Persisting Mortality in Diabetic Ketoacidosis

Basu, Abhijit; Close, Colin; Jenkins, David; Krentz, Andrew J.; Nattrass, M.; Wright, Alexander D.

doi:10.1111/j.1464-5491.1993.tb00060.x

Cited by 133 publications

(74 citation statements)

References 12 publications

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“…Interestingly, the use of standardised written guidelines appear to be more important in determining outcome than the type of hospital or the specialty of the attending physician, 9 14 18 55-58 though implementation of the guidelines may not always be as straightforward as it sounds. 59 In these studies, 9 14 18 55-58 and in a UK study 13 mortality rates for DKA were ,5% and those for HHS <15%; most deaths occurred in patients over 50 years of age and were secondary to severe concomitant illnesses. Increasing age, severity of concomitant illness, severity of acidosis, or the presence of HHS are persuasive factors in arguing for management on an intensive care or high dependency unit.…”

Section: General Measuresmentioning

confidence: 89%

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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Section: General Measuresmentioning

confidence: 89%

Hyperglycaemic crises and lactic acidosis in diabetes mellitus

English

Williams

2004

Postgraduate Medical Journal

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“…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).…”

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confidence: 99%

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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“…DKA hospitalizations comprise a significant portion of health care costs for diabetes (1). Although mortality for DKA has fallen, it remains an important cause of diabetes-associated death, especially among younger patients with diabetes (2). Prior analyses of DKA have been single-center intensive care unit (ICU) studies or based on hospital discharges (3)(4)(5).…”

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confidence: 99%