Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials
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Abstract:
The optimal resuscitative fluid for patients with diabetic ketoacidosis (DKA) remains controversial. Therefore, our objective was to assess the effect of balanced crystalloids in contrast to normal saline on clinical outcomes among patients with DKA.Keywords:
Diabetic ketoacidosis
Ketoacidosis
Objective To understand the clinical characteristic of diabetic ketoacidosis ,to reduce the misdiagnosis rate of diabetic ketoacidosis with the first clinical manifestation of abdominal pain, and to increase the recognition of diagnosing and treating diabetic ketoacidosis Methods To retrospectively analyse the clinical data of 298 patients, with diabetic ketoacidosis from 2000 to 2005,to summarize the clinical characteristic of diabetic ketoacidosis with the first clinical manifestation of abdominal pain. Results There were 20 cases (6.7%) with the first clinical manifestation of cardiopericarditis. Conclusions The diabetic ketoacidosis with the first clinical manifestation of abdominal pain is easiler misdiagnosed and it must be thought highly of much
Diabetic ketoacidosis
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Objective:To explore the clinical diagnosis and treatment of diabetic ketoacidosis.Methods:Slected our hospital in June 2007 to June 2009 treated 60 patients with diabetic ketoacidosis,in which 30 patients with conventional treatment(control group),30 cases were treated with insulin pump therapy(treatment group),comparing two group effect.Results:The main reason for the infection pathogenesis of diabetic ketoacidosis,hypoglycemia in the treatment group the number of times and the insulin dosage was significantly less than the control group,P0.05,but the two groups of patients with blood glucose and ketone bodies was no significant difference in time lost significance,P0.05.Conclusion:The complications of diabetic ketoacidosis prone,easily lead to serious metabolic disorders,observing closely and timely insulin treatment is the key to successful treatment.
Diabetic ketoacidosis
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Diabetic ketoacidosis is a well-known acute complication in patients with both type 1 andtype 2 diabetes mellitus. Although mortality has decreased considerably, it remains an importantcause for admission to intensive care units. Medical management includes intravenous fluidtherapy, insulin, correction of electrolyte abnormalities, and addressing the precipitating factorwhich in most cases is infection or non-compliance with insulin therapy. Usually patients withdiabetic ketoacidosis are admitted to the intensive care unit for continuous infusion of insulin;however, the development of rapid acting insulin analogues has made it possible to treatmild to moderate diabetic ketoacidosis with subcutaneous insulin. Although studies usingsubcutaneous insulin include only a small number of patients, this approach seems as effectiveas intravenous insulin infusions in patients with mild to moderate diabetic ketoacidosis. Diabeticeducation and close follow-up for patients admitted for diabetic ketoacidosis remain essentialto avoid recurrence and readmissions.Keywords: Diabetic ketoacidosis, acute complication in diabetes, rapid acting insulinanalogues, subcutaneous insulin in diabetic ketoacidosis
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Introduction: Recently, euglycemic diabetic ketoacidosis has been an increasing topic of discussion within emergency medicine literature. Euglycemic diabetic ketoacidosis can easily be missed, as a normal point-of-care glucose often mistakenly precludes the work-up of diabetic ketoacidosis. Case Report: A 16-year-old female with a past medical history of type 1 diabetes presented to the emergency department with altered mental status, vomiting, and abdominal pain. She was diagnosed with euglycemic diabetic ketoacidosis. Conclusion: Reported cases of euglycemic diabetic ketoacidosis are most frequently attributed to sodium glucose cotransporter-2 inhibitors, but other potential causes have been discussed in the literature. In this patient, a starvation state with continued insulin use in the setting of acute appendicitis led to her condition.
