Frequent Hypoglycemic Episodes in the Treatment of Patients With Diabetic Ketoacidosis

Malone, Michael L.; Klos, Steven E.; Gennis, Virginia M.; Goodwin, James S.

doi:10.1001/archinte.1992.00400240090015

Cited by 17 publications

(8 citation statements)

References 25 publications

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“…Patients who were admitted and treated for DKA had significant rates of electrolyte and metabolic disturbance during the course of their resuscitation. In 26 admissions (4.1%), significant hypoglycemia was recorded within the first 48 h. This compares with other reported figures of 12.7% within the first 48 h and 30% within the first 14 d after admission (29). The pathogenesis of cerebral edema remains enigmatic (12, 30).…”

Section: Discussionsupporting

confidence: 55%

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

2002

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The number of episodes of diabetic ketoacidosis (DKA) is a significant outcome measure for diabetes care. We ascertained patterns of admission due to DKA over 15 yr to determine whether this indicator of diabetes care had improved in parallel with clinical practices. Between 1 January 1985 and 31 December 1999, 630 admissions were reviewed. We subanalyzed these admissions according to whether the patient was newly diagnosed, had infrequent episodes of DKA (non-relapsers) or had frequent (> or = 2/yr) episodes of DKA (relapsers). Overall there was a slight downward trend in the incidence of DKA admissions over the study period. There was a proportionate increase in the incidence of DKA amongst newly diagnosed patients, with a proportionate decrease in the incidence of DKA seen in relapsers. DKA occurring in non-relapsers remained relatively stable. Adverse clinical events during the admission were relatively uncommon and occurred in all three subgroups. There was no significant difference in HbA1C prior to admission between the relapser and non-relapser groups and there was similarity in the degree of acidosis between all three subgroups. The frequency of significant complications associated with DKA remained unchanged over the study period. Slower rehydration policies were not associated with decreases in either cerebral edema or death rates. DKA remains a significant complication of type 1 diabetes associated with a variety of significant adverse events. Our experience indicates that further efforts to reduce the occurrence of DKA must be focused upon earlier diagnosis and intervention in newly diagnosed patients.

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Section: Discussionsupporting

confidence: 55%

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

2002

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“…A common complication of intravenous insulin therapy is hypoglycemia. Prior studies have reported an incidence of DKA treatment-related hypoglycemia ranging from 13 to 30% (5,27,28). These data from observational studies in realworld settings contrast with the data from the several randomized controlled studies using low-dose insulin protocols showing lower rates (,5%) of hypoglycemia under controlled conditions (24)(25)(26)29).…”

Section: Discussionmentioning

confidence: 85%

Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

et al. 2019

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Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises. RESEARCH DESIGN AND METHODSWe analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality. RESULTSThere were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P 5 0.0019). In all groups, hypoglycemia (<40 mg/dL) during treatment was associated with a 4.8fold increase in mortality (aOR 4.8; 95% CI 1.4, 16.8). Hypokalemia £3.5 mEq/L was frequent (55%). Severe hypokalemia (£2.5 mEq/L) was associated with increased inpatient mortality (aOR 4.9; 95% CI 1.3, 18.8; P 5 0.02). CONCLUSIONSCombined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with higher hospital mortality in patients with hyperglycemic crises.

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“…7 Hypokalemia or hypoglycemia sometimes complicates treatment of hyperglycemic crises. [15][16][17][18] The American Diabetes Association consensus statement recommends using a weight-based insulin IR until attainment of target range control. 1 In evaluation of the glycemic control achieved by the algorithms designed for treatment of DKA or HHS, we did not require that a definition of DKA or HHS be met.…”

Section: Discussionmentioning

confidence: 99%

Target Attainment Through Algorithm Design During Intravenous Insulin Infusion

Devi

Zohra

Howard³

et al. 2014

Diabetes Technology & Therapeutics

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Frequent Hypoglycemic Episodes in the Treatment of Patients With Diabetic Ketoacidosis

Abstract: Hypoglycemia is still a common complication of diabetic ketoacidosis, is associated with hepatic and renal disease as well as fever and "nothing orally" status, and is not documented well in physician notes.

Cited by 17 publications

References 25 publications

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

Target Attainment Through Algorithm Design During Intravenous Insulin Infusion

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