ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Wolfsdorf, Joseph I.; Glaser, Nicole; Agus, Michael S. D.; Fritsch, Maria; Hanås, Ragnar; Rewers, Arleta; Sperling, Mark A.; Codner, Ethel

doi:10.1111/pedi.12701

Cited by 616 publications

(933 citation statements)

References 280 publications

(620 reference statements)

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“…Cases with C‐peptide values less than 0.6 ng/mL were considered as having endogenous insulin deficiency . Diabetic ketoacidosis (DKA) was diagnosed according to the Clinical Practice Consensus Guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD) . In addition, we examined whether mutation carriers had extra‐pancreatic complications.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive screening for monogenic diabetes in 89 Japanese children with insulin-requiring antibody-negative type 1 diabetes

et al. 2017

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This study demonstrated significant genetic overlap between autoantibody-negative T1D and monogenic diabetes. Mutations in INS and HNF genes, but not those in GCK and other monogenic diabetes genes, likely play critical roles in children with insulin-requiring T1D. This study also suggests the relatively high de novo rates of INS and HNF mutations, and the etiological link between autoimmune abnormalities and T1D in the non-carrier group. Carriers of monogenic mutations show non-specific phenotypes among all T1D cases, although they are more likely to have a normal BMI at diagnosis than non-carriers.

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Section: Methodsmentioning

confidence: 99%

Comprehensive screening for monogenic diabetes in 89 Japanese children with insulin-requiring antibody-negative type 1 diabetes

et al. 2017

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“…We identified all events using a combination of automated searches of the electronic medical record (EMR) database and manual review of clinical databases. DKA was defined in accordance with the International Society of Pediatric and Adolescent Diabetes (ISPAD) consensus guidelines: pH < 7.3 or bicarbonate < 15 mEq/L (15 mmol/L), with blood glucose ≥ 200 mg/dL (11.1 mmol/L), and the presence of ketones . For all events, anthropometrics, vital signs, laboratory data, past medical history, and physical exam were collected.…”

Section: Methodsmentioning

confidence: 99%

Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

et al. 2017

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Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. Nephrolithiasis can increase insulin resistance due to increased pain and inflammation, so these patients should be monitored closely for recurrence of DKA. As patients with diabetes have increased risk of chronic kidney disease and nephrolithiasis can cause kidney injury, risk factors for nephrolithiasis should be identified and addressed to avoid subsequent kidney damage.

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“…Prompt administration of mannitol therapy administered at a dose of 0.5-1 g/kg over 20 minutes can help to abort further neurologic deterioration 96. Delaying potential lifesaving treatment while awaiting results of computed tomography imaging is not recommended.…”

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

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

French

Donihi

Korytkowski

2019

BMJ

127

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Cited by 616 publications

References 280 publications

Comprehensive screening for monogenic diabetes in 89 Japanese children with insulin-requiring antibody-negative type 1 diabetes

Comprehensive screening for monogenic diabetes in 89 Japanese children with insulin-requiring antibody-negative type 1 diabetes

Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

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

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