Diabetic Ketoacidosis Associated With Cocaine Use

Abstract

In this preliminary study, cocaine use was found in a significant number of adults admitted with DKA and was associated with more frequent omission of insulin therapy and the absence of precipitating systemic illness. Either because of its association with insulin therapy omission or its effects on counterregulatory hormones, cocaine use should be considered a risk factor for DKA, particularly in patients with multiple admissions.

Diagnosis and management of hyperglycemic emergencies

“…22 Cocaine abuse causes recurrent DKA via several mechanisms, including therapeutic noncompliance, stimulation of adrenal release of epinephrine and norepinephrine and increased release of other counter regulatory hormones. 23,24 Cytomegalovirus infection, 25,26 protease inhibitor treatment, 27,28 and highly active antiretroviral therapy (via immune restoration) may precipitate DKA in HIV-infected patients. 29 Acute myocardial infarction, stroke, major trauma and other severe/ acute illnesses may precipitate either DKA or HHS.…”

Acidocétose compliquée d’une mort fœtale révélant un diabète fulminant au troisième trimestre de grossesse

“…Ensuite, l'Imurel ® est incriminé dans la survenue de pancréatite, surtout dans les maladies inflammatoires digestives [17,18]. Enfin, Mme X. avoue une consommation de toxiques, ce qui est considéré comme un facteur de risque de décom-pensation chez les diabétiques [19,20].…”

Addictive Disorders in Nutritional Diseases ‐ From a Nutritional Viewpoint

“…Pedersen-Bjergaard et al [13] found that 31% of diabetics admitted with severe hypoglycemia had a psychoactive substance in their blood sample, and 17% had alcohol in their system. Warner et al [14]. found that 14% of admissions of DKAwere cocaine users.…”

“…Cocaine increases the levels of catecholamines, which greatly affects carbohydrate metabolism in the following ways: inhibiting pancreatic insulin secretion, increasing glucagon production, stimulating glycogenolysis and gluconeogensis in the liver, activating lipolysis in the skeletal muscle, impairing the peripheral use of glucose, as well as stimulating ketogensis. This increased production of ketoacids combined with omission of insulin therapy greatly increases the chance of DKA [14].…”