diabetestalk.net

Dka Case Study Ppt

Diabetic Ketoacidosis Case Presentation

Diabetic Ketoacidosis Case Presentation

1. DIABETIC KETOACIDOSIS CASE PRESENTATION ICU ,MEDICAL WARD ROTATION 2. Presented by : Walaa Aljuaid , Manal Alosaimi 2. OUTLINES : • THE CASE . • WHAT IS THE DKA • DEFINITION • CAUSES • INCIDENCE AND PREVALENCE • DIAGNOSIS • COMPLICATION • TREATMENT • INTERVENTION 3. THE CASE : ▸ N is a 37 years old female , come to the ER complaining of abdominal pain, shortness of breath, chest pain and palpitation . ER 4. HISTORY OF PRESENT ILLNESS ▸ She has had 2 times Gestational diabetes 4 years ago in her first pregnant and 1 years ago in her second pregnant . ▸ Family history : Unknown ▸ Allergy : No Kind of Allergy . ▸ Medication history : did not mention . ER 5. REVIEW OF SYSTEMS : ‣ Eyes: normal ‣ Mental status: conscious . ‣ Respiratory system: Normal sounds ‣ Cardiovascular system: S1+S2 ‣ Chest wall & breast: No any diseases ‣ Abdomen: soft and lax . ‣ Extremities : No any diseases. ER 6. VITAL SIGN ON ADMISSION ▸ Normal Ranges : ▸ Patient Vital sign : Temperature PR RR O saturation BP 36-37 60-100 16-20 > 96% 120/80 Temperature PR RR O saturation BP 37.3 160 40 98% 130/80 ER 7. LAB TESTS: ▸ Normal Blood Gases : ▸ Patient’s Blood Gases : PH PCO2 PO2 7.35-7.45 32-48 83-108 PH PCO2 PO2 7.002 16.3 63 ER 8. ▸ Glucose ++++ ▸ Ketones +++ URINE ANALYSIS : LAB RESULTS : Glucose mg/dl K Na Cl 70-119 3.5-5.3 135-153 98-110 Normal Ranges Glucose mg/dl K Na Cl 417 4.99 136 99 Patient’s Ranges ER 9. CBC : Normal Ranges WBC 10^9/uL RBC 10^12/uL Hb g/dL 4-10 x10^9/L 4,5 -5,5 X10^12/L 12-16 WBC 10^9/uL RBC 10^12/uL Hb g/dL 12.06 5.5 14 Patient’s Ranges ER 10. FINAL DIAGNOSIS: DIABETIC KETOACIDOSIS 11. WHAT IS THE DIABETIC KETOACIDOSIS ( DKA ) ? ▸ DKA is a life-threatening condition that develops when cells in the body are un Continue reading >>

Case Study: Diabetic Ketoacidosis Complications In Type 2 Diabetes

Case Study: Diabetic Ketoacidosis Complications In Type 2 Diabetes

CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 CASE STUDIES Case Study: Diabetic Ketoacidosis Complications in Type 2 Diabetes Craig D. Wittlesey, MD Presentation A 48-year-old Hispanic woman with a long history of obesity, diabetes, dyslipidemia, and reactive airway disease presented to the hospital emergency department with a 5-day history of weakness, tactile fever, productive cough, nausea, and vomiting. Patient report and chart review confirmed that 2 years before this presentation, her diabetes had been managed with diet alone. In the past year, glipizide (Glucotrol), metformin (Glucophage), and ultralente insulin were added because of poor glycemic control. On examination, her temperature was 99.1° F, blood pressure was 98/64 mmHg, pulse was 136, and respirations were 36. There was a strong smell of ketones in the exam room. The patient was drowsy but cogent. Her head and neck exam revealed poor dentition and periodontal disease. Her lung sounds were clear without wheezes or rhonchi. Her heart sounds were normal. The abdominal exam revealed mild epigastric tenderness to deep palpation but no rebound tenderness or guarding. Extremities were well perfused with symmetric pulses. Laboratory results were remarkable for a room air arterial blood gas with pH of 7.12, pCO2 of 17 mmHg, and bicarbonate of 5.6 mEq/l. Urinalysis revealed 4+ glucose and 3+ ketones. Chemistry panel revealed a glucose of 420 mg/dl, BUN of 16 mg/dl, creatinine of 1.3 mg/dl, sodium of 139 mEq/l, chloride of 112 mEq/l, CO2 of 11.2 mmol/l, and potassium of 5.0 mEq/l. Chest X-ray revealed no infiltrate. Questions Is this patient experiencing diabetic ketoacidosis (DKA)? What type of diabetes does this patient have? What is the etiology of DKA in this patient? What is the rationale for inpatient treatm Continue reading >>

