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Dyanne P Westerberg - One of the best experts on this subject based on the ideXlab platform.

  • Diabetic Ketoacidosis evaluation and treatment
    American Family Physician, 2013
    Co-Authors: Dyanne P Westerberg
    Abstract:

    Diabetic Ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic Ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate Diabetic Ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of Diabetic Ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as information on the importance of medication compliance.

Daniel L Levin - One of the best experts on this subject based on the ideXlab platform.

  • cerebral edema in Diabetic Ketoacidosis
    Pediatric Critical Care Medicine, 2008
    Co-Authors: Daniel L Levin
    Abstract:

    Objective: To review the causes of cerebral edema in Diabetic Ketoacidosis (CEDKA), including pathophysiology, risk factors, and proposed mechanisms, to review the diagnosis, treatment, and prognosis of CEDKA and the treatment of Diabetic Ketoacidosis as it pertains to prevention of cerebral edema. Data Source: A MEDLINE search using OVID was done through 2006 using the search terms cerebral edema and Diabetic Ketoacidosis. Results of Search: There were 191 citations identified, of which 150 were used. An additional 42 references listed in publications thus identified were also reviewed, and two book chapters were used. Study Selection: The citations were reviewed by the author. All citations identified were used except 25 in foreign languages and 16 that were duplicates or had inappropriate titles and/or subject matter. Of the 194 references, there were 21 preclinical and 40 clinical studies, 35 reviews, 15 editorials, 43 case reports, 29 letters, three abstracts, six commentaries, and two book chapters. Data Synthesis: The data are summarized in discussion. Conclusions: The causes and mechanisms of CEDKA are unknown. CEDKA may be due as much to individual biological variance as to severity of underlying metabolic derangement of the child's state and/or treatment risk factors. Treatment recommendations for CEDKA and Diabetic Ketoacidosis are made taking into consideration possible mechanisms and risk factors but are intended as general guidelines only in view of the absence of conclusive evidence.

Michael Faust - One of the best experts on this subject based on the ideXlab platform.

  • Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
    DMW - Deutsche Medizinische Wochenschrift, 2018
    Co-Authors: Christina Schumann, Michael Faust
    Abstract:

     Diabetic Ketoacidosis and the hyperosmolar hyperglycemic state are the most serious Diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in Diabetic Ketoacidosis equivalent to a torturous death. Today, mortality from Diabetic Ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education. Therefore, there is a need to raise awareness of hyperglycemic crisis and its management amongst physicians.  Insulin deficiency or resistence and increased concentrations of counterreulatory hormones (glucagon, catecholamines, cortisol and growth hormone) are responsible for the development of Diabetic Ketoacidosis and the hyperosmolar hyperglycemic state. Hyperglycemia develops as a result of increased gluconeogenesis and accelerated glyconeogenesis. In DKA, the absolute insulin deficiency additionally leads to increased lipolysis and production of ketone bodies and resulting metabolic acidosis.  Both DKA and HHS require prompt recognition and management. The diagnosis can be suspected by clinical features and confirmed by laboratory findings.  The treatment of DKA and HHS is similar, including correction of fluid and electrolyte abnormalities and the administration of insulin. © Georg Thieme Verlag KG Stuttgart · New York.

Jacquie Rand - One of the best experts on this subject based on the ideXlab platform.

  • Diabetic Ketoacidosis and hyperosmolar hyperglycemic state in cats.
    Veterinary Clinics of North America: Small Animal Practice, 2013
    Co-Authors: Jacquie Rand
    Abstract:

    Diabetic Ketoacidosis and hyperosmolar hyperglycemic state are 2 potentially life-threatening presentations of feline diabetes mellitus. Presentations range from mildly anorexic cats with Diabetic Ketoacidosis to comatose cats with Diabetic Ketoacidosis or hyperosmolar hyperglycemic state. Such cases are the result of severe insulin deficiency and/or concurrent disease, resulting in nausea and vomiting, electrolyte and water losses, acidosis, and circulatory collapse. The condition requires careful attention to supportive care to correct fluid and electrolyte abnormalities, treatment of concurrent diseases, and reversal of the effects of insulin deficiency. However, early diagnosis of diabetes mellitus and institution of appropriate insulin therapy prevents these complications.

Masamitsu Nakazato - One of the best experts on this subject based on the ideXlab platform.

  • Bilateral pulmonary mucormycosis with Diabetic Ketoacidosis
    Journal of the Japanese Association for Infectious Diseases, 2007
    Co-Authors: Masatoshi Tokojima, Jun-ichi Ashitani, Nobuhiro Matsumoto, Masamitsu Nakazato
    Abstract:

    A 38 year-old woman admitted for bilateral infiltrates with a cavity and treated Diabetic Ketoacidosis and elevated inflammatory reaction in clinical examination was found in transbronchial lung biopsy specimens to have bilateral pulmonary mucormycosis. We controlled blood glucose with insulin and removed bilateral pulmonary lesions separately. Pulmonary mucormycosis with Diabetic Ketoacidosis is a rare but fatal fungal infection. Early diagnosis, intensive insulin therapy, and surgical resection may save patients with pulmonary mucormycosis even if lesions are bilateral.