Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

2012 ◽  
Vol 11 (4) ◽  
pp. 219-221
Author(s):  
Robert John ◽  
◽  
Hemang Yadav ◽  
Martin John ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Ketone Body ◽  
Insulin Infusion ◽  
Care Setting ◽  
Intensive Care Setting

Euglycaemic ketoacidosis is a rare endocrine emergency, which can have disastrous consequences if left undiagnosed. We present the case of a 57 year old man with type 2 diabetes who developed ketoacidosis (DKA) following a myocardial infarction, despite being normoglycaemic, following discontinuation of his insulin infusion in an intensive care setting. The case highlights the importance of capillary ketone body testing in this scenario as well as the dangers of an over reliance on blood glucose values in the diagnosis of ketoacidosis. The notion that DKA can occur in both type 1 and type 2 diabetes is reaffirmed and the value of adequate insulin therapy in euglycaemic ketoacidosis is emphasized.

Higher glucose variability in type 1 than in type 2 diabetes patients admitted to the intensive care unit: A retrospective cohort study

2017 ◽  
Vol 38 ◽  
pp. 300-303 ◽  
Author(s):  
Marjolein K. Sechterberger ◽  
Sigrid C.J. van Steen ◽  
Esther M.N. Boerboom ◽  
Peter H.J. van der Voort ◽  
Rob J. Bosman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Glucose Variability ◽  
Diabetes Patients

Type 2 diabetes and 1-year mortality in intensive care unit patients

2012 ◽  
Vol 43 (3) ◽  
pp. 238-247 ◽  
Author(s):  
Christian F. Christiansen ◽  
Martin B. Johansen ◽  
Steffen Christensen ◽  
James M. O'Brien ◽  
Else Tønnesen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Intensive Care Unit ◽  
Intensive Care

Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India

2011 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Christina George ◽  
Jayakrishnan Sukumaran Nair ◽  
Johann Alex Ebenezer ◽  
Alan Gangadharan ◽  
Anna ChristuDas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
South India ◽  
Care Setting ◽  
Intensive Care Setting ◽  
Resource Poor ◽  
Medical Intensive Care

CONCENTRATED INSULINS: CLINICAL UPDATE OF THERAPEUTIC OPTIONS

2020 ◽  
Vol 26 (Supplement 3) ◽  
pp. 1-12
Author(s):  
Guillermo E. Umpierrez ◽  
Elizabeth H. Holt ◽  
Daniel Einhorn ◽  
Janet B. McGill
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Infusion ◽  
Cell Function ◽  
Total Daily Dose ◽  
Β Cell ◽  
Oral Antidiabetic Agents

Improved glycemic control is associated with a reduced risk of diabetic complications. Optimal management of patients with type 2 diabetes includes nutritional therapy, physical activity, and pharmacotherapy for glycemic control. Most patients with type 2 diabetes are initially managed with oral antidiabetic agents, but as β-cell function declines and the disease progresses, insulin therapy is frequently needed to maintain glycemic control. Insulin therapy given with multidose insulin injection regimen or by continuous insulin infusion is needed for patients with type 1 diabetes to achieve control. Obesity and its associated insulin resistance contribute to greater insulin requirements in patients with both type 1 and type 2 diabetes to achieve glycemic control, creating a need for concentrated insulin. Concentrated insulin formulations can be prescribed as an alternative to 100 unit/mL insulin and provide the advantage of low injection volume, leading to less pain and possibly fewer insulin injections. This review includes a stepwise analysis of all currently available concentrated insulin products, analyzes the most up-to-date evidence, and presents this in combination with expert guidance and commentary in an effort to provide clinicians with a thorough overview of the characteristics and benefits of concentrated insulins in patients with type 1 and type 2 diabetes–instilling confidence when recommending, prescribing, and adjusting these medications. Abbreviations: A1C = glycated hemoglobin; β-cell = pancreatic betacell; BG = blood glucose; CI = confidence interval; CSII = continuous subcutaneous insulin infusion; MDI = multiple daily injections; NHANES = National Health and Nutrition Examination Survey; PD = pharmacodynamic; PK = pharmacokinetic; TDD = total daily dose; U100 = 100 units/mL; U200 = 200 units/mL; U300 = 300 units/mL; U500 = 500 units/mL; USD = United States dollars