Case Presentation

Case Presentation

EM Registrar Case 12 year old male 1/12 fatigue Severe LOW 3/7 increasing SOB 1/7 confusion + lethargy Case Med Hx: Nil Chronic Medication: Nil Allergies: Nil known Multiple GP visits: fatigue due to puberty Case Clinically: Emaciated P 140 BP 70/40 RR 45 Temp 37.6°C Glucose: 36 mmol/l Acidotic breathing, shocked CNS – drowsy, but rousable, orientated to person, not place or time Other systems essentially normal Case Urine Ketones + UEC 129/ 5,2/ 9.3/ 108 ABG pH 7.05 pCO2 1.8 pO2 18 Bicarb 5.2 BE – 20 Case Problems New Type I DM DKA Hypovolaemic Shock Hyponatraemia Cerebral Oedema Management First bolus: 10ml/kg N/Saline – remained hypotensive Second bolus 10ml/kg N/Saline: still hypotensive, but ↑ confusion Concern about worsening cerebral oedema Fluid boluses stopped, commenced on fluid rehydration 0.45% Saline Admitted to ICU CT Brain: cerebral oedema Worsened over next 48 hrs, but eventually made complete recovery Case Type of fluid? Volume for resuscitation? Management of cerebral oedema in DKA? Predictors of cerebral oedema in DKA? Type of Fluid Normal (0.9%) Saline Generally recommended fluid1 Concerns about hyperchloraemic acidosis2 Ringers Lactate3 More hypotonic → increased risk cerebral oedema Lactate potentially metabolised to glucose Non-metabolised lactate can ↓ level of consciousness Contains potassium No evidence to support other crystalloids/ colloids for resuscitation Very little evidence overall for different fluids Best evidence for 0.9% Saline4 If not available, isotonic fluid Consider 0.45% saline for rehydration if hypernatraemic Volume for Resuscitation ≤ 10ml/kg boluses repeat to max 3 doses (30ml/kg)1,5 Fluid bolus not required if not shocked Fluid deficit replacement over 24-48 hrs Lower fluid Continue reading >>

Diabetic Emergencies, Part 5: Dka Case Studies

Diabetic Emergencies, Part 5: Dka Case Studies

Case Study 1 A 32-year-old male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough started 2 days ago and the patient could not eat or drink water. He has been treated with an intensive insulin regimen (insulin glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal). On examination he was tachypneic, his temperature was 39° C (102.2° F), pulse rate 104 beats per minute, respiratory rate 24 breaths per minute, supine blood pressure 100/70 mmHg; he also had dry mucous membranes, poor skin turgor, and rales in the right lower chest. He was slightly confused. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9, PO 2 95 mmHg, PCO 2 28 mmHg, HCO 3−9 mEq/L, and O 2 sat 98%. The result of the strip for ketone bodies in urine was strongly positive and the concentration of β-OHB in serum was 3.5 mmol/L. Urinalysis showed glucose 800 mg/dl and specific gravity 1030. What is your diagnosis? The patient has hyperglycemia, ketosis, and metabolic acidosis. Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Do you need more tests to confirm the diagnosis? Determination of the effective serum osmolality and anion gap should be performed in all patients presenti Continue reading >>

