<p>Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis</p>

Abstract

Aim We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology. Methods This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies. Results Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05–5.13 mmol/L and 1.02–15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L). Conclusions Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA.

Comparison of Combined Hemodialysis and Hemoperfusion with Hemoperfusion Alone in 106 Patients with Diabetic Ketoacidosis and Acute Renal Failure: A Retrospective Study from a Single Center in China

“…It is mainly characterized by hyperglycemia, hyperkalemia, dehydration, electrolyte imbalance, and acidosis. Diabetic ketoacidosis can induce tissue ischemic injury as the disease progresses, and the mortality rate is high [ 17 ].…”

A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children

“…Lee et al reported significantly decreased biochemical levels at the time of death vs. at the time of admission. SBP, DBP, creatinine level, and serum lactate level were found to be predictors of mortality [ 22 ]. In our study, significantly different HR and RR were observed in patients with severe DKA (p<0.001).…”

Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis

“…These discrepancies imply that the effects of DKA on long-term prognosis are not only possibly due to ethnical differences but also different physiological conditions at the time of initial T1DM diagnosis. In fact, a recent report suggested that the co-occurrence of various medical conditions with DKA, such as lactic acidosis, also result in worse clinical outcomes [ 21 ]. Although we speculated in this study that high HbA1c levels might suggest deleterious metabolic conditions to the residual islet cell function, their exact effects were not evaluated, especially in various ethnicities.…”