The psychological impact of COVID-19 on staff and patients in a psychiatric intensive care setting

2020 ◽  
Author(s):  
Bethan Harries ◽  
Luke Skelton ◽  
Lucy Blake ◽  
Ria Pugh ◽  
Margaret Butler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Care Setting ◽  
Psychological Impact ◽  
Intensive Care Setting

This article is part of a series exploring how the COVID-19 pandemic affected,and continues to affect, a psychiatric intensive care unit (PICU) in London, UK. The series so far has focused primarily on the systems, processes and practical challenges of managing acutely disturbed patients in the npatient setting with the added complexity of COVID-19 infection. This article outlines the psychological impact on staff and patients on a PICU during this time.

Rumination—A New Complication of Neonatal Intensive Care

PEDIATRICS ◽  
1980 ◽  
Vol 66 (4) ◽  
pp. 551-555
Author(s):  
Thomas G. Sheagren ◽  
Henry H. Mangurten ◽  
Frantz Brea ◽  
Susan Lutostanski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Treatment Program ◽  
Successful Treatment ◽  
Neonatal Intensive Care ◽  
Care Setting ◽  
Intensive Care Setting ◽  
Rumination Syndrome ◽  
Newborn Intensive Care Unit ◽  
Newborn Intensive Care

The infant rumination syndrome has not been previously reported in a neonatal intensive care setting. We recently managed three infants in our newborn intensive care unit who developed rumination following chronic courses in the unit. The events leading to this condition in each infant are described, as well as the successful treatment program that was instituted. With recognition of factors predisposing to this disorder, the problem may be avoided, providing these infants with the best chance for optimal development despite the need for prolonged intensive care.

scholarly journals Hypoglycemia with Intensive Insulin Therapy: A Systematic Review and Meta-Analyses of Randomized Trials of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

2009 ◽  
Vol 94 (3) ◽  
pp. 729-740 ◽  
Author(s):  
Mitra M. Fatourechi ◽  
Yogish C. Kudva ◽  
M. Hassan Murad ◽  
Mohamed B. Elamin ◽  
Claudia C. Tabini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Odds Ratio ◽  
Randomized Trials ◽  
Insulin Infusion ◽  
Multiple Daily Injections

Abstract Context: Hypoglycemia limits the efficacy of intensive insulin therapy. The extent to which continuous insulin infusion (CSII) overcomes this limitation is unclear. Objective: The aim was to summarize evidence on the effect of CSII and multiple daily injections (MDIs) on glycemic control and hypoglycemia. Data Sources: We searched electronic databases between 2002 and March 2008. Study Selection: We selected published randomized trials of CSII vs. MDI. Data Extraction: Reviewers working in duplicate and independently extracted study characteristics and quality and differences in glycosylated hemoglobin (HbA1c) and hypoglycemic events. Data Synthesis: We found 15 eligible randomized trials of moderate quality, with elevated baseline and end-of-study HbA1c levels. Patients with type 1 diabetes using CSII had slightly lower HbA1c [random-effects weighted mean difference, −0.2%; 95% confidence interval (CI), −0.3, −0.1, compared with MDI], with no significant difference in severe (pooled odds ratio, 0.48; 95% CI, 0.23, 1.00) or nocturnal hypoglycemia (pooled odds ratio 0.82, 95% CI 0.33, 2.03). Adolescents and adults with type 1 diabetes enrolled in crossover trials had nonsignificantly fewer minor hypoglycemia episodes per patient per week (−0.08; 95% CI, −0.21, 0.06) with CSII than MDI; children enrolled in parallel trials had significantly more episodes (0.68; 95% CI, 0.16, 1.20; Pinteraction = 0.03). Outcomes were not different in patients with type 2 diabetes. Conclusions: Contemporary evidence indicates that compared to MDI, CSII slightly reduced HbA1c in adults with type 1 diabetes, with unclear impact on hypoglycemia. In type 2 diabetes, CSII and MDI had similar outcomes. The effect in patients with hypoglycemia unawareness or recurrent severe hypoglycemia remains unclear because of lack of data.

Sign in / Sign up

Export Citation Format

Share Document