Diabetic Acidosis: An Evaluation of the Cause, Course and Therapy of 73 Cases

doi:10.7326/0003-4819-52-1-55

Cited by 58 publications

(3 citation statements)

References 37 publications

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“…Two31,45 of the six remaining studies neither provided pH nor potassium level in the report. The maximum number of patients reported with CV disorder in any single study was 17, where abnormal ECG was mentioned with recorded CV abnormality 32. In the context of insulin, one death was reported secondary to an increase in insulin 36.…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies reported any findings related to the pH-adjusted corrected potassium level and only one reported CV outcomes of DKA with respect to potassium 32. It is understandable that an initial report that focused on clerking the files of DKA patients after the discovery of insulin did not focus on the potassium at all, despite adverse CV events being the reason for eight deaths in uncomplicated DKA 31.…”

Section: Discussionmentioning

confidence: 99%

“…This is because it was Holler8 who described the effect of insulin on potassium during the treatment of DKA, which later became a part of established protocols. The attempt by Cohen et al32 reported a detailed description of DKA admissions. The authors did report on the measured potassium level at the time of admission and also concluded for a case that hypokalemia might have been a reason for the death of a patient from septicemia.…”

Section: Discussionmentioning

confidence: 99%

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<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

Usman

Makmor‐Bakry

Mustafa

et al. 2019

DMSO

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Background During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events. Objective To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA. Methodology Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale. Results Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level. Conclusion The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

Usman

Makmor‐Bakry

Mustafa

et al. 2019

DMSO

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Metabolic Acidosis—Diabetic

Nuttall

1965

Arch Intern Med

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Psychological Factors in Diabetes Mellitus

Greydanus¹,

Hofmann²

1979

Am J Dis Child

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In this thorough review of the literature of the past 100 years concerning psychological factors in diabetes mellitus, interpretation is channeled toward adolescence. In addition, emphasis is given to the major role that emotional components play in the development and maintenance of the brittle teenage diabetic. The integration of adolescent developmental issues of into physician treatment plans is stressed.

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Diabetic Acidosis: An Evaluation of the Cause, Course and Therapy of 73 Cases

Cited by 58 publications

References 37 publications

<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

Metabolic Acidosis—Diabetic

Psychological Factors in Diabetes Mellitus

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