Management of diabetic ketoacidosis

Barski, Leonid; Golbets, Evgeny; Jotkowitz, Alan; Schwarzfuchs, Dan

doi:10.1016/j.ejim.2023.07.005

Cited by 4 publications

(2 citation statements)

References 74 publications

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“…Current protocols involve ED clinicians prioritizing the immediate assessment and stabilization of the patient's airway and hemodynamic status (Dingle & Slovis, 2020). Critically ill patients undergo a thorough investigation, including laboratory tests and diagnostic assessments, to identify potential causes for unexplained DKA, such as a drug screen, blood alcohol level, and assessments of aspirin/acetaminophen levels (Barski et al, 2023). Infections and injuries are also assessed.…”

Section: Author's Discussionmentioning

confidence: 99%

Can Artificial Intelligence Be Utilized to Predict Real-Time Adverse Outcomes in Individuals Arriving at the Emergency Department With Hyperglycemic Crises?

Bhimani,

Frenkel,

Hasham

2024

Advanced Emergency Nursing Journal

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This column on translating research into practice is crafted to offer advanced practice registered nurses an analysis of current research topics that hold practical relevance for emergency care settings. The article titled “Using Artificial Intelligence to Predict Adverse Outcomes in Emergency Department Patients With Hyperglycemic Crises in Real Time,” authored by C. Hsu et al. (2023), investigates through a randomized control trial, the effectiveness of artificial intelligence as a practical tool compared with the traditional predicting hyperglycemic crisis death score to clinically predict adverse outcomes in individuals presenting to the emergency department with hyperglycemic crises. The results are discussed in the context of averting adverse outcomes associated with sepsis/septic shock, intensive care unit admission, and all-cause mortality within a 1-month time frame.

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Section: Author's Discussionmentioning

confidence: 99%

Can Artificial Intelligence Be Utilized to Predict Real-Time Adverse Outcomes in Individuals Arriving at the Emergency Department With Hyperglycemic Crises?

Bhimani,

Frenkel,

Hasham

2024

Advanced Emergency Nursing Journal

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“…Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus described in patients with both type 1 and type 2 diabetes ( 1 ). The pivotal facets of acute DKA management involve the administration of intravenous fluids and insulin therapy ( 2 , 3 ). Despite a consensus on the appropriate insulin dosage and administration route, the selection of fluid therapy remains a subject of contention, particularly in the context of both DKA and critical illness ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials

Liu,

Zhang,

et al. 2024

Front. Endocrinol.

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PurposeThe optimal resuscitative fluid for patients with diabetic ketoacidosis (DKA) remains controversial. Therefore, our objective was to assess the effect of balanced crystalloids in contrast to normal saline on clinical outcomes among patients with DKA.MethodsWe searched electronic databases for randomized controlled trials comparing balanced crystalloids versus normal saline in patients with DKA, the search period was from inception through October 20th, 2023. The outcomes were the time to resolution of DKA, major adverse kidney events, post-resuscitation chloride, and incidence of hypokalemia.ResultsOur meta-analysis encompassed 11 trials, incorporating a total of 753 patients with DKA. There was no significant difference between balanced crystalloids and normal saline group for the time to resolution of DKA (MD -1.49, 95%CI -4.29 to 1.31, P=0.30, I2 = 65%), major adverse kidney events (RR 0.88, 95%CI 0.58 to 1.34, P=0.56, I2 = 0%), and incidence of hypokalemia (RR 0.80, 95%CI 0.43 to 1.46, P=0.46, I2 = 56%). However, there was a significant reduction in the post-resuscitation chloride (MD -3.16, 95%CI -5.82 to -0.49, P=0.02, I2 = 73%) among patients received balanced crystalloids.ConclusionAmong patients with DKA, the use of balanced crystalloids as compared to normal saline has no effect on the time to resolution of DKA, major adverse kidney events, and incidence of hypokalemia. However, the use of balanced crystalloids could reduce the post-resuscitation chloride.Systematic review registrationhttps://osf.io, identifier c8f3d.

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Fluid therapy in diabetic ketoacidosis

Ramanan,

Delaney,

Venkatesh

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review To evaluate recent evidence (2021–2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed. Recent findings Balanced crystalloid solutions, compared to the commonly recommended and used 0.9% sodium chloride solution (saline), may result in better outcomes for patients with diabetic ketoacidosis, including faster resolution of acidosis, less hyperchloremia and shorter hospital length of stay. Upcoming results from randomized trials may provide definitive evidence on the use of balanced crystalloid solutions in diabetic ketoacidosis. Evidence remains scarce or conflicting for the use of “two-bag” compared to conventional “one-bag” fluid, and rates of fluid administration, especially for adult patients. In children, concerns about cerebral oedema from faster fluid administration rates have not been demonstrated in cohort studies nor randomized trials. Summary Fluid therapy is a key aspect of diabetic ketoacidosis management, with important evidence gaps persisting for several aspects of management despite recent evidence.

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Management of diabetic ketoacidosis

Cited by 4 publications

References 74 publications

Can Artificial Intelligence Be Utilized to Predict Real-Time Adverse Outcomes in Individuals Arriving at the Emergency Department With Hyperglycemic Crises?

Can Artificial Intelligence Be Utilized to Predict Real-Time Adverse Outcomes in Individuals Arriving at the Emergency Department With Hyperglycemic Crises?

Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials

Fluid therapy in diabetic ketoacidosis

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