Les pièges de l’acidocétose diabétique

Ayed, Soufia; Bouguerba, Abdelaziz; Ahmed, Pepita Ould; Barchazs, J.; Boukari, M.; Goldgran-Tolédano, Dany; Bornstain, Caroline; Vincent, François

doi:10.1007/s13546-015-1113-z

Cited by 1 publication

(1 citation statement)

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“…Diabetic ketoacidosis is, thus, defined by the association of ketonemia ≥ 3 mmol/l or ketonuria ≥ 3+, blood glucose > 11 mmol/l (or known diabetes mellitus), venous plasma bicarbonates (HCO 3 − ) < 15 mmol/l and/or venous pH < 7.30. The four key points of DKA patient management are (i) admission in a high dependency unit if presence of at least one severity criterium, (ii) rehydration with isotonic saline, (iii) intravenous insulin therapy, and (iv) potassium supplementation [6, 7]. Severity criterium defined by international guidelines include neurological, hemodynamic, pulmonary or biological criterium [6].…”

Section: Introductionmentioning

confidence: 99%

Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study

Balmier

Dib

Serret-Larmande

et al. 2019

Ann. Intensive Care

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Background Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. Methods Multicentre retrospective study conducted at five adult intermediate and intensive care units in Paris and its suburbs, France. All patients admitted for DKA between 2013 and 2014 were included. Patients were grouped and compared according to the underlying type of diabetes into three groups: type 1 diabetes, type 2 or secondary diabetes, and DKA as the first presentation of diabetes. Outcomes of interest were the rate of metabolic complications (hypoglycaemia or hypokalaemia) and the recovery time. Results Of 122 patients, 60 (49.2%) had type 1 diabetes, 28 (22.9%) had type 2 or secondary diabetes and 34 (27.9%) presented with DKA as the first presentation of diabetes (newly diagnosed diabetes). Despite having received lower insulin doses, hypoglycaemia was more frequent in patients with type 1 diabetes (76.9%) than in patients with type 2 or secondary diabetes (50.0%) and in patients with newly diagnosed diabetes (54.6%) ( p = 0.026). In contrast, hypokalaemia was more frequent in the latter group (82.4%) than in patients with type 1 diabetes (57.6%) and type 2 or secondary diabetes (51.9%) ( p = 0.022). The median recovery times were not significantly different between groups. Conclusions Rates of metabolic complications associated with DKA treatment differ significantly according to underlying type of diabetes. Decreasing insulin dose may limit those complications. DKA treatment recommendations should take into account the type of diabetes. Electronic supplementary material The online version of this article (10.1186/s13613-019-0567-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%