Management of diabetic ketosis and ketoacidosis with intramuscular regular insulin in a low-resource family medicine setting

Basetty, Sudhakar; Kumar, Gautam; Shalini, Martina; Angeline, Ruby P; David, Kirubah V; Abraham, Sunil

doi:10.4103/2249-4863.214992

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…Patients with severe DKA had longer duration of hospital stay compared with patients with mild DKA, which was similar to other studies [26]. The most common precipitating factor of DKA in our study was infection, which was closely approximated other developing countries [13,20,22,27].…”

Section: Discussionsupporting

confidence: 90%

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Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

She

Wang

et al. 2020

Preprint

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Objective：Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most common hyperglycemic emergencies (HEs) associated with diabetes mellitus. Individuals with HEs can present with combined features of DKA and HHS. The objective of this study is to assess the clinical characteristics, therapeutic outcomes, and associated predisposing factors of type 2 diabetic patients with isolated or combined HEs in China. Methods: We performed a retrospective analysis of 158 patients with type 2 diabetes (T2DM), complicated with DKA, HHS, or DKA combined with HHS (DKA-HHS) in Shanghai Tongji Hospital, China from 2010 to 2015. Admission clinical features, therapeutic approaches and treatment outcomes of those patients were extracted and analyzed.Results: Of the 158 patients with T2DM, 65 (41.1%) patients were DKA, 74 (46.8%) were HHS, and 19 (12.0%) were DKA-HHS. The most common precipitants were infections (111, 70.3%), newly diagnosed diabetes (28,17.7%) and non-compliance to medications (9, 5.7%). DKA patients were divided into mild, moderate and severe group, based on arterial blood gas. Spearman correlation analysis revealed that C-reaction protein (CRP) was positively correlated with severity of DKA, whereas age and fasting C peptide were inversely correlated with severity of DKA (P<0.05). The mortality was 10.8% (17/158) in total and 21.6% (16/74) in the HHS group, 5.9% (1/17) in DKA-HHS. Spearman correlation analysis indicated that lethal outcome of HHS patients was positively correlated to effective plasma osmolality (EPO), renal function indicators and hepatic enzymes, while inversely associated with the continuous subcutaneous insulin infusion (CSII) therapy. Logistic regression analysis suggested that elevated blood urea nitrogen (BUN) on admission was an independent predisposing factor of mortality in HHS, while CSII might be a protective factor for patients with HHS. Furthermore, the receiver-operating characteristic (ROC) curve analysis indicated that BUN had the largest area under the ROC curves for predicting lethal outcome in patients with HHS.Conclusions: Our findings showed elevated CRP and decreased fasting C-peptide might serve as indicator for severe DKA. Elevated BUN might be an independent predictor of mortality in patients with HHS, whereas CSII might be a protective factor against lethal outcome in HHS.

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Section: Discussionsupporting

confidence: 90%

“…8,26.7%), whereas the lowest mortality rate occurred in age groups < 70 years (3, 13.6%). The mortality recorded in patients with age 70-80 was 22.7% (5/22).…”

mentioning

confidence: 90%

Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

She

Wang

et al. 2020

Preprint

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“…Duration of hospital stay in our study was similar to other studies. In a study conducted in a secondary health care center in Vellore, Tamil Nadu, the mean duration of stay in patients with mild and moderate DKA was 5.29 days,[ 10 ] which was similar to our study and other studies. Patients with moderate and severe DKA had longer duration of stay as compared to the patients with DKA.…”

Section: Discussionsupporting

confidence: 90%

Correlation between the outcomes and severity of diabetic ketoacidosis: A retrospective pilot study

George

Mishra

Iyadurai

2018

J Family Med Prim Care

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Introduction:Diabetic ketoacidosis (DKA) is a serious acute metabolic complication of diabetes mellitus (DM). It is classified into mild, moderate, and severe based on severity as per the American Diabetes Association (ADA) guidelines. There are limited data on the correlation between the severity of DKA and its outcomes using this classification system. The aim is to study the correlation between the outcomes and severity of DKA in a tertiary care center in India.Methodology:In this retrospective pilot study, 1527 patients with DM were identified over a span of 3 years, of which 63 had a discharge diagnosis of DKA and 37 fulfilled the ADA criteria for DKA. Following inclusion details on clinical parameters and outcomes of patients with mild, moderate, and severe DKA were compared.Results:Mild, moderate, and severe DKA accounted for 8%, 41%, and 51% of the patients, respectively. Intensive Care Unit (ICU) care was required in 6.7% and 47.4% of those with moderate and severe DKA, respectively. Invasive ventilation (IV) was required in 47% (9) of those with severe DKA only. The mortality rates were 13.3% and 26% among those with moderate and severe DKA. The mean expenditure was ₹29,000, ₹30,000, and ₹64,000 among those with mild, moderate, and severe DKA, respectively.Conclusions:The ADA classification of severity of DKA correlates well with the duration of inhospital stay, costs of care, requirement of ICU care, need for IV or non-IV, and mortality. This suggests that this classification system could be a valuable tool in predicting outcomes.

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“…The criteria for diagnosing DKA was blood glucose (BG) > 11 mmol/L, venous pH < 7.3, or bicarbonate < 15 mmol/L. A diagnosis of DK was made if blood glucose was more than 11 mmol/L, urine ketones were positive, but venous pH ≥7.3 or serum bicarbonate level was normal (≥15 mmol/L) [16]. Euthyroidism was defined when levels of thyroid function tests were within the following reference ranges: FT3 3.1-6.8 pmol/L, FT4 12-22 pmol/L, and TSH 0.27-4.2 μIU/mL.…”

Section: Patient Recruitment and Exclusion Criteriamentioning

confidence: 99%

Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

Shao

Guo

et al. 2020

BMC Endocr Disord

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Background: Euthyroid sick syndrome (ESS) frequently arises in children admitted with diabetic ketoacidosis/ diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children suffering from DKA/DK. Methods: 98 DKA and 96 DK pediatric patients were selected from hospital records. Those on thyroxine replacement, with overt hypothyroidism, or with positive anti-thyroperoxidase (TPO) antibody were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done on all patients. Children were divided into euthyroid (n = 88) and ESS groups (n = 106). Results: The ESS group had a higher level of white blood cell count (WBC), plasma glucose (PG), betahydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), glycosylated hemoglobin (HbA1c) and a lower level of HCO 3 − , prealbumin (PA), and albumin (ALB) compared with the euthyroid group (P < 0.05). Free T3 (FT3) levels were significantly correlated to β-HB, HCO 3 − , AG, PA, and HbA1c (r = − 0.642, 0.681, − 0.377, 0.581, − 0.309, respectively; P < 0.01). Free T4 (FT4) levels were significantly correlated to β-HB, HCO 3 − , and ALB levels (r = − 0.489, 0.338, 0.529, respectively; P < 0.01). TSH levels were significantly affected by HCO 3 − only (r = − 0.28; P < 0.01). HCO 3 − level was the most important factor deciding euthyroid or ESS on logistic regression analysis (OR = 0.844, P = 0.004, 95%CI = 0.751-0.948). Conclusions: Lower levels of free thyroid hormones and occurrence of ESS were associated with a higher degree of acidosis in children with DKA/DK.

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Management of diabetic ketosis and ketoacidosis with intramuscular regular insulin in a low-resource family medicine setting

Cited by 11 publications

References 11 publications

Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

Correlation between the outcomes and severity of diabetic ketoacidosis: A retrospective pilot study

Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

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