Diabetic Emergencies

Diabetic Emergencies

Introduction Welcome to your tutorial on diabetic emergencies. This tutorial will take around 45 minutes to complete. You will attempt three case studies with real patients presenting with diabetic emergencies - ketoacidosis, HONK, and insulin-induced hypoglycaemia. Please have a pen and paper handy as you will need them for some of the tasks. These will be reviewed in your seminar relating to this topic. This document should be downloaded and printed out to complete the scenario tasks in the tutorial. Either left-click on the link and follow the instructions on how to save the file, or right-click on the link and select "save target" or "save link as". Objectives To be able to take a history from a patient with hyper- or hypoglycaemia, including demonstrating knowledge of some of the possible causes of their presentation. To be able to perform an initial assessment of a patient with hyperglycaemia in terms of clinical and laboratory investigations. To understand the management principles for a patient with DKA or HONK and to understand differences in management associated with the two conditions. To know how to treat a patient with hypoglycaemia in the emergency setting, and to have an awareness of the intermediate management that that patient may require. A 21 year old man arrives in the department by ambulance. He appears very unwell. The ambulance crew provide you a completed patient report form - select the thumbnail to access the form. What is the important information that you need to obtain from this patient's history? Note this down and then continue with the patient's history on the next page. Patient history This is what the patient tells you.... "I was completely well until two days ago, when I started to feel a bit under the weather. I felt a bit hot and fe Continue reading >>

Case Study- Diabetic Ketoacidosis

Case Study- Diabetic Ketoacidosis

Case Details A 22- year-old diabetic comes to the Accident and Emergency department. She gives a 2-day history of vomiting and abdominal pain. She is drowsy and her breathing is deep and rapid. There is distinctive smell from her breath What is the most likely diagnosis? What is the biochemical basis for all the presenting symptoms? Which laboratory test would you request? Case discussion The patient is most probably suffering from diabetic ketoacidosis. She is a known diabetic and the presenting symptoms like abdominal pain, vomiting, rapid breathing and distinctive smell of breath, all indicate associated ketoacidosis. Basic concept Diabetic Ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in type 1 diabetes mellitus, but it can also occur in type 2 diabetes mellitus under certain circumstances. Causes- DKA occurs most frequently in knownDiabetics. It may also be the first presentation in patients who had not been previously diagnosed as diabetics. There is often a particular underlying problem that has led to DKA episode. This may be- 1) Inter current illness such as Pneumonia,Influenza, Gastroenteritis, Urinary tract infection or pregnancy. 2) Inadequate Insulin administration may be due to defective insulin pen device or in young patient intentional missing of dose due to fear of weight gain. 3) Associated myocardial infarction, stroke or use of cocaine 4) Inadequate food intake– may be due to anorexia associated with infective process or due to eating disorder in children. Diabetic keto acidosis may occur in those previously known to have diabetes mellitu Continue reading >>

25-40% Of Newly Diagnosed Cases Present In Dka

25-40% Of Newly Diagnosed Cases Present In Dka

Case Scenario #1 What is your assessment? DKA exists when: Venous pH < 7.3 Serum bicarbonate < 15 mEq/dL Blood glucose > 300 mg/dL Presence of ketonemia/ketonuria How much fluid would you administer as a bolus? Would you administer bicarbonate? How much insulin would you administer? What IVF would you start? At what rate? * 10 - 20 cc/kg bolus of NS would be adequate. Though the patient is dehydrated (dry lips), his hemodynamics are good, with acceptable vitals and good perfusion. There would be no reason to administer more than 20 cc/kg fluids. While this patient is clearly acidemic, he is NOT in impending cardiovascular collapse and therefore there is no justification for the administration of bicarbonate. In fact, administration of bicarbonate has been associated with the development of cerebral edema. The “true†serum sodium is 143 133 + 0.016[700-100] Insulin is generally started at 0.1 u/kg/hr. Therefore, in this 30 kg patient, an insulin infusion of 3 u/hr of regular insulin should be initiated. IVF of NS should be started at ~ 2400 cc/m2/day, which is approximately 1.5 x maintenance Continue reading >>

