scholarly journals Clinical conundrums in the management of diabetic ketoacidosis in the elderly

2019 ◽  
Vol 7 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Vishal Sehgal ◽  
Brian Ulmer
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Diabetic Ketoacidosis ◽  
Kidney Injury ◽  
The Elderly ◽  
Complications Of Diabetes ◽  
Clinical Presentations ◽  
Life Threatening

Abstract One of the dreaded life-threatening complications of diabetes mellitus (DM) is diabetic ketoacidosis (DKA). American Diabetic Association (ADA) came out with 2018 guidelines on the management of DM and its complications, but these are woefully silent on the clinical conundrums that accompany DKA in elderly patients. In elderly patients, DKA is often complicated by sepsis, atrial fibrillation, polypharmacy, nonketotic hyperosmolar states, atypical clinical presentations, acute kidney injury (AKI), dementia, and noncompliance with medications. Here in we highlight these conundrums that need to be addressed to improve morbidity and mortality in elderly patients.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Acute kidney injury in the elderly patients of Thai-surgical intensive care units (Thai-SICU) study

2017 ◽  
Vol 30 (2) ◽  
pp. 131
Author(s):  
Konlawij Trongtrakul ◽  
Sujaree Poopipatpab ◽  
Ploynapas Limphunudom ◽  
Chawika Pisitsak ◽  
Kaweesak chittawatanarat ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Elderly Patients ◽  
Intensive Care Units ◽  
Kidney Injury ◽  
The Elderly ◽  
Surgical Intensive Care

scholarly journals Exploration of the Relationship Among Key Risk Factors of Acute Kidney Injury for Elderly Patients Considering Covid-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Yen-Ching Chuang ◽  
Tao-Hsin Tung ◽  
Jau-Yuan Chen ◽  
Ching-Wen Chien ◽  
Kao-Yi Shen
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Elderly Patients ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Nutritional Assessment ◽  
Kidney Injury ◽  
The Elderly ◽  
The Relationship

Background: Previous systematic reviews and meta-analyses supported the relationship between frailty and risk of acute kidney injury (AKI) in elderly patients. However, few studies evaluated proactive management to wear down AKI risk in such frail populations.Purpose: To understand how AKI risk factors might influence each other and to identify the source factors for clinical decision aids.Methods: This study uses the decision-making trial and evaluation laboratory (DEMATEL) method to establish influential network-relationship diagrams (INRDs) to form the AKI risk assessment model for the elderly.Results: Based on the DEMATEL approach, the results of INRD identified the six key risk factors: comorbidity, malignancy, diabetes, creatinine, estimated glomerular filtration rate, and nutritional assessment. (The statistical significance confidence is 98.423%, which is higher than 95%; the gap error is 1.577%, which is lower than 5%). After considering COVID-19 as an additional risk factor in comorbidity, the INRD revealed a similar influential relationship among the essential aspects.Conclusion: While evaluating the geriatric population, physicians need to pay attention to patients' comorbidities and nutritional assessment; also, they should note patients' creatinine values and glomerular filtration rate. Physicians could establish a preliminary observation index and then design a series of preventive guidelines to reduce the incidence of AKI risk for the elderly.

scholarly journals Tatalaksana Penurunan Kesadaran Pada Penderita Diabetes Mellitus

Medicinus ◽  
2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Ian Huang
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Lactic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Complications Of Diabetes ◽  
Uremic Encephalopathy ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening

Hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar hyperglycemic state), lactic acidosis, hypoglycemia, and uremic encephalopathy are life-threatening complications of diabetes mellitus (DM). Specific therapies of each condition are essential in reducing mortality rate of the complications.

scholarly journals Characteristics of and risk factors for death in elderly patients with acute kidney injury: a multicentre retrospective study in China

2018 ◽  
Vol 94 (1111) ◽  
pp. 249-253 ◽  
Author(s):  
Jie-Qiong Liu ◽  
Guang-Yan Cai ◽  
Shuang Liang ◽  
Wen-Ling Wang ◽  
Si-Yang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Multiple Logistic Regression Analysis ◽  
Significant Risk ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients

Purpose of the studyThe incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics of and risk factors for death from AKI in the elderly and help improve prognosis.Study designThis study was a retrospective cohort study based on data from adult patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of AKI in the elderly were compared with those in younger patients.ResultsIn elderly patients with AKI, rates of hypertension, cardiovascular disease and multiple organ dysfunction syndrome (MODS) were higher than in younger patients (44.2% vs 31.2%, 16.1% vs 4.6% and 20.9% vs 16.9%, respectively), the length of ICU stay was longer (3.8 days vs 2.7 days, P=0.019) and renal biopsy (1.0% vs 7.13%, P<0.001) and dialysis (9.6% vs 19.2%, P<0.001) were performed less. Hospital-acquired (HA) AKI was more common than community-acquired (CA) AKI (60.3% vs 39.7%), while the most common cause of AKI was pre-renal (53.5%). Multiple logistic regression analysis showed that age (OR 1.041, 95% CI 1.023 to 1.059), cardiovascular disease (OR 1.980, 95% CI 1.402 to 2.797), cancer (OR 2.302, 95% CI 1.654 to 3.203), MODS (OR 3.023, 95% CI 1.627 to 5.620) and mechanical ventilation (OR 2.408, 95% CI 1.187 to 4.887) were significant risk factors for death.ConclusionsHA-AKI and pre-renal AKI were more common in the elderly. Age, cardiovascular disease, cancer, MODS and mechanical ventilation were independent risk factors for death in the elderly with AKI.

scholarly journals Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Ami Amin ◽  
Bhavika Gandhi ◽  
Steven Torre ◽  
Alireza Amirpour ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Ketoacidosis ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Dark Urine ◽  
Threatening Condition ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening ◽  
Electrolyte Abnormalities

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.

scholarly journals 132 OUTCOME OF THE ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY IN HOSPITAL SELAYANG

2017 ◽  
Vol 2 (4) ◽  
pp. S20
Author(s):  
V.E. Phui ◽  
H.S. Wong ◽  
Y. Suryati ◽  
C.Y. Goh ◽  
T. Esther ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Kidney Injury ◽  
The Elderly

scholarly journals Antithrombin III Predicts Acute Kidney Injury in Septic Elderly Patients

2019 ◽  
Author(s):  
Yun Xie ◽  
Rui Tian ◽  
Wei Jin ◽  
Hui Xie ◽  
Jiang Du ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Antithrombin Iii ◽  
Kidney Injury ◽  
The Elderly ◽  
Age Group ◽  
Cutoff Value ◽  
Mechanical Ventilation Time ◽  
Worse Prognosis

Abstract Background The elderly are the primary age group of acute kidney injury (AKI). The predictive value of Antithrombin III (ATIII) level in preventing AKI among septic elderly patients has not been studied. The purpose of this study was to evaluate the value of ATIII in predicting AKI nondevelopment and prognosis in septic elderly patients under ICU settings. Materials and methods This is a retrospective study enrolling 107 elderly patients with sepsis who were admitted to ICUs from October 2015 to March 2018. Assessment of renal function was performed daily by measuring serum creatinine level and urine output. The ATIII level was obtained within the first 48 hours of the diagnosis of sepsis (ATIII1). Results Among all enrolled patients, 29 (27.1%) developed AKI. The ATIII level was a predictor of AKI nondevelopment (AUC-ROC =0.729, and sensitivity 0.700and specificity0.714). The ATIII/Cr ratio was also a predictor of AKI nondevelopment (AUC-ROC =0.971, and sensitivity 0.900and specificity1).The accuracy of ATIII and ATIII/Cr in predicting survival was intermediate, with AUC-ROC of 0.681 and 0.804 repectively, sensitivity ranging between 0.802 and 0.596, and specificity between 0.542 and 0.875. The ATIII level demonstrated excellent ability in predicting AKI nondevelopment in septic elderly patients in ICUs. Patients were divided into low ATIII group and high ATIII group using 66.95 or 55.7 as cutoff value. In comparison, ICU stay was significantly lower in the high ATIII group(p=0.020 and 0.049, repectively. Off mechanical ventilation time, off CRRT time, and survival time were significantly higher in high ATIII group(p=0.049,0.048,0.014 using 66.95 as cutoff and 0.041,0.036,0.021 using 55.7 as cutoff). Conclusion This study suggests that ATIII predicts acute kidney injury in septic elderly patients. Lower ATIII predicts worse prognosis .

Antithrombin III Protects Against Acute Kidney Injury in Septic Elderly Patients

2019 ◽  
Author(s):  
Yun Xie ◽  
Rui Tian ◽  
Wei Jin ◽  
Hui Xie ◽  
Jiang Du ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Antithrombin Iii ◽  
Kidney Injury
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