scholarly journals Precipitating factors, clinical features and outcome of diabetic ketoacidosis in children and adolescents admitted in a tertiary care hospital in Dhaka

2013 ◽  
Vol 13 (1) ◽  
pp. 53-57
Author(s):  
Rubaiya Islam ◽  
Shahida Akhter ◽  
Rumana Shelim ◽  
Fauzia Mohsin ◽  
Tahmina Begum ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Diabetic Ketoacidosis ◽  
Clinical Features ◽  
Tertiary Care ◽  
Medical Science ◽  
Background Information ◽  
Care Hospital ◽  
Precipitating Factors ◽  
Precipitating Factor

Background Information: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (DM). It is an acute complication of type 1 DM. Objective: This study was designed to identify the precipitating factors, clinical features and immediate outcomes of DKA in children and adolescents. Method: This was a retrospective study which was done in the department of Pediatrics, BIRDEM, from January 2002 to April 2007. Data were collected from the hospital record for all diabetic children below 18 years admitted with DKA. Result: Fourty nine children and adolescents were admitted with DKA. Sixty one percent were known cases and the remaining (39%) were new DM. Majority were female (63%). Most (49%) of the children were between 11- 15 years. Infection was the commonest (49%) precipitating factor followed by insulin omission (24%). Major clinical features were kussmaul breathing (94%) and dehydration (94%).Eighty eight percent patients improved after treatment and mortality was 12%. Conclusion: Infection was the commonest precipitating factor of DKA. Kussmaul breathing and dehydration were the commonest clinical features. Most of the patients improved after treatment.DOI: http://dx.doi.org/10.3329/bjms.v13i1.17429 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 53-57

scholarly journals Precipitating Factors, Clinical Features and Outcome of Diabetic Ketoacidosis in Children in a Tertiary Care Hospital of Bangladesh

2019 ◽  
Vol 9 (2) ◽  
pp. 121-126
Author(s):  
Farzana Yasmin ◽  
Md Ashraf Uddin Ahmed ◽  
ASM Morshed ◽  
Tahmina Begum ◽  
Fouzia Mohsin ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Clinical Features ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Complication ◽  
Clinical Feature ◽  
Care Hospital ◽  
Precipitating Factors ◽  
Increased Risk ◽  
Precipitating Factor

Background: Diabetic ketoacidosis (DKA) is a major complication of type 1 and type 2 diabetes mellitus and is associated with increased risk of morbidity and mortality. Infections, non-compliance and co-morbid states are most important precipitating causes. Proper identification of the precipitating factor is very important in management of DKA. Clinical feature and management of DKA are well known and have been described in many text books and reviews in literature. However, there are a very few published large studies from Bangladesh. For this reason, this study had evaluated fifty children with Diabetic ketoacidosis and to identify their clinical features, precipitating factors and outcome. Methods: This observational study was done among admitted children with DKA in the deptartment of Paediatrics of Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital during study period between September 2016 to February 2017. Results: Fifty children were admitted with Diabetic ketoacidosis. Seventy percent were new diabetes cases and the remaining (30%) were known diabetic patient. Majority (62%) were female. Mean age was 9.31 years with 4.40 standard deviation. Infection was the commonest (62%) precipitating factor followed by insulin omission (10%). Major clinical features were dehydration (100%), polyuria (98%), Kussmaul’s breathing (60%) and abdominal pain (38%). Eighty four percent patients improved after treatment and 16% patient developed complications like acute kidney injury and septicaemia. There was no mortality. Conclusion: Infection was the commonest precipitating factor of DKA. Kussmaul’s breathing and dehydration were the commonest clinical features. Most of the patients improved after treatment Birdem Med J 2019; 9(2): 121-126

scholarly journals Comparison of outcome of milwaukee regimen and 48 hours regimen in diabetic ketoacidosis in a tertiary care hospital in Chitradurga, Karnataka, India

2020 ◽  
Vol 7 (5) ◽  
pp. 1123
Author(s):  
Basavanthappa S. P. ◽  
Srinivasa V. ◽  
Sivachand T.
Keyword(s):  
Diabetic Ketoacidosis ◽  
Tertiary Care Hospital ◽  
Average Length ◽  
Venous Blood ◽  
Tertiary Care ◽  
Medical Emergency ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Pediatric Age Group

Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

Electrocardiographic Changes in Type-1 Diabetes Mellitus Children with Diabetic Ketoacidosis Presenting to Tertiary care Hospital, Karachi

2021 ◽  
Vol 15 (11) ◽  
pp. 3340-3342
Author(s):  
Irum Rafique ◽  
Roshia Parveen ◽  
Zubair Khoso ◽  
Shazia Mahar ◽  
Versha Rani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Ecg Changes ◽  
Electrocardiographic Changes