Case Presentation

Case Presentation

History of present illness Pat B is a 48 year old Type I diabetic who was transferred from Darlington ER, where she presented with 3 days of nausea, vomiting and intermittent chills. In the ER, she was found to have a blood sugar of 980, pH 6.96, pCO2 11.2, bicarbonate of 2.5. She was placed on an insulin drip and transferred to Meriter Hospital. Review of systems Most of the history is obtained from the patient’s husband as the patient is unable to provide us with any information as she is obtunded. The patient’s blood sugars have recently been in the 400s, despite her taking insulin and other medications as she usually does. She was drinking a lot of water, but did not complain of chest pain, shortness of breath, cough, sputum production, abdominal pain, diarrhea. Past Medical History Diabetes mellitus Type I for 21 years. Hypertension, well controlled. Seizure disorder, no seizures for “many years†on Lamictal Hysterectomy Breast lumpectomy, benign Right lung resection for “lung spots†Social History Pat is married and the mother of 2 grown up children. She works as a registered nurse at a clinic in Darlington, WI. No history of tobacco or alcohol or illicit drug use. Family History Both parents died of cancer of unknown primary. Siblings and children healthy Physical Exam VITAL SIGNS: BP 98/46, HR 113, Temp 91.3, O2 Sat 99 % on RA. GEN APP: Obtunded middle-aged female breathing spontaneously, answers yes or no to questions. HEENT: R pupil reactive 4mm ïƒ 2 mm. L pupil sluggish and minimally reactive. No oral lesions. Tongue dry and cracked. No carotid bruits, JVD, thyromegaly or LAD. LUNGS: CTA bilaterally. HEART: Tachycardia. No gallops, murmurs, rubs, heaves or thrills. ABDOMEN: Hypoactive bowel sounds. Diffuse, mild to moderate Continue reading >>

Diabetic Ketoacidosis And Pediatric Stroke

Diabetic Ketoacidosis And Pediatric Stroke

THE CASE: A 6-year-old previously healthy right-handed girl presented with a 3-day history of progressive epigastric abdominal pain, polydipsia and secondary nocturnal enuresis and a 2-week history of weight loss of 5 kg. Her initial assessment revealed tachypnea with Kussmaul's respiration, tachycardia and moderate dehydration, with an estimated fluid deficit of 6%– 9%. The girl was hyperglycemic (plasma glucose level 43.4 mmol/L) and acidotic (pH 7.13, bicarbonate level 3.8 mmol/L), with urinalysis revealing ketonuria and glucosuria. After admission, appropriate fluid resuscitation and insulin treatment were started. The patient's diabetic ketoacidosis resolved over 20 hours, at which point a diabetic diet was introduced along with subcutaneous insulin therapy. On the morning after admission, the patient was found by the nursing staff to be irritable, lethargic and intermittently combative. Twelve hours later a right hemiparesis and aphasia became evident. A cranial CT scan showed an evolving infarct in the left basal ganglia. Transcranial Doppler ultrasonography and magnetic resonance angiography showed occlusion of the proximal left middle cerebral artery (Fig. 1). Echocardiography showed 2 thrombi, measuring 11 х 9 mm and 1 х 1 mm respectively, on the underside of the anterior mitral valve leaflet. There was no associated congenital heart disease. Because of a high risk of further thromboembolic events, heparin infusion was begun, and open thrombectomy was performed on the third day. Pathological examination revealed inflammatory cells and an organized thrombus. Blood cultures and prothrombotic studies yielded negative findings. Intensive rehabilitation therapy and low-molecular-weight heparin (enoxaparin, 30 mg subcutaneously every 12 hours) were started after Continue reading >>

Case Study: Hyperglycemia, Concern For Diabetic Ketoacidosis, And Type 1 Diabetes

Case Study: Hyperglycemia, Concern For Diabetic Ketoacidosis, And Type 1 Diabetes

Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes Case Study: Hyperglycemia, concern for diabetic ketoacidosis, and type 1 diabetes The patient presented to the emergency room with hyperglycemia and possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient is a 36-year-old man who has had type 1 diabetes for 15 years. He presents to the emergency room with hyperglycemia and concern for possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient reports that he is currently homeless and has lost his supply of insulin, syringes, glucose meter, and related glucose testing supplies. Diabetes-related comorbidities/complications Hypertension, hyperlipidemia, retinopathy, and bipolar disorder The patient states that at the time of his initial diagnosis with type 1 diabetes , he was hospitalized, with a glucose value >1000 mg/dL, and he was experiencing polyuria, polydipsia, and polyphagia. He reports that he has been on insulin since the time of his diagnosis, and he has never been prescribed oral agents for diabetes management. He recalls that glutamic acid decarboxylase (GAD) antibodies and a C-peptide level have been previously evaluated. GAD antibodies were positive, and C-peptide value was low, helping to confirm the diagnosis of type 1 diabetes. Most recently, he has been using insulin glargine 55 units once daily, and insulin aspart per correction doses 3 times daily. There was an imbalance when comparing his basal and bolus insulin doses. When asked about meal doses of insulin aspart, the patient relates that he is currently homeless and eats when food is available, often snacking on bits of food throughout the day. He was not using a meal dose of insulin aspart, but he would use this in Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic Ketoacidosis (DKA) A state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone. Can occur in both Type I Diabetes and Type II Diabetes In type II diabetics with insulin deficiency/dependence The presenting symptom for ~ 25% of Type I Diabetics. Hyperosmolar Hyperglycemic State (HHS) An acute metabolic complication of diabetes mellitus characterized by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. Occurs predominately in Type II Diabetics A few reports of cases in type I diabetics. The presenting symptom for 30-40% of Type II diabetics. Diagnostic Criteria for DKA and HHS Mild DKA Moderate DKA Severe DKA HHS Plasma glucose (mg/dL) > 250 > 250 > 250 > 600 Arterial pH 7.25-7.30 7.00-7.24 < 7.00 > 7.30 Sodium Bicarbonate (mEq/L) 15 – 18 10 - <15 < 10 > 15 Urine Ketones Positive Positive Positive Small Serum Ketones Positive Positive Positive Small Serum Osmolality (mOsm/kg) Variable Variable Variable > 320 Anion Gap > 10 > 12 > 12 variable Mental Status Alert Alert/Drowsy Stupor/Coma Stupor/Coma Causes of DKA/HHS Stressful precipitating event that results in increased catecholamines, cortisol, glucagon. Infection (pneumonia, UTI) Alcohol, drugs Stroke Myocardial Infarction Pancreatitis Trauma Medications (steroids, thiazide diuretics) Non-compliance with insulin Diagnostic Studies in DKA/HHS Chemistry ï‚ Glucose  Bicarbonate Anion gap = (Na+) – (Cl- + HCO3-) Frequently seen: ï‚ BUN/creatinine (dehydration) ï‚ potassium  sodium Pseudohyponatremia: to correct, add 1.6 mEq of sodium to every 100mg/dL of glucose above normal Serum acetones Positive in Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Case Scenario 52 male presents to GP with 3/12 lethargy and 2/52 thirsty and drinking more than normal. PMH HTN Drinks alcohol socially, non-smoker BMI 32 Urine Dip: glucose +++ Random Blood Sugar = 13 Contents Diagnosis Risk Factors Complications Investigations Management DKA + HONK Type 1 vs Type 2 Type 1 = Inability to produce insulin (autoimmune process against beta islet pancreas cells) Type 2 = insensitivity to insulin over time Gestational Diabetes = decreased insulin sensitivity during pregnancy Secondary Diabetes: Pancreatic Disease/CF/Chronic Pancreaitis/Pancreatic Ca Steroid use/ antipsychotics/ thiazide diuretics Diagnosis Random Glucose >11.1 mmol/L Fasting Glucose >7 mmol/L 2x Fasting glucose samples to confirm Or presence of symptoms HbA1c >6.5% (48mmol/L) OGTT – two hour glucose after 75g glucose IGT = normal fasting glucose and OGTT between 7-11 IFG = OGTT <7.8 but fasting glucose 6.1 – 6.9 Risk Factors T1: Family Hx, Caucasian/Scandinavian, Juvenile onset T2: High BMI Physical inactivity South Asian/Afro-carribean/middle-eastern Hx of gestational diabetes, IGT, IFG Steroid use PCOS Family Hx Presentation Polyuria Polydipsia Lethargy Recurrent infections Complications DKA (T1) HONK (T2) Presentation - case 67 male admitted feeling generally unwell, SOB, sweating and lethargic over last 2 days. He is a known Type 2 diabetic on insulin with PVD, peripheral neuropathy and previous CVA. His BM is 5.6. ECG showed residual ST elevation in anterior leads with Q wave and reciprocal changes. Echo showed new septal hypokinesia The patient had no history of chest pain Complications Macrovascular: Stroke, MI, PVD Retinopathy, Xanthelasma, Cataracts, Opthalmoplegia, maculopathy Peripheral Neuropathy, Diabetic amyotrophy, neuropathic pain, Autonomic neu Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Professor of Pediatric Endocrinology University of Khartoum, Sudan Introduction DKA is a serious acute complications of Diabetes Mellitus. It carries significant risