review Aug 2020
Review
Topics: Abdominal Pain; Adolescent; Child; Child, Preschool; Diabetic Ketoacidosis; Diagnosis, Differential; Female; Humans; Migraine Disorders; Pain, Referred; Pediatrics; Pelvic Inflammatory Disease; Peptic Ulcer
PubMed: 32737258
DOI: 10.1542/pir.2019-0221