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Journal of Pediatric Endocrinology &... Sep 2022Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). The aim of this study is to analyze the incidence, clinical characteristics,...
OBJECTIVES
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). The aim of this study is to analyze the incidence, clinical characteristics, management and outcome of children presenting with DKA in new-onset T1D from 2008 to 2018 in Hong Kong.
METHODS
Data was extracted from the Hong Kong Childhood Diabetes Registry. All subjects less than 18 years with newly diagnosed T1D from 1 January 2008 to 31 December 2018 managed in the public hospitals were included. Information on demographics, laboratory parameters, DKA-related complications and management were analyzed.
RESULTS
In the study period, there were 556 children with newly diagnosed T1D in our registry and 43.3% presented with DKA. The crude incidence rate of new-onset T1D with DKA was 1.79 per 100,000 persons/year (CI: 1.56-2.04). Subjects presenting with DKA were younger (9.5 ± 4.5 vs. 10.5 ± 4.4, p=0.01) and had shorter duration of symptoms (4.2 ± 5.9 days vs. 10.6 ± 17.1 days, p<0.01). Regarding management, up to 12.4% were given insulin boluses and 82.6% were started on insulin infusion 1 h after fluid resuscitation. The rate of cerebral edema was 0.8% and there was no mortality.
CONCLUSIONS
Younger age and shorter duration of symptoms were associated with DKA in new-onset T1D. Despite availability of international guidelines, there was inconsistency in acute DKA management. These call for a need to raise public awareness on childhood diabetes as well as standardization of practice in management of pediatric DKA in Hong Kong.
Topics: Child; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Hong Kong; Humans; Incidence; Insulin; Risk Factors
PubMed: 36001345
DOI: 10.1515/jpem-2022-0255 -
Journal of Clinical Psychopharmacology Oct 2017The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute... (Review)
Review
BACKGROUND
The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation, which may be associated with the use of SGAs. This study aims to review published reports of patients with schizophrenia and antipsychotic drug-associated DKA, focusing on the effective management of both conditions.
METHODS
Using a predefined search strategy, we searched PubMed and EMBASE from their inception to July 2016. The search terms were related to "diabetic ketoacidosis" and "antipsychotic medication." Case reports, case series, and reviews of case series written in English language were included in the review.
RESULTS
Sixty-five reports were analyzed. In most patients who developed antipsychotic-associated DKA, 1 or more suspected antipsychotic medications were discontinued. In 5 cases, a rechallenge test was trialed, and in only 1 case, it resulted in the elevation of blood glucose. The majority was subsequently treated with a different SGA in combination with insulin/oral hypoglycemic agents; although approximately a third of patients had a complete resolution of symptoms or could control diabetes with diet only at the point of discharge.
CONCLUSIONS
Patients taking antipsychotic medications should be regularly screened for insulin resistance and educated about potential complications of antipsychotic medications. This will allow clinicians to individualize treatment decisions and reduce iatrogenic contribution to morbidity and mortality. To achieve best treatment outcomes, antipsychotic-induced DKA should be treated jointly by psychiatry and endocrinology teams.
Topics: Antipsychotic Agents; Diabetic Ketoacidosis; Humans; Schizophrenia
PubMed: 28816925
DOI: 10.1097/JCP.0000000000000772 -
Revista Espanola de Enfermedades... May 2022Gurvits syndrome, black esophagus or acute esophageal necrosis (AEN) is a rare and multifactorial disorder resulting from a combination of ischemic insult, corrosive...
Gurvits syndrome, black esophagus or acute esophageal necrosis (AEN) is a rare and multifactorial disorder resulting from a combination of ischemic insult, corrosive injury of the mucosa from gastric contents, and impaired reparative mechanism in the setting of acute illness. The diagnosis is made by visualization of a circumferential black discoloration of the distal oesophagus that abruptly ends at the gastroesophageal junction. We report a case of Gurvits syndrome secondary to diabetic ketoacidosis (DKA).
Topics: Acute Disease; Diabetes Mellitus; Diabetic Ketoacidosis; Esophageal Diseases; Humans; Necrosis; Syndrome
PubMed: 34991321
DOI: 10.17235/reed.2021.8527/2021 -
Medicine Nov 2020To analyze the influencing factors and outcomes of the different severity of diabetic ketoacidosis (DKA).A total of 50 children with DKA admitted to the Department of...
To analyze the influencing factors and outcomes of the different severity of diabetic ketoacidosis (DKA).A total of 50 children with DKA admitted to the Department of Pediatrics, Tianjin Medical University General Hospital from January 2009 to December 2018 were included in this study. The patients were divided into mild group, moderate group, and severe group according to the severity of the disease. We then analyzed the clinical characteristics and outcomes of the 3 groups.Compared to mild and moderate DKA groups, patients with severe DKA were more likely to present chest tightness, and higher levels of blood osmotic pressure, urea, and creatinine (P < .05). Logistic regression analysis showed that blood osmotic pressure, creatinine, and chest tightness were independent factors for severity of DKA. There was a significant difference in the resolution time of DKA among the 3 groups (mild vs moderate: 9.0 hours vs 15.25 hours; moderate vs severe: 15.25 hours vs 24.5 hours, P < .001). There were statistical differences in the decline of Glasgow score among 3 groups (P = .004).Patients with severe DKA showed higher osmotic pressure and creatinine, as well as dyspnea. The children with severe DKA were more likely to present progression of neurological symptoms, which was necessary to pay attention to the presence of brain edema.