Introduction: Cardiac arrhythmias and arrest have been described in children with diabetic ketoacidosis and generally have been presumed to be caused by electrolyte abnormalities. The rationale of this study was to assess the role and importance of ECG monitoring, as a simple, quick, non-invasive and readily available tool in the diagnosis and confirmation of hypokalemia and hyperkalemia in patients with DKA in the Emergency Department Objective: To Assess the Frequency of electrocardiographic changes in Type-1 diabetes mellitus children with diabetic ketoacidosis presenting to tertiary care hospital, Karachi. Materials and Methods: This retrospective cross sectional study was carried out at the department of pediatric medicine, NICH Karachi. At the time of presentation, the standard 12-lead ECG was recorded by a single pediatric cardiologist having more than 2 years of experience, QT and RR intervals were measured. Three separate measurements were obtained from each ECG, and the mean of these measurements was used as the value for QTC. QTC of at least 0.45s (450ms) was considered as prolonged QTC. QTD was also assessed at the same time and QTD>50 ms was considered as prolonged QTD. Results: One hundred cases of T1DM with DKA were included in this study. Average age of children was 7.9 ±3.5 years (Min – Max = 0.5 – 14 years), male to female ratio was 1: 0.96. Prolong QTc and QTd interval was observed in (56%) and (38%) children respectively, Mean (±SD) QTc and QTd interval was 449.4 ±36.6 mc and 39.3 ±16.1 mc respectively. While ECG changes were found in (58%) cases. Association between ECG changes and the cases with higher RBS (>350 mg/dl) was statistically significant 81 (81%) cases with ECG changes had higher RBS (p<0.0001) while ECG changes were statistically similar in both age groups and gender (p-values > 0.05). Conclusion: The frequency of ECG changes was higher in T1DM children with diabetic ketoacidosis. ECG changes was significantly associated with higher RBS (>350 mg/dl). Key words: T1DM, Diabetic Ketoacidosis, ECG, QTc, QTd

scholarly journals Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

2021 ◽  
Vol 9 (2) ◽  
pp. e002451
Author(s):  
Emma Ooi ◽  
Katrina Nash ◽  
Lakshmi Rengarajan ◽  
Eka Melson ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Final Analysis ◽  
Care Hospital ◽  
Hospital Data ◽  
Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

scholarly journals Clinical Spectrum and Management of Diabetic Ketoacidosis: Experience in A Tertiary Care Hospital

2012 ◽  
Vol 1 (1) ◽  
pp. 15-20
Author(s):  
MA Rahim ◽  
KN Uddin ◽  
S Zaman ◽  
AKM Musa ◽  
MR Rahman ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Electrolyte Imbalance ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Metabolic Complication

Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus (DM). It may be the presenting feature in type 1 DM, but more commonly it complicates previously diagnosed diabetic patients, both type 1 and type 2. If not recognized early and treated in a judicious way the outcome is often fatal. Objectives: The objectives of this study was to see the common presenting features of DKA, their precipitating causes, patterns of electrolyte imbalance, treatment requirement in early hours and to see the outcome. Materials and methods: This cross sectional study was done in BIRDEM General Hospital on fifty adult patients who presented with DKA over a period of nine months (January 2007 to September 2007). Results: Total number of patients were 50, male were 24 and female were 26 (M:F =12:13). Mean age was 27.6 ± 3.7 years. The incidence of DKA was more in known diabetic patients (32, 64%), in comparison with new cases (18, 36%). Frequency was more in poor village people (31, 62%). Vomiting (24, 48%) was the most frequent complaint, followed by fever (19, 38%), nausea (16, 32%), abdominal pain (14, 28%), weakness (13, 26%), polyuria (12, 24%) and polydypsia ( 8, 16%). Infection (18, 36%) was the most common precipitating cause, closely followed by inadherence to insulin therapy (17, 34%). In 12 (24%) cases no cause could be identified. Glycaemic control was poor, HbA1c was >7% in 98% cases. Severe acidosis (pH < 7) was less common (4, 8%) and gross electrolyte imbalance was uncommon but all patients required potassium supplementation in course of treatment. Neutrophilic leukocytosis was present in 44 (88%) cases, irrespective of presence of infection. Mortality was low (3, 6%). Conclusion: Diagnosis and treatment of DKA is not difficult if recognized early. So, high index of suspicion is necessary, particularly in previously undiagnosed cases. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12380 Birdem Med J 2011; 1(1): 15-20

Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

2021 ◽  
Vol 18 (4) ◽  
pp. 429-436
Author(s):  
Santhiya K. ◽  
Jayanthi S. ◽  
Ananthasubramanian M. ◽  
Appalaraju B.
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Medical Science ◽  
Geographical Location ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

scholarly journals Facing Death: Attitudes toward Physician-Assisted End of Life among Physicians Working at a Tertiary-Care-Hospital in Israel

2021 ◽  
Vol 18 (12) ◽  
pp. 6396
Author(s):  
Keren Dopelt ◽  
Dganit Cohen ◽  
Einat Amar-Krispel ◽  
Nadav Davidovitch ◽  
Paul Barach
Keyword(s):  
End Of Life ◽  
Tertiary Care Hospital ◽  
Human Life ◽  
Tertiary Care ◽  
Terminally Ill ◽  
Background Information ◽  
Care Hospital ◽  
Medical Assistance In Dying ◽  
Terminally Ill Patients ◽  
The Right

The demand for medical assistance in dying remains high and controversial with a large knowledge gap to support optimal patient care. The study aimed to explore physicians’ attitudes regarding euthanasia and examine the factors that related to these attitudes. We surveyed 135 physicians working at a tertiary-care hospital in Israel. The questionnaire was comprised of demographic and background information, DNR procedure information, encounters with terminally ill patients, familiarity with the law regarding end-of-life questions, and Attitudes toward Euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should be allowed, while 29% thought that physicians should preserve a patients’ life even when they expressed the wish to die. A negative statistically significant relationship was found between the level of religiosity and attitudes toward euthanasia. The physicians’ attitudes towards euthanasia are quite positive when compared to other countries. The data shows a conflict of values: the sacredness of human life versus the desire to alleviate patients’ suffering. The Coronavirus-19 outbreak reinforces the importance of supporting physicians’ efforts to provide ethical and empathic communication for terminally ill patients. Future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to end-of-life requests.

Improving Diabetic Ketoacidosis Management at a Tertiary Care Hospital

2018 ◽  
Vol 42 (5) ◽  
pp. S59-S60
Author(s):  
Neha Puri ◽  
Angela Assal ◽  
Geetha Mukerji
Keyword(s):  
Diabetic Ketoacidosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital
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