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Diabetic ketoacidosis
Ketoacidosis
Bicarbonate
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An analysis of 1000 cases of diabetic ketoacidosis has suggested to the authors their classification into four evolutive stages: incipient ketoacidosis (normal pH, decrease of total CO2, between 20--26 mMol/l and of excess bases between -2 and -5 mMol/l), moderate ketoacidosis (pH 7.31-7.35, total CO2, between 15--19.9 mMol/l, excess bases between -5 and -10 mMol/l); advanced ketoacidosis, "diabetic precoma" (pH 7.21-7.30 total CO2 between 11 and 14.9 mMol/l, excess bases between -10 and -15 mMol/l, and severe diabetic ketoacidosis or "diabetic coma" (pH less than or equal to 7.20, total CO2 less than or equal to 10 mMol/l, excess bases greater than -15 mMol/l). The follow up of the four therapeutical parameters (number of hours, amount of fluids, insulin and KCl necessary for equilibration) showed that this classification of ketoacidosis reflects the degree of metabolic and hydroelectrolytic disorders, suggesting at the same time the intensity of the treatment to be administered in view of correcting them.
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We present the case of a 70-year-old Caucasian female who presented to the emergency department with acute pancreatitis and ketoacidosis. An extensive workup for ketoacidosis showed that the patient had hyperglycemic ketoacidosis with findings similar to diabetic ketoacidosis (DKA). However, the patient did not have a history of diabetes, and no diagnosis of diabetes could be made on the current admission as well. Ketoacidosis was determined to be induced by acute hyperglycemia secondary to pancreatitis, which suppresses insulin secretion transiently. It is important to note that DKA can be seen in patients with different types of diabetes and is not just limited to type 1 diabetes.
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Risk factors for recurrent admissions with diabetic ketoacidosis: a case–control observational study
To perform a detailed analysis of patients with recurrent diabetic ketoacidosis admissions in order to establish risk factors for readmission.The medical records of all adults and young people (> 15 years) with Type 1 diabetes admitted to Auckland City Hospital over a 15-year period from 1997 to 2011 with a primary diagnosis of ketoacidosis were analysed. Patients readmitted with ketoacidosis within 5 years of their index admission were identified and compared with patients without ketoacidosis readmission who were matched for age, gender, ethnicity and duration of diabetes.A total of 268 patients accounted for a total of 412 admissions. In all, 58 patients had more than one admission for diabetic ketoacidosis during this period. Of these, 40 patients readmitted with diabetic ketoacidosis were compared with matched control subjects (n = 40) who had only one admission for diabetic ketoacidosis. The mean ± sd age of the cohort was 31 ± 12 years. The readmission group had more severe diabetic ketoacidosis and poorer glycaemic control. Alcohol abuse was commonly noted in both groups, with insulin dose omission being the main contributor to the development of ketoacidosis. Both groups had high rates of clinic non-attendance. There were no other differences noted between the groups.When patients with recurrent diabetic ketoacidosis were matched for age, duration of diabetes, gender and ethnicity with patients who had only one admission for diabetic ketoacidosis, few differences were noted. This makes designing intervention strategies to reduce readmission with diabetic ketoacidosis difficult.
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Objective To explore the application of serum β-hydroxybutyric acid(β-HB) in diagnosing Diabetic Ketoacidosis(DKA).Methods To detect the levels of serum β-hydroxybutyric acid、fasting blood glucose(FBG) and urine ketone in 96 diabetes without ketoacidosis,28 diabetic ketoacidosis,60 normal contrals.All results were compared.Results In diabetic ketoacidosis,the results of β-HB,FBG,positive ratio of ketone were respectively(1.75±1.77) mmol/L,(14.27±5.17) mmol/L and 85.7%.In group of diabetes without ketoacidosis,the results of β-HB,FBG were separately(0.275±0.34) mmol/L,(11.34±3.65) mmol/L,Urine ketone were negative.The levels of β-HB、FBG in diabetic ketoacidosis were significantly higher than those of other two groups(P 0.05).Conclusion Examination of serum β-HB can help diagnosis and treat diabetic ketoacidosis,Its sensitivity is higher than urine ketone.
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Diabetic ketoacidosis is a common illness among patients with diabetes. The exact prevalence is unknown, but in one community the rate was estimated to be 13.4 episodes per 1000 patient-years in young persons with diabetes.1 It remains a serious event, with mortality rates as high as 6 to 10 per cent.2 , 3 In children under 10 years of age, diabetic ketoacidosis accounts for 70 per cent of diabetes-related deaths.4 Death may be due to derangements that are directly attributable to ketoacidosis, to complications associated with the illness itself, or to abnormalities induced by treatment. Because a substantial percentage of deaths is . . .
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