Abstract:Aims/hypothesisThe aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA.MethodsWe conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge cod… Show more
“…196,197 The Centers for Disease 198 and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA. 199,200 Cerebral injury is the major cause of mortality and morbidity 195,201 and cerebral edema accounts for 60% to 90% of all DKA deaths. 102,202 From 10% to 25% of survivors of cerebral edema have significant residual morbidity.…”
Section: Morbidity and Mortalitymentioning
confidence: 99%
“…A number of possible reasons have been proposed for the reduction in diabetes‐related deaths in children, including improved diabetes care and treatment, increased awareness of diabetes symptoms, possibly resulting in earlier recognition and treatment, and advances in education regarding diabetes and management of DKA. However, recent data show that DKA is still the leading cause of death in subjects with T1D diagnosed less than 15 years of age and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA …”
Section: Introduction Of Oral Fluids and Transition To Sc Insulin Injmentioning
“…196,197 The Centers for Disease 198 and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA. 199,200 Cerebral injury is the major cause of mortality and morbidity 195,201 and cerebral edema accounts for 60% to 90% of all DKA deaths. 102,202 From 10% to 25% of survivors of cerebral edema have significant residual morbidity.…”
Section: Morbidity and Mortalitymentioning
confidence: 99%
“…A number of possible reasons have been proposed for the reduction in diabetes‐related deaths in children, including improved diabetes care and treatment, increased awareness of diabetes symptoms, possibly resulting in earlier recognition and treatment, and advances in education regarding diabetes and management of DKA. However, recent data show that DKA is still the leading cause of death in subjects with T1D diagnosed less than 15 years of age and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA …”
Section: Introduction Of Oral Fluids and Transition To Sc Insulin Injmentioning
“…Patients admitted to hospital with diabetic ketoacidosis represent a group at high risk for all cause mortality and hospital readmissions including recurrent diabetic ketoacidosis 13103104105. Those with a history of psychiatric illness or alcohol or substance misuse are at even higher risk for readmission, which contributes to long term risk for death 106107.…”
Section: Complications Related To Management Of Diabetic Ketoacidosismentioning
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.
“…In Birmingham, UK, high-dose insulin was also being used with similar success—doses varying depending on the degree of consciousness, with those unarousable on admission given doses between 500 and 1400 units per 24 h [4]. DKA remains a medical emergency; over time, mortality has continued to fall but remains a significant risk, especially amongst the young, socially isolated and when care provision is fragmented [5•, 6•]. Overall, the diagnosis and treatment of DKA are very similar in the UK and USA with a few differences.…”
Purpose of ReviewDiabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries.Recent FindingsLarge-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation.SummaryThere is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol.
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