Epidemiology and Treatment of Diabetic Ketoacidosis in a Community Population

Ellemann, Karsten; Soerensen, Jan; Pedersen, Lasse Eggers; Edsberg, Berit; Andersen, O. Ortved

doi:10.2337/diacare.7.6.528

Cited by 83 publications

(46 citation statements)

References 9 publications

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“…Although it has been repeatedly shown that infection is a common precipitating event in DKA and HHS in this country and abroad (4,12), recent studies suggest that omission of insulin or undertreatment with insulin may be the most important precipitating factor in urban African-American populations (5,26). Table 3 summarizes various studies (2,5,6,(27)(28)(29)(30) describing precipitating events for DKA.…”

Section: Precipitating Events -mentioning

confidence: 99%

“…Recent studies that have emphasized the use of standardized written guidelines for therapy have demonstrated mortality rates Ͻ5% in DKA and ϳ15% in HHS (6,9,10,(12)(13)(14)(15)(16)214). The majority of deaths have occurred in patients Ͼ50 years of age because of concomitant life-threatening illnesses, suggesting that further major decreases in mortality rates may not be attainable based on treatment of DKA alone (9).…”

Section: Resource Utilization Inmentioning

confidence: 99%

“…Mortality rates, which are Ͻ5% in DKA and ϳ15% in HHS (4)(5)(6)(8)(9)(10)(11)(12)13), increase substantially with aging and the presence of concomitant life-threatening illnesses. Similar outcomes of treatment of DKA have been noted in both community and teaching hospitals (14)(15)(16), and outcomes have not been altered by whether the managing physician is a family physician, general internist, house officer with attending supervision, or endocrinologist, so long as standard written therapeutic guidelines are followed (17,18).…”

mentioning

confidence: 99%

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Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

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Abbreviations: AaO 2 , alveolar-to-arteriolar oxygen; AKA, alcoholic ketoacidosis; ARDS, adult respiratory distress syndrome; BUN, blood urea nitrogen; CPT, carnitine palmitoyl-transferase; CSF, cerebrospinal fluid; DKA, diabetic ketoacidosis; FFA, free fatty acid; HHS, hyperosmolar hyperglycemic state; IRI, immunoreactive insulin; PaO 2 , arteriolar partial pressure of oxygen; RDKA, recurrent DKA.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Management of Hyperglycemic Crises in Patients With Diabetes T E C H N I C A L R E V I E R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s 132DIABETES CARE, VOLUME 24, NUMBER 1, JANUARY 2001Technical Review noted in newly diagnosed obese type 2 diabetic patients (5,26,31). Therefore, the concept that the presence of DKA in type 2 diabetes is a rare occurrence is incorrect.The most common types of infections are pneumonia and urinary tract infection, accounting for 30-50% of cases (Table 4). Other acute medical illnesses as precipitating causes include alcohol abuse, trauma, pulmonary embolism, and myocardial infarction, which can occur both in type 1 and 2 diabetes (6). Various drugs that alter carbohydrate metabolism, such as corticosteroids, pentamidine, sympathomimetic agents, and ␣-and ␤-adrenergic blockers, and excessive use of diuretics in the elderly may also precipitate the development of DKA and HHS.The recent increased use of continuous subcutaneous insulin infusion pumps that use small amounts of short-acting insulin has been associated with an incidence of DKA that is significantly increased over the incidence seen with conventional methods of multiple daily insulin injections, in spite of the fact that most of the mechanical problems with insulin pumps have been resolved (6,(32)(33)(34). In the Diabetes Control and Complications Trial, the incidence of DKA in patients on insulin pumps was about twofold higher than that in the multipleinjection group over a comparable time period (35). This may be due to the exclusive use of short-acting insulin in the pump, which if interrupted leaves no reservoir of insulin for blood glucose control.Psychological factors and poor compliance, leading to omission of insulin therapy, are important precipitating factors for recurrent ketoacidosis. In young female patients with type 1 diabetes, psychological problems complicated by eating disorders may be contributing factors in up to 20% of cases of recurrent ketoacidosis (36,37). Factors that may lead to insulin omission in younger patients include fear of weight gain with good metabolic control, fear of hypoglycemia, rebellion against authority, and stress related to chronic disease (36). Noncompliance with insulin therapy has been found to be the leading precipitating cause for DKA in urban African-Americans and medically indigent patients (5,26). In addition, a recent study showed that diabetic patients without health insurance or with Medicaid alone had hospitali...

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Section: Precipitating Events -mentioning

confidence: 99%

Section: Resource Utilization Inmentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

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“…The annual incidence of DKA among subjects with type 1 diabetes is between 1% and 5% in European and American series [6][7][8][9][10] and this incidence appears to have remained relatively constant over the last decade in Western countries. Episodes of DKA are more common in younger than older subjects and are twice as common in females than males.…”

Section: Epidemiologymentioning

confidence: 99%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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Diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and lactic acidosis represent three of the most serious acute complications of diabetes. There have been some advances in our understanding of the pathogenesis of these conditions over the last three decades, together with more uniform agreement on their treatment and innovations in technology. Accordingly their incidence, morbidity, and mortality are decreasing, but at rates that fall short of our aspirations. Hyperglycaemic crises in particular remain an important cause of morbidity and mortality in diabetic populations around the world. In this article, understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed. As far as is possible, the recommendations are based on clear published evidence; failing that, what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.

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“…The diagnoses of HNKHC and DKA are clinically very easy to confuse, [10][11][12][13][14] because both of them are acute diabetic complications caused by a lack of insulin secretion. The difference is that HNKHC is common in the elderly, and dehydration, hyperosmosis, and hyperglycemia is more serious, but without or with only mild ketoacidosis.…”

mentioning

confidence: 99%

Hyperosmolar nonketotic hyperglycemic coma induced by methylprednisolone pulse therapy for acute rejection after liver transplantation: a case report and review of the literature

Zhou¹,

Wang²,

Yuan³

et al. 2014

TRRM

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Hyperosmolar nonketotic hyperglycemic coma (HNKHC) is a serious, rare complication induced by methylprednisolone (MP) pulse therapy for acute rejection after orthotopic liver transplantation (OLT). Herein, we report an unusual case of a 58-year-old woman who experienced acute rejection at 30 months after OLT, only one case in which HNKHC resulted in MP pulse therapy for acute rejection in all 913 recipients in our center. The general morbidity of HNKHC was 1.09‰ in this study. HNKHC is characterized by rapid onset, rapid progression, and a lack of specific clinical manifestations. High-dose MP management was a clear risk factor. The principle of treatment included rapid rehydration, low-dose insulin infusion, and correcting disorders of electrolytes and acidosis. In conclusion, clinicians considering MP pulse therapy after OLT should be alert to the occurrence of HNKHC.

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Epidemiology and Treatment of Diabetic Ketoacidosis in a Community Population

Cited by 83 publications

References 9 publications

Management of Hyperglycemic Crises in Patients With Diabetes

Management of Hyperglycemic Crises in Patients With Diabetes

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

Hyperosmolar nonketotic hyperglycemic coma induced by methylprednisolone pulse therapy for acute rejection after liver transplantation: a case report and review of the literature

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