Endocrine emergencies

2010 ◽  
pp. 515-572
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir Sam
Keyword(s):  
Diabetic Ketoacidosis ◽  
Urgent Surgery ◽  
Patients With Diabetes ◽  
Hypoglycaemic Coma

Diabetic ketoacidosis (DKA): assessment 516 DKA: management 1 518 DKA: management 2 520 DKA: complications 522 Hyperosmolar non-ketotic coma (HONK) 1 524 HONK 2 526 Hypoglycaemic coma: assessment 528 Hypoglycaemic coma: management 530 Urgent surgery in patients with diabetes 532 Hyponatraemia: assessment 534 Hyponatraemia: causes ...

Diabetes and endocrine emergencies

2019 ◽  
pp. 545-606
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Malignant Hyperthermia ◽  
Diabetic Ketoacidosis ◽  
Neuroleptic Malignant Syndrome ◽  
Diabetic Foot ◽  
Pituitary Apoplexy ◽  
Urgent Surgery ◽  
Foot Complications ◽  
Patients With Diabetes ◽  
Thyrotoxic Crisis ◽  
Hypoglycaemic Coma

This chapter describes diabetes and endocrine emergencies, including diabetic ketoacidosis (DKA; assessment, management, complications), hyperosmolar non-ketotic coma (HONK), hypoglycaemic coma, urgent surgery in patients with diabetes, diabetic foot complications, hyponatraemia, hypernatraemia, acute hypocalcaemia, hypercalcaemia, hypophosphataemia, Addisonian crisis, myxoedema coma, thyrotoxic crisis, pituitary apoplexy, hypopituitary coma, phaeochromocytomas, polyuria, malignant hyperthermia, and neuroleptic malignant syndrome.

scholarly journals Cerebrospinal fluid lactate in patients with diabetes mellitus and hypoglycaemic coma.

1989 ◽  
Vol 52 (3) ◽  
pp. 372-375 ◽  
Author(s):  
H Yao ◽  
S Sadoshima ◽  
Y Nishimura ◽  
K Fujii ◽  
M Oshima ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebrospinal Fluid ◽  
Patients With Diabetes ◽  
Hypoglycaemic Coma

scholarly journals Management of Diabetic Ketoacidosis in Patients with Diabetes Type I

2019 ◽  
Author(s):  
Basam Zuhaer Sindi ◽  
Naif Mishkhas Alazwari ◽  
Abdulaziz Mohammed Khateeb ◽  
Aqil Abdulmonem Alzaher ◽  
Mohammad Abdulaziz M Alkhawajah ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Fluid Replacement ◽  
Diabetic Patients ◽  
Type I ◽  
Care Providers ◽  
Patients With Diabetes ◽  
Type One Diabetes ◽  
Diabetes Type I ◽  
Comprehensive Search ◽  
Health Complications

Background: DKA is the leading cause of mortality among pediatric age and young adults with T1D, responsible for almost 50% of all fatalities in diabetic patients younger than 24 years of age. Goals of DKA management include optimization of volume status, hyperglycemia and ketoacidosis, electrolyte abnormalities, and potential precipitating factors. Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1987, through February 2017. The following search terms were used: ketoacidosis, management of diabetic ketoacidosis, type I diabetic patients’ emergency complication, fluid replacement in DKA, insulin therapy approach. Aim: in this review, we aim at evaluating the various ways of approaching patients who suffer from type-one diabetes during ketoacidosis and keto-acidotic coma. We will try to understand the triggers and pathophysiology behind this condition, and explore ways to prevent them. Conclusion: prompt diagnoses, aggressive treatment, and education of patient and their care providers about prevention strategies must be implemented. Also, more studies are required in the area of preventing health complications due to these types of diseases to effectively manage DKA in the future.

