Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French, Esra Karslioglu; Donihi, Amy C.; Korytkowski, Mary T.

doi:10.1136/bmj.l1114

Cited by 113 publications

(99 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results indicated a temporal association between initiation of glucose-lowering medication and hospitalization due to hyponatremia, i.e., the risk of severe hyponatremia was higher for drugs newly initiated versus ongoing treatment, especially for insulin and GLP-1 analog use. This may be explained by the fact that a subclinical diabetes is often revealed by severe diseases such as pneumonia, pyelonephritis, or acute pancreatitis [35], which in turn may increase the risk for a near future hospitalization due to hyponatremia.…”

Section: Resultsmentioning

confidence: 99%

Inverse association between glucose-lowering medications and severe hyponatremia: a Swedish population-based case-control study

et al. 2019

View full text Add to dashboard Cite

Context Glucose-lowering medications have occasionally been reported to cause hyponatremia, but the evidence is scarce. Objectives To explore the association between glucose-lowering medications and severe hyponatremia. Design, setting, and participants Subjects hospitalized with a principal diagnosis of hyponatremia (n = 14,359) were compared with matched controls (n = 57,383). Data were derived by linkage of national population-based registers. Multivariable logistic regression adjusting for co-medication, diseases, previous hospitalizations, and socioeconomic factors was used to explore the association between hospitalization for hyponatremia and the use of different glucose-lowering medications. Furthermore, newly initiated (≤90 days) and ongoing use was investigated separately. Main outcome measures Hospitalization due to hyponatremia. Results The unadjusted ORs (95% CI) for hospitalization due to hyponatremia were 1.41 (1.29-1.54) for insulins, 1.38 (1.27-1.50) for metformin, and 1.22 (1.07-1.38) for sulfonylureas. However, after adjustment for confounding factors the association was consistently reversed. Thus, for any glucose-lowering medication the adjusted OR was 0.63 (0.58-0.68). For insulins, metformin and sulfonylureas, adjusted ORs (95% CI) were 0.58 (0.52-0.65), 0.81 (0.72-0.90) and 0.81 (0.69-0.94), respectively. Odds ratios for newly initated medications were overall higher while those for ongoing treatment were further decreased. Thus, adjusted ORs (95% CI) for ongoing treatment with insulins, metformin, and sulfonylureas were 0.54 (0.48-0.61), 0.82 (0.73-0.91) and 0.78 (0.66-0.92). Conclusions Glucose-lowering medications did not increase the risk for hospitalization due to severe hyponatremia. In fact, the association was inverse across all investigated drugs. The association may be mediated by pharmacologic mechanisms, but the uniform effects across drug-classes suggest properties of the diabetic disease are of importance.

show abstract

Section: Resultsmentioning

confidence: 99%

Inverse association between glucose-lowering medications and severe hyponatremia: a Swedish population-based case-control study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…[ 11 ] In adults, high blood osmotic pressure was a risk factor for the DKA mortality. [ 12 ] Besides, a high osmotic pressure was considered a risk factor for brain edema. [ 13 ] High concentration of blood glucose may induce osmotic diuresis.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of patients with diabetic ketoacidosis of different severity

Ying

Wu²,

Su³

et al. 2020

Medicine

View full text Add to dashboard Cite

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.

show abstract

“…The effectiveness of insulin seems to be poor and, therefore, the effect of early insulin treatment at this stage should mainly be to alleviate the acidosis. The recommended administration of insulin is 0.1 units/kg/h [ 14 ]. The risk of hypovolemic hypotension would probably be much greater if pronounced if early uptake of glucose to the ICF occurred.…”

Section: Discussionmentioning

confidence: 99%

Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia

Svensson

Zdolsek

Malm

et al. 2020

ICMx

View full text Add to dashboard Cite

Background Early treatment of severe hyperglycemia involves large shifts of body fluids that entail a risk of hemodynamic instability. We studied the feasibility of applying a new electrolyte equation that estimates the degree of volume depletion and the distribution of infused 0.9% saline in this setting. Methods The new equation was applied to plasma and urinary concentrations of sodium and chloride measured before and 30 min after a 30-min infusion of 1 L of 0.9% saline on two consecutive days in 14 patients with severe hyperglycemia (mean age 50 years). The extracellular fluid (ECF) volume was also estimated based on the volume dilution kinetics of chloride. Results On day 1, the baseline ECF volume amounted to 11.5 L. The saline infusion expanded the ECF space by 160 mL and the intracellular fluid space by 375 mL. On day 2, the ECF volume was 15.5 L, and twice as much of the infused fluid remained in the ECF space. The chloride dilution kinetics yielded baseline ECF volumes of 11.6 and 15.2 L on day 1 and day 2, respectively. No net uptake of glucose to the cells occurred during the two 1-h measurement periods despite insulin administration in the intervening time period. Conclusions The electrolyte equation was feasible to apply in a group of hyperglycemic patients. The ECF space was 3 L smaller than expected on admission but normal on the second day. Almost half of the infused fluid was distributed intracellularly.

show abstract

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Cited by 113 publications

References 103 publications

Inverse association between glucose-lowering medications and severe hyponatremia: a Swedish population-based case-control study

Inverse association between glucose-lowering medications and severe hyponatremia: a Swedish population-based case-control study

Clinical characteristics and outcomes of patients with diabetic ketoacidosis of different severity

Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia

Contact Info

Product

Resources

About