The Pathophysiology and Management of Diabetic Ketoacidosis in COVID-19 Patients: A Literature Review

Tilincă, Mariana; Gliga, Maximilian Cosma; Varga, Andreea

doi:10.2478/jccm-2021-0024

Cited by 2 publications

(2 citation statements)

References 61 publications

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“…We report a 33 years old male who presented with severe Diabetic ketoacidosis (DKA) which was complicated by hypernatremia. DKA is a serious and preventable acute complication of diabetes mellitus that occurs due to a relative or absolute deficiency of insulin, resulting in reduced glucose uptake and utilization by cells and excessive lipolysis, which in turn triggers the uncontrolled production of ketone bodies, ultimately resulting in state of acidosis 11 . DKA predominantly occurs in individuals with T1DM, accounting for approximately 82.6% of cases 12 .…”

Section: Discussionmentioning

confidence: 99%

Hypernatremia in Diabetic Ketoacidosis: A Rare Metabolic Derangement Requiring a Cautionary Approach in Fluid Resuscitation

Ghimire,

Chaulagain

2023

Preprint

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Type 1 diabetes mellitus (T1DM) is an autoimmune disorder leading to the destruction of insulin producing pancreatic beta cells, resulting in elevated blood sugar levels 1 . Polyuria, polydipsia and weight loss are the key presenting symptoms 2 . A systematic review and meta-analysis reported the global T1DM prevalence of 9.5%, with an incidence of 15 per 100,000 people 3 . Diabetic ketoacidosis (DKA) is a grievous complication of diabetes mellitus caused by insufficient insulin, resulting in elevated blood glucose, ketonemia and acidosis. The overall DKA prevalence across 13 countries over 13 years was 29.9%, with a 3.5% prevalence in Nepal. 4,5 .The most common risk factors leading to DKA include missed insulin doses and infections, while other factors like stress-inducing events or the initial onset of diabetes can also trigger DKA. The clinical manifestations of DKA encompass a range of symptoms, including nausea, severe vomiting, dehydration, polyuria, polydipsia, abdominal pain or discomfort, presence of acetone breath odor, Kussmaul breathing, overall profound fatigue with altered consciousness, disorientation, confusion or occasionally coma when the condition is severe 6 . Typical diagnosing criteria for DKA include blood glucose greater than 250 mg/dl, arterial pH less than 7.3, serum bicarbonate less than 15 mEq/l, and the presence of ketonemia or ketonuria 7 .Immediate intervention is crucial that includes restoring the circulatory volume, correcting electrolyte abnormalities, insulin therapy and addressing the underlying cause 8 . Failure to promptly treat DKA can result in the breakdown of compensatory mechanisms and cause electrolyte abnormalities like hyponatremia, hyperkalemia and ultimately lead to life threatening complications including cerebral edema, acute respiratory distress syndrome, and sepsis. Nursing management for a patient with Diabetic Ketoacidosis (DKA) involves a comprehensive approach that involves monitoring vital signs, blood sugar levels, and electrolytes, administering fluids, assessing renal function and mental status, monitoring intake output, checking for signs of infection, assessing lung sound; educating the patient on insulin injection techniques, medication compliance, promoting lifestyle changes like smoking cessation and diabetic diet 9 .In DKA, dilutional hyponatremia is common due to rising glucose level that creates osmolar gradient causing water to shift from cells into the intravascular space. However, on rare occasion, hypernatremia is found that happens when there's a deficit of water intake and excessive loss of free water, which outweighs electrolyte loss through various factors 10 . This report emphasizes the significance of a fluid management strategy for DKA patients, even when encountering the unusual occurrence of hypernatremia.

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Section: Discussionmentioning

confidence: 99%

Hypernatremia in Diabetic Ketoacidosis: A Rare Metabolic Derangement Requiring a Cautionary Approach in Fluid Resuscitation

Ghimire,

Chaulagain

2023

Preprint

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“…The exact underlying mechanism of DKA development in COVID-19 is not clear. The disease is hypothesized to aggravate metabolic dysfunction in asymptomatic diabetic patients or change the body's metabolic defense mechanisms ( 6 ).…”

mentioning

confidence: 99%

Diabetes Ketoacidosis and COVID-19: An Insight into the Pathophysiology

Ahadiat

Hosseinian

2023

Int J Endocrinol Metab

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The Pathophysiology and Management of Diabetic Ketoacidosis in COVID-19 Patients: A Literature Review

Cited by 2 publications

References 61 publications

Hypernatremia in Diabetic Ketoacidosis: A Rare Metabolic Derangement Requiring a Cautionary Approach in Fluid Resuscitation

Hypernatremia in Diabetic Ketoacidosis: A Rare Metabolic Derangement Requiring a Cautionary Approach in Fluid Resuscitation

Diabetes Ketoacidosis and COVID-19: An Insight into the Pathophysiology

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