Diabetic ketoacidosis in adult patients: an audit of factors influencing time to normalisation of metabolic parameters

Lee, Melissa H; Calder, Genevieve L; Santamaria, John; MacIsaac, Richard J

doi:10.1111/imj.13735

Cited by 30 publications

(45 citation statements)

References 25 publications

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“…13 It is interesting to note that this analysis reports a substantially lower incidence of infection compared to previous studies including from this facility, despite the tropical climate. [3][4][5][6] However, the infection incidence of 14.5% was similar to that reported by Randall et al 14 , who reviewed low socioeconomic status minority patients. That study reported the major precipitant of DKA to be noncompliance with insulin at 68%, similar to our own findings.…”

Section: Discussionsupporting

confidence: 86%

“…1,2 International data demonstrate that infection is one of the most common precipitating causes of DKA. 3,4 Lee et al 5 recently demonstrated that 29% of DKA presentations at a large tertiary Australian hospital were associated with the presence of infection. Our facility previously showed that 29-36% of DKA presentations had been precipitated by infection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antimicrobial stewardship in diabetic ketoacidosis: a single‐centre experience

Gassiep

Bachmeier

Hendry

et al. 2020

Internal Medicine Journal

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Background Diabetic ketoacidosis (DKA) is a common and serious complication arising predominantly in patients with type 1 diabetes mellitus. International data demonstrate that infection is one of the most common precipitating causes of DKA. Currently there are limited data regarding the role of antimicrobial stewardship (AMS) in this setting. Aim To provide epidemiologic data regarding infections precipitating DKA, microbiological aetiology and antimicrobial prescribing practices in order to inform AMS interventions. Methods Retrospective chart review of all type 1 diabetes mellitus DKA presentations from May 2015 to June 2018. Results In total, 249 DKA presentations occurred in 111 patients. Suspected infection accounted for 100/249 (40%) presentations, and only 36/249 (14.5%) were proven or probable infections. Skin and soft tissue infection was the most common (9/36, 25%), followed by urinary tract infection (8/36, 22%) and respiratory tract infection (7/36, 19%). A pathogen was identified in 24/100 presumed infections and included Staphylococcus aureus (24, 46%), Klebsiella pneumoniae (4/24, 17%) and Escherichia coli (3/24, 13%). No viral pathogens were identified. Of 80 empirical antimicrobial prescriptions, 75% were inappropriate based on guideline management of the documented suspected infection. Single agent ceftriaxone was appropriately prescribed in 7/23 (30%) cases, and was most frequently prescribed overall 23/80 (29%). Conclusion This study demonstrates a lower incidence of infection compared to most previous publications, and suggests that infection‐precipitated DKA may be over reported. Furthermore, our findings provide support for the role of AMS in the management of DKA.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Antimicrobial stewardship in diabetic ketoacidosis: a single‐centre experience

Gassiep

Bachmeier

Hendry

et al. 2020

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…The most common precipitants of DKA in type 1 diabetes mellitus (T1DM) are insulin omission (42%) and infection (30%) . Other important precipitants include medications (glucocorticoids, antipsychotics, SGLT2i and immune CPI), myocardial ischaemia, eating disorders and unrecognised malfunction of continuous subcutaneous insulin infusion devices.…”

Section: Methodsmentioning

confidence: 99%

Review article: Ketoacidosis in the emergency department

Morton

2020

Emerg Medicine Australasia

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Diabetic ketoacidosis, a life‐threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium‐glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. Ketoacidosis with these medications may be prolonged and recur after initial resolution. Checkpoint inhibitors may present with fulminant diabetic ketoacidosis in individuals with previously normal glucose tolerance. Ketoacidosis may also occur as a result of starvation and alcohol excess, as well as a number of rare causes. Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.

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“…To meet this goal, scientific societies worldwide have developed recommendations and step -by -step algorithms for DKA therapy. 20,21 They are clear, easy to follow, and evidence based. Literature data confirm the benefits of using appropriate algorithms in DKA treatment.…”

Section: Patients and Methods Study Populationmentioning

confidence: 99%

Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

Cieluch¹,

Uruska²,

Falkowski³

et al. 2018

Polish Archives of Internal Medicine

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Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management. Nonadherence to the protocol was defined as too low or too high doses of potassium compared with the recommended potassium replacement protocol. Results The median duration of DKA treatment was longer in the nonadherent group than in the adherent group: 37 hours (interquartile range [IQR], 27-48) and 30 hours (IQR, 17-43), respectively (P = 0.005). Treatment duration correlated positively with nonadherence to potassium replacement protocol (r = 0.18; P = 0.005) and severity of DKA (r = 0.52; P <0.0001). Stepwise multivariate linear regression analysis indicated nonadherence to the protocol (β = 0.14; P = 0.02) and severity of DKA (β = 0.43; P <0.0001) as predictors of treatment duration, after adjustment for body mass index and age (R2 = 0.28; P <0.0001). Conclusions Nonadherence to potassium replacement protocol leads to prolongation of DKA management. Medical staff should be educated about the benefits of potassium replacement and precision in potassium administration and dosing in patients with DKA.

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Diabetic ketoacidosis in adult patients: an audit of factors influencing time to normalisation of metabolic parameters

Abstract: Lower admission pH levels and higher admission serum potassium levels are independent predictors of slower time to resolution of DKA. This may assist to stratify patients with DKA using markers of severity to determine who may benefit from closer monitoring and to predict LOS.

Cited by 30 publications

References 25 publications

Antimicrobial stewardship in diabetic ketoacidosis: a single‐centre experience

Antimicrobial stewardship in diabetic ketoacidosis: a single‐centre experience

Review article: Ketoacidosis in the emergency department

Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

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