Fatal Diabetic Ketoacidosis: Major Causes and Approaches to Their Prevention

Clements, Rex S.; Vourganti, Bhaskar

doi:10.2337/diacare.1.5.314

Cited by 70 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was also true in our study. It has been suggested that hyperosmolar coma has a higher mortality than ketoacidosis [9,21,22]. We found a high mortality in both conditions in the elderly.…”

Section: Discussionsupporting

confidence: 45%

Severely uncontrolled diabetes in the over-fifties

1981

View full text Add to dashboard Cite

Between 1969 and 1976, 317 adults were admitted to hospital in Nottingham with severely uncontrolled diabetes (plasma glucose over 33 mmol/l and/or venous bicarbonate less than 14 mmol/l). A third of episodes were in patients over the age of 50 years, of which 43% were fatal. In contrast, only 3.4% of episodes in patients under 50 years were fatal. In the older group, 65% of deaths occurred within 48 h of admission and in 44% no cause was found other than uncontrolled diabetes. Later deaths were due to underlying disease, infection or thromboembolism. Amongst older patients 38% were not previously known to have diabetes. Presentation to hospital was late and we conclude that many deaths were potentially avoidable by earlier detection in the community.

show abstract

Section: Discussionsupporting

confidence: 45%

Severely uncontrolled diabetes in the over-fifties

1981

View full text Add to dashboard Cite

show abstract

“…The blood glucose decrement during hydration is partially due to improvement in glomerular filtration rate and excretion of large amounts of glucose in the urine (90,134,135). Lack of blood glucose decrement may therefore indicate inadequate hydration or renal function impairment (13). Hydration therapy alone has been reported to partially correct pH and plasma bicarbonate in two studies (44,90), but in another study, pH and plasma bicarbonate were not corrected until insulin was added to the regimen (128).…”

Section: Kitabchi and Associatesmentioning

confidence: 99%

“…Recent studies that have emphasized the use of standardized written guidelines for therapy have demonstrated mortality rates Ͻ5% in DKA and ϳ15% in HHS (6,9,10,(12)(13)(14)(15)(16)214). The majority of deaths have occurred in patients Ͼ50 years of age because of concomitant life-threatening illnesses, suggesting that further major decreases in mortality rates may not be attainable based on treatment of DKA alone (9).…”

Section: Resource Utilization Inmentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Management of Hyperglycemic Crises in Patients With Diabetes

et al. 2001

View full text Add to dashboard Cite

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...

show abstract

“…2 A recent review of the major causes of fatal diabetic ketoacidosis does not list electrolyte imbalance and its fatal myocardial consequence. 6 Although abnormal potassium levels are well known in diabetic ketoacidosis, a reminder seems appropriate at this time. The importance of this reminder is that toxic electrolyte levels can be effectively managed if considered and confirmed early in the course of management.…”

mentioning

confidence: 99%

The Value of Electrocardiogram Monitoring in Diabetic Ketoacidosis

Malone

Brodsky

1980

Diabetes Care

View full text Add to dashboard Cite

Electrolyte abnormalities cause fatal cardiac arrhythmias in patients with diabetic ketoacidosis. A patient is reported with electrocardiogram (ECG) abnormalities characteristic of toxic hyperkalemia and hypocalcemia. The ECG abnormalities were noted during the first hour after arriving at the hospital. The laboratory values confirming the electrolyte abnormalities were not available for more than 1 h after the ECG indicated the danger of myocardial toxicity. During the initial 2 h of therapy the patient was urinating and not in shock. ECG monitoring of this patient prevented the routine administration of intravenous potassium, which was potentially lethal. The clinical importance of electrolyte levels in the management of diabetic ketoacidosis is the prevention of cardiac arrhythmias. ECG monitoring should be a minimal standard in the management of diabetic ketoacidosis.

show abstract

Fatal Diabetic Ketoacidosis: Major Causes and Approaches to Their Prevention

Cited by 70 publications

References 33 publications

Severely uncontrolled diabetes in the over-fifties

Severely uncontrolled diabetes in the over-fifties

Management of Hyperglycemic Crises in Patients With Diabetes

The Value of Electrocardiogram Monitoring in Diabetic Ketoacidosis

Contact Info

Product

Resources

About