Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis

Freire, Amado X.; Umpiérrez, Guillermo E.; Afessa, Bekele; Latif, Kashif; Bridges, Lisa J.; Kitabchi, Abbas E.

doi:10.1053/jcrc.2002.36755

Cited by 54 publications

(70 citation statements)

References 26 publications

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“…In 1973, several reports demonstrated the effectiveness of small doses of insulin in patients with DKA (7,12,20,21). Although multiple controlled studies in patients with DKA have shown that low-dose insulin therapy is effective regardless of the route of administration (4,6,7,22,23), most medical centers and authorities recommend the administration of IV infusion because of the delayed onset of action and prolonged half-life of SC regular insulin (2,5,9,11,12,24,25). In a prospective randomized study in patients with DKA treated either with IM or SC injections or with continuous IV infusion of regular insulin, Fisher et al (6) reported that 30 -40% of patients in the IM and SC groups did not lower their plasma glucose by 10% in the first hour after insulin injection and that the concentration of ketone bodies was lowered at a significantly faster rate in the IV group than with IM or SC insulin.…”

Section: Figure 1-changes In Metabolic Profile In Patients With Dka Tmentioning

confidence: 99%

“…Most patients with poor compliance are younger, are less critically ill, have lower disease severity scores, and have a lower rate of complications and mortality than non-DKA patients admitted to the ICU (11,31,34). Although these patients should be candidates for early discharge, the length of hospitalization in mild DKA has been reported to be similar to patients admitted with moderate or severe DKA (10,34).…”

Section: Figure 1-changes In Metabolic Profile In Patients With Dka Tmentioning

confidence: 99%

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Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart

et al. 2004

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OBJECTIVE—In this prospective, randomized, open trial, we compared the efficacy and safety of aspart insulin given subcutaneously at different time intervals to a standard low-dose intravenous (IV) infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS—A total of 45 consecutive patients admitted with DKA were randomly assigned to receive subcutaneous (SC) aspart insulin every hour (SC-1h, n = 15) or every 2 h (SC-2h, n = 15) or to receive IV infusion of regular insulin (n = 15). Response to medical therapy was evaluated by assessing the duration of treatment until resolution of hyperglycemia and ketoacidosis. Additional end points included total length of hospitalization, amount of insulin administration until resolution of hyperglycemia and ketoacidosis, and number of hypoglycemic events. RESULTS—Admission biochemical parameters in patients treated with SC-1h (glucose: 44 ± 21 mmol/l [means ± SD], bicarbonate: 7.1 ± 3 mmol/l, pH: 7.14 ± 0.09) were similar to those treated with SC-2h (glucose: 42 ± 21 mmol/l, bicarbonate: 7.6 ± 4 mmol/l, pH: 7.15 ± 0.12) and IV regular insulin (glucose: 40 ± 13 mmol/l, bicarbonate 7.1 ± 4 mmol/l, pH: 7.11 ± 0.17). There were no statistical differences in the mean duration of treatment until correction of hyperglycemia (6.9 ± 4, 6.1 ± 4, and 7.1 ± 5 h) or until resolution of ketoacidosis (10 ± 3, 10.7 ± 3, and 11 ± 3 h) among patients treated with SC-1h and SC-2h or with IV insulin, respectively (NS). There was no mortality and no differences in the length of hospital stay, total amount of insulin administration until resolution of hyperglycemia or ketoacidosis, or the number of hypoglycemic events among treatment groups. CONCLUSIONS—Our results indicate that the use of subcutaneous insulin aspart every 1 or 2 h represents a safe and effective alternative to the use of intravenous regular insulin in the management of patients with uncomplicated DKA.

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Section: Figure 1-changes In Metabolic Profile In Patients With Dka Tmentioning

confidence: 99%

Section: Figure 1-changes In Metabolic Profile In Patients With Dka Tmentioning

confidence: 99%

Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart

et al. 2004

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“…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). Patients may, however, be treated in the emergency department and then admitted to a non-ICU setting or discharged; the frequency of these practices is not known.…”

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confidence: 99%

National Study of U.S. Emergency Department Visits With Diabetic Ketoacidosis, 1993–2003

2006

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“…Lee et al [1] reported that poor glycemic control is the most common factor for DKA and In Western countries, the incidence of DKA is relatively high, ranging from 4.6 to 8.0 cases per 1,000 patients with diabetes [5][6][7]. Furthermore, 7.6% of patients who are hospitalized due to DKA receive intensive care; mortality rates of 5~13% have been reported in this population [8,9]. Therefore, greater understanding of DKA in children with T1DM is needed in order to reduce mortality rates and associated health care costs.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

et al. 2017

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Background: Diabetic ketoacidosis (DKA) is an acute complication of pediatric type 1 diabetes mellitus (T1DM). We aimed to determine the risk factors and clinical characteristics of children and adolescents with DKA. Methods: We retrospectively evaluated 59 episodes of DKA in 43 patients who were hospitalized for DKA between January 2006 and December 2015. DKA was classified as mild, moderate, or severe, according to patient history of DKA. The clinical and laboratory characteristics of these subgroups were compared. Results: The average patient age was 11.98 ± 4.40 years (range, 1.3~17.9 years). Moderate episodes were the most common, with 21 episodes (35.6%), followed by 19 severe (32.2%) and 19 mild episodes (32.2%). Significant differences were observed between the subgroups regarding their characteristics of aggravated. Severe DKA episodes were more often observed during the winter season. Recurrent DKA cases were determined in 31 episodes (52.5%) who were significantly older, had higher body mass index, and lower serum C-peptide levels than the newly diagnosed DKA group. Female patients experienced severe and moderate cases more frequently (P = 0.041), which included two deaths. Only blood glucoseCorresponding author: Min Sun Kim Department of Pediatrics, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, E-mail: children@jbnu.ac.kr Received: Feb. 20, 2017; Revised: Jun. 5, 2017; Accepted: Jul. 18, 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis

Cited by 54 publications

References 26 publications

Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart

Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart

National Study of U.S. Emergency Department Visits With Diabetic Ketoacidosis, 1993–2003

Clinical and Laboratory Characteristics of Pediatric Diabetic Ketoacidosis: A Single-Center Study

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