Respiratory failure in diabetic ketoacidosis

Konstantinov, Nikifor K.; Rohrscheib, Mark; Agaba, Emmanuel I; Dorin, Richard I.; Murata, Glen H.; Tzamaloukas, Antonios H.

doi:10.4239/wjd.v6.i8.1009

Cited by 22 publications

(28 citation statements)

References 206 publications

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“…The outcomes of DKA have been shown to improve with adherence to treatment guidelines. [11][12][13][14][15] Minor variants of the commonly used treatment protocol for DKA based on the published guidelines use insulin infusions and intravenous electrolyte solution and dextrose solution when blood sugar drops below 250 mg/dL. 2 In order to correct dehydration in patients with DKA, intravenous electrolyte solutions are administered at the beginning of the treatment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

Munir

Fargo

Garrison

et al. 2017

BMJ Open Diab Res Care

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ObjectiveWe compared the conventional ‘one-bag protocol’ of management of diabetic ketoacidosis (DKA) with the ‘two-bag protocol’ which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the other containing the same solution with the addition of 10% dextrose.Research design and methodsA retrospective chart review and analysis was done on adult patients admitted for DKA to the Riverside University Health System Medical Center from 2008 to 2015. There were 249 cases of DKA managed by the one-bag system and 134 cases managed by the two-bag system.ResultsThe baseline patient characteristics were similar in both groups. The anion gap closed in 13.56 hours in the one-bag group versus 10.94 hours in the two-bag group (p value <0.0002). None of the individual factors significantly influenced the anion gap closure time; only the two-bag system favored earlier closure of the anion gap. Plasma glucose levels improved to <250 mg/dL earlier with two-bag protocol (9.14 vs 7.82 hours, p=0.0241). The incidence of hypoglycemic events was significantly less frequent with the two-bag protocol compared with the standard one-bag system (1.49% vs 8.43%, p=0.0064). Neither the time to improve serum HCO3 level >18 mg/dL nor the hospital length of stay differed between the two groups.ConclusionsOur study indicates that the two-bag protocol closes the anion gap earlier than the one-bag protocol in adult patients with DKA. Blood glucose levels improved faster with the two-bag protocol compared with the one-bag protocol with fewer associated episodes of hypoglycemia. Prospective studies are needed to evaluate the clinical significance of these findings.

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Section: Introductionmentioning

confidence: 99%

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

Munir

Fargo

Garrison

et al. 2017

BMJ Open Diab Res Care

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“…Glycaemia in DKA rarely exceeds 33 mmol/L. Predictors of mortality are comorbidities, severe acidemia at presentation (arterial blood pH < 7.0), development of coma, or fever [4]. …”

Section: Discussionmentioning

confidence: 99%

“…This shift is an osmotic consequence of solute accumulation in the extracellular compartment during development of hyperglycaemia. The magnitude of this shift affects the severity of the ensuing circulatory overload and one of the main factors in this process is the degree of hyperglycaemia [4, 7]. …”

Section: Discussionmentioning

confidence: 99%

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An Exceptional Case of Diabetic Ketoacidosis

Vyver

Damen

Haentjens

et al. 2017

Case Reports in Emergency Medicine

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We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome.

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“…In addition to correction of hyperglycemia and ketoacidosis, when present, the treatment of hyperglycemic crises addresses the critical areas of hypovolemia, potassium deficit and hypertonicity plus less frequently other deficits, e.g ., deficits of phosphate or magnesium[49,60]. Current guidelines address all these disturbances of hyperglycemic crises[48].…”

Section: Hyperglycemiamentioning

confidence: 99%

Hypertonicity: Clinical entities, manifestations and treatment

Rondon‐Berrios

Argyropoulos

Ing

et al. 2017

WJN

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Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.

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Respiratory failure in diabetic ketoacidosis

Cited by 22 publications

References 206 publications

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis

An Exceptional Case of Diabetic Ketoacidosis

Hypertonicity: Clinical entities, manifestations and treatment

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