Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols

Tran, Tara Thi Thien; Pease, Anthony; Wood, A. K. W.; Zajac, Jeffrey D; Mårtensson, Johan; Bellomo, Rinaldo; Ekinci, Elif I

doi:10.3389/fendo.2017.00185

Cited by 5 publications

(6 citation statements)

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“…Comparable to the situation in animals, the ideal type of insulin and the optimal route of insulin administration is a matter of debate in human patients with DKA. 18,34 Except for resource-poor countries, 17 showing the time (h) from the start of treatment until discharge from the hospital. The curves of the 2 groups were compared using the log-rank (Mantel-Cox) test (P = 0.033) currently the most common treatment for human patients is continuous IV infusion of regular insulin because of its rapid onset of action and ease of dose titration.…”

Section: Discussionmentioning

confidence: 99%

“…The curves of the 2 groups were compared using the log-rank (Mantel-Cox) test (P = 0.033) currently the most common treatment for human patients is continuous IV infusion of regular insulin because of its rapid onset of action and ease of dose titration. 34 Δ, difference between baseline and discharge. Data are presented as number of animals or median (range).…”

Section: Discussionmentioning

confidence: 99%

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Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Zeugswetter

Luckschander-Zeller

Karlovits

et al. 2021

J Vet Emergen Crit Care

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Objectives: To determine whether basal-bolus administration of glargine insulin is a safe and effective alternative treatment compared to the standard continuous rate infusion (CRI) protocol. Design: Prospective randomized clinical trial.Setting: University teaching hospital. Animals: Twenty cats diagnosed with diabetic ketoacidosis (DKA).Interventions: The cats were block-randomized to either a CRI protocol using regular insulin (CRI-group; n = 10) or a basal-bolus SC and IM glargine protocol (glarginegroup, n = 10). Baseline blood gases, electrolytes, glucose, and β-hydroxybutyrate (β-OHB) concentrations were measured at the time of admission and later at predefined intervals until reaching the primary endpoint of the study, defined as a βhydroxybutyrate concentration < 2.55 mmol/L. Measurements and main results:The main outcome measure was time (h) to resolution of ketonemia. Secondary outcome measures were time until first improvement of hyperglycemia and ketonemia, decrease of glucose to ≤13.9 mmol/L (250 mg/dL), resolution of acidosis, consumption of first meal, and discharge from hospital. Additionally, occurrence of treatment-associated adverse events and death were compared. Seventeen cats (85%) survived to discharge, with no difference in survival between groups (P = 1.0). Median times to β-OHB < 2.55 mmol/L were 42 (CRI-group) and 30 (glarginegroup) hours, respectively (P = 0.114). Median times to first improvement of hyperglycemia (glargine-group: 2 h; CRI-group: 6 h; P = 0.018) and until discharge from hospital (glargine-group: 140 h; CRI-group: 174 h; P = 0.033) were significantly shorter in the glargine-group. No significant differences were observed in any other parameter under investigation (P > 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Zeugswetter

Luckschander-Zeller

Karlovits

et al. 2021

J Vet Emergen Crit Care

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“…The other notable factor influencing hospitalisation length in multiple regression was serum creatinine level. Coagulopathy is occasionally a persistent problem in DKA especially when the reduction in pH from normal range or loss of TBW is very high 45,46 . The contracted volume of TBW and altered bicarbonate buffer usually cause acute kidney injury in DKA 47 .…”

Section: Discussionmentioning

confidence: 99%

Mapping the role of pH‐adjusted potassium in diabetic ketoacidosis: Hypokalemia and the patient outcomes

et al. 2021

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Hypokalemia is a frequently observed complication during the treatment of diabetic ketoacidosis (DKA). Its incidence ranges anywhere between 4% and 60% where it adversely affects patient outcomes and may also add to the total cost of DKA treatment and extended hospitalisation. 1,2 Mainly, insulin is responsible to maintain the intracellular-(ICF) and extracellular-fluid (ECF) balance of potassium. 3 In addition, catecholamines and aldosterone also regulate serum potassium (S K ) level. 3,4 Pathophysiology of DKA causes an abrupt change in the concentration of these hormones and total body water (TBW). However, the resultant effect is observed partially at the time of admission when patients are either hyperkalemic or eukalemic. 5,6 With the commencement of DKA treatment, expansion of contracted hemoconcentration and insulin-mediated ECF to ICF movement of potassium causes a sudden drop in S K . 7,8 Though such

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“…Importantly, misinterpretation of clinico-laboratory picture delayed proper treatment. The combined infusion of normal saline and bicarbonate over the first 12 h was in fact not efficacious on acidosis due to absence of the necessary continuous insulin infusion [8]. Besides being ineffective, the combined infusion in the presence of osmotic diuresis (persistent glycosuria) and poor intake of water (due to the confusional status) caused a net salt gain with development of hypernatremia that contributed to further worsening the clinical picture.…”

Section: Discussionmentioning

confidence: 99%

“…This discrepancy indicates a higher incidence of DKA in the real world as compared to the ideal setting of RCT unless renal dysfunction is present. Nevertheless, in clinical practice, this critical event is likely underdiagnosed, and the management still guided by weak evidence and consensus opinion [3,6,7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

Nappi¹,

Verde

Carfora

et al. 2019

Medicina

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Euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I), despite being reported as consistent, though infrequent, adverse effect in all trials on SGLT2-I in type 2 diabetes mellitus (T2D), still remains poorly known in the real world. On the other hand, the use of this new class of antihyperglycemic agents is expected to increase based on the recent solid evidence of remarkable cardiorenal protection. Therefore, improving awareness on risk factors, diagnosis, and treatment of euDKA is essential to allow correct implementation of SGLT2-I in clinical practice. We here report a T2D patient admitted to the emergency department and then transferred to the nephrology-dialysis unit because of severe euglycemic diabetic ketoacidosis (euDKA) related to sodium-glucose cotransporter 2 inhibitor (SGLT2-I). In our patient, a concurrent acute kidney injury at presentation, initially attributed to excessive use of nonsteroid anti-inflammatory agents, and the absence of severe hyperglycemia led to delayed diagnosis and proper therapy. The detailed description of decision-making process for diagnosis and therapy, and the analysis of precipitating factors as well, discloses the helpful contribution of nephrologist to optimize prevention and management of euDKA.

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Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols

Abstract: An author name was incorrectly spelled as Elif I. I Ekinci. The correct spelling is Elif I. Ekinci. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.

Cited by 5 publications

References 0 publications

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Mapping the role of pH‐adjusted potassium in diabetic ketoacidosis: Hypokalemia and the patient outcomes

Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

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