Topics: Child; Diabetic Ketoacidosis; Female; Humans; Male; Outcome Assessment, Health Care; Prognosis; Risk Factors; Severity of Illness Index
PubMed: 33157926
DOI: 10.1097/MD.0000000000022838 -
Endocrinology, Diabetes & Metabolism May 2023Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure.
METHODS
We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2-6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing.
RESULTS
Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p = .003, partial η = .15. This effect persisted after accounting for socioeconomic status and ethnicity.
CONCLUSIONS
A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.
Topics: Humans; Child, Preschool; Infant; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Cognition; Cognitive Dysfunction
PubMed: 36788736
DOI: 10.1002/edm2.412 -
The Review of Diabetic Studies : RDS Sep 2022Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive...
Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive Care Unit (PICU) in a large teaching hospital in the Eastern region of Saudi Arabia. We conducted a retrospective, analytical study at King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia. We retrieved the complete medical records of 2234 children who were admitted to the PICU during the 10-year period of 2010 through 2019. The children included those with polydipsia, polyurea, abdominal pain, vomiting, dehydration, and weight loss, as well as breathing disturbances due to acidosis and CNS issues such as lethargy or coma and elevated blood glucose level, > 200 mg/dL [> 11.1 mmol/L], venous pH 7.3, serum total CO2 15 mmol/L, and blood- hydroxybutyrate concentration 3 mmol/L or moderate or severe ketonuria. Out of 2234 PICU admissions, 211 (9.4%) were diagnosed with DKA. A persistent increase in the rate of DKA ended up at 14.1% in 2019 (p = .005). The incidence of DKA was 88/2234 (3.93%). The severity of DKA was as follows: 130 (61.6%) had severe and 81 (38.4%) had moderate DKA. Excessive sweet intake without adding insulin in 83 (39.3%) patients and unhealthy lifestyles (35.1%) were the best predictors of severe DKA (p = .001). Over a 10-year period, the DKA pattern was persistently rising and slightly falling, which ended up at the significantly highest rate of 14.1% in 2019. URTI, pneumonia, unhealthy lifestyle, and excess sweet intake were significant precipitating factors associated with severe DKA.
Topics: Child; Humans; Diabetic Ketoacidosis; Diabetes Mellitus, Type 1; Retrospective Studies; Saudi Arabia; Hospitals, Teaching
PubMed: 36309773
DOI: 10.1900/RDS.2022.18.146 -
Archives of Disease in Childhood Feb 2004Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). Mortality is predominantly related to the... (Review)
Review
Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). Mortality is predominantly related to the occurrence of cerebral oedema; only a minority of deaths in DKA are attributed to other causes. Cerebral oedema occurs in about 0.3-1% of all episodes of DKA, and its aetiology, pathophysiology, and ideal method of treatment are poorly understood. There is debate as to whether physicians treating DKA can prevent or predict the occurrence of cerebral oedema, and the appropriate site(s) for children with DKA to be managed. There is agreement that prevention of DKA and reduction of its incidence should be a goal in managing children with diabetes.
Topics: Adolescent; Brain Edema; Child; Child, Preschool; Diabetic Ketoacidosis; Europe; Fluid Therapy; Humans; Insulin; Phosphates; Potassium Deficiency
PubMed: 14736641
DOI: 10.1136/adc.2003.044875 -
Diabetic Medicine : a Journal of the... Oct 2021
Topics: Adolescent; Adult; COVID-19; Child; Child, Preschool; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Disease Progression; Female; Hospitalization; Humans; Infant; Male; Ohio; Pandemics; Prevalence; SARS-CoV-2; Severity of Illness Index; Young Adult
PubMed: 34053098
DOI: 10.1111/dme.14610 -
BMJ Open Diabetes Research & Care Dec 2021We explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2... (Observational Study)
Observational Study
INTRODUCTION
We explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.
RESEARCH DESIGN AND METHODS
This observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.
RESULTS
From 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1-21.9); type 2 diabetes 13.9 units (7.7-21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7-6.1); type 2 diabetes: 11.0 days (5.0-23.1); p<0.0001).
CONCLUSIONS
In this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.
Topics: Adult; Aged; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Ethnic and Racial Minorities; Ethnicity; Humans; Minority Groups; Retrospective Studies
PubMed: 34879999
DOI: 10.1136/bmjdrc-2021-002451 -
Diabetes & Metabolic Syndrome Jan 2022Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods.
BACKGROUND AND AIM
Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods.
METHODS
Retrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3).
RESULTS
Demographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66-3.68) vs. pre-pandemic period (0.72%, 0.54-0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4-54.3) vs. pre-pandemic period (18%, 8.6-31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0-4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2-6.3) and BHBA by 2.1 mmol/L (1.2-3.1) (p < 0.001).
CONCLUSIONS
COVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.
Topics: COVID-19; Cohort Studies; Diabetic Ketoacidosis; Female; Humans; Male; Middle Aged; Pandemics; Patient Admission; Prevalence; Retrospective Studies; SARS-CoV-2; United States
PubMed: 35016042
DOI: 10.1016/j.dsx.2022.102389