Preoperative Assessment of the Patient with Diabetes Mellitus

2019 ◽  
Author(s):  
Sean A. Josephs ◽  
Gretchen A. Lemmink
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Ketoacidosis ◽  
Preoperative Assessment ◽  
Major Surgery ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Hyperglycemic Hyperosmolar State ◽  
Patients With Diabetes

Diabetes mellitus is a major cause of morbidity and mortality.  Nearly 30 million Americans have diabetes, more than 25% of which are undiagnosed. Patients with diabetes have multiple problems that should be addressed prior to surgery. They often have uncontrolled glucose levels that should be treated preoperatively. Current studies suggest that outcomes may be improved if perioperative glycemic control is optimized. Patients with diabetes develop end-organ dysfunction that can complicate perioperative management. Preoperative assessment of cardiac, neurologic, vascular, and renal function is necessary for all patients with diabetes that undergo major surgery. Optimization of cardiac disease in particular can reduce major adverse cardiac events for patients with risk factors such as diabetes. Diabetic patients can occasionally present for major surgery with hyperglycemic emergencies such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. These conditions require urgent treatment to prevent mortality regardless of the need for surgery. This article reviews the preoperative assessment and management of these issues. This review contains 1 figure, 4 tables, and 37 references. Key Words: diabetes mellitus (DM), end-organ damage, hyperglycemia, polyuria, polydipsia, polyphagia, perioperative glycemic management, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), perioperative cardiac risk factors

scholarly journals Diabetic ketoacidosis: difference between potassium determined by blood gas analysis versus plasma measurement

2011 ◽  
Vol 55 (4) ◽  
pp. 256-259 ◽  
Author(s):  
Fernando César Robles ◽  
Daniel Laguna Neto ◽  
Fábio Guirado Dias ◽  
Márcia Spressão ◽  
Priscila Nascimbeni Matos ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Concordance Correlation Coefficient ◽  
Blood Gas ◽  
Concordance Correlation ◽  
Gold Standard Method ◽  
Plasma Measurement ◽  
Initial Care ◽  
Patients With Diabetes

OBJECTIVE: To evaluate the accuracy of potassium concentrations measured by blood gas analysis (PBG) compared with laboratory serum potassium (LSP), in the initial care of patients with diabetic ketoacidosis (DKA). SUBJECTS AND METHODS: Fifty three patients with diabetes mellitus were evaluated in a retrospective analysis. PBG was carried out using the Radiometer ABL 700 (Radiometer Copenhagen®), and results were compared with LSP ADVIA 1650 Chemistry system (Siemens®), the gold standard method. Both methods are based on potentiometry. RESULTS: Mean PBG was 3.66 mmol/L and mean LSP was 4.79 mmol/L. Mean difference between PBG and LSP was -1.13 mmol/L (p < 0.0005, 95% CI, -1.39 to -0,86). Lin concordance correlation coefficient was rc = 0.28 (95% CIb, 0.10 to 0.45), demonstrating low concordance between the methods. CONCLUSION: Although PBG measurement is faster and easier, it should not be used as a surrogate for LSP in the clinical treatment of DKA.

Rate and Predictors of 30-Day Readmission following Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A US Analysis

2021 ◽  
Author(s):  
Hafeez Shaka ◽  
Maria Aguilera ◽  
Maria Aucar ◽  
Zain El-Amir ◽  
Farah Wani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Readmission Rate ◽  
Cox Regression ◽  
Diabetes Mellitus Type 1 ◽  
Principal Diagnosis ◽  
Chi Square ◽  
Female Sex ◽  
Patients With Diabetes

Abstract Introduction This study aimed to describe rates and characteristics of non-elective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for diabetic ketoacidosis (DKA) and also identify predictors of readmission. Methods The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using ICD-10-CM codes. We utilized Chi-square tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors. Results The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs. 34.9 years, p=0.018) and a higher proportion of females (52.8 vs. 49.6%,p&lt;0.001) compared to the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs. 0.24%, OR: 2.84, 95% CI: 1.99 – 4.06, p&lt;0.001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA). Conclusion The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.

scholarly journals Impact of Diabetic Ketoacidosis on Thyroid Function in Patients with Diabetes Mellitus

2021 ◽  
Vol 2021 ◽  
pp. 1-26
Author(s):  
Yuling Xing ◽  
Jinhu Chen ◽  
Guangyao Song ◽  
Liying Zhao ◽  
Huijuan Ma
Keyword(s):  
Diabetic Ketoacidosis ◽  
Thyroid Function ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Diabetic Patients ◽  
Academic Journal ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Diabetes Patients

Background. Changes in thyroid function in diabetes patients who developed diabetic ketoacidosis (DKA) still need to be fully elucidated. The aim of this study was to systematically review available data on the relationship between thyroid function and DKA in diabetes patients who developed DKA. Methods. Electronic databases (PubMed, EMBASE, Cochrane Library, and China Academic Journal Full-text Database (CNKI)) were searched systematically to search relevant literature before December 2020. The mean ± standard deviation and 95% confidence interval (95% CI) were used for evaluation, and sensitivity analysis was performed. Publication bias was estimated by funnel plot, Egger’s test, and Begger’s test. Results. 29 studies were included in the meta-analysis, and the indicators (T4, T3, FT3, FT4, TSH, T3RU, and rT3) of patients with DKA were compared and analyzed. The results of this study showed that the levels of T4, T3, FT3, FT4, and TSH were decreased and the level of rT3 was increased in patients with DKA. Compared with after treatment, the levels of T4, T3, FT3, and FT4 in patients with DKA were decreased before treatment, while the levels of rT3 were increased, and there was no significant difference in changes of TSH. With the aggravation of DKA, the levels of T4, T3, FT3, and FT4 will further decrease, while the changes of TSH have no statistical difference. Conclusion. Thyroid function changed in diabetic patients with DKA. It changed with the severity of DKA. This condition may be transient, preceding further recovery of DKA.

Diabetic Ketoacidosis

2017 ◽  
Author(s):  
Anne Newcomer ◽  
Michael Gropper
Keyword(s):  
Diabetic Ketoacidosis ◽  
Clinical Manifestations ◽  
Postoperative Recovery ◽  
Intravascular Volume ◽  
Treatment Algorithms ◽  
Hyperglycemic Hyperosmolar State ◽  
Patients With Diabetes ◽  
Underlying Mechanisms ◽  
Basic Treatment ◽  
Electrolyte Abnormalities

Perioperative clinicians caring for patients with diabetes should understand the underlying mechanisms, diagnosis, and treatment of hyperglycemic crises. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) require prompt recognition and treatment. Disturbances such as these can create acute problems associated with intravascular volume and electrolyte abnormalities, as well as effect postoperative recovery and wound healing. Common precipitants, clinical manifestations, and basic treatment algorithms aimed at safely correcting the underlying cause, as well as the associated problems, are described in this chapter. Perioperative glycemic control is an area of recent intense investigation, and specific recommendations are provided herein.

scholarly journals SGLT-2 Inhibitors—a Culprit of Diabetic Ketoacidosis Postbariatric Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Qasim Zafar Iqbal ◽  
Danil Mishiyev ◽  
Muhammad Raphay Niazi ◽  
Zeeshan Zia ◽  
Saud Bin Abdul Sattar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Bariatric Surgery ◽  
Diabetic Ketoacidosis ◽  
Case Series ◽  
Clinical Findings ◽  
Normal Diet ◽  
Sglt2 Inhibitors ◽  
Protective Effects ◽  
Organ Systems ◽  
Patients With Diabetes

Sodium-glucose cotransporter-2 SGLT2 inhibitors are antihyperglycemic drugs that are currently being recommended as second-line therapy for patients with diabetes mellitus. They have grown increasingly popular over recent years, as they have been shown to have some protective effects on the heart and kidneys, both organ systems that diabetes mellitus has shown to have deleterious effect on over time. Despite their growing popularity, they have been found to increase the risk of euglycemic diabetic ketoacidosis (DKA). There is an increasing body of literature detailing cases of euglycemic DKA after bariatric surgery. We present a case series of three cases of euglycemic DKA postbariatric surgery in patients with an underlying history of type 2 diabetes mellitus, who were being treated with SGLT2 inhibitors prior to the surgery. All three patients reported to the emergency room with signs, symptoms, and clinical findings of euglycemic DKA. The AACE recommends SGLT2 inhibitors to be discontinued at least 24 hours prior to surgery and resumed when a patient resumes a normal diet. Our patients presented with euglycemic DKA after bariatric surgery, and we recommend more research should be done targeted at the prolonged postoperative course of patients on SGLT-2 inhibitors and into creating specific guidelines for their use after bariatric surgery.

scholarly journals Management of Diabetic Ketoacidosis in Patients with Diabetes Type I

2017 ◽  
Vol 69 (4) ◽  
pp. 2278-2285
Author(s):  
Basam Zuhaer Sindi ◽  
Naif Mishkhas Alazwari ◽  
Abdulaziz Mohammed Khateeb
Keyword(s):  
Diabetic Ketoacidosis ◽  
Diabetes Type ◽  
Type I ◽  
Patients With Diabetes ◽  
Diabetes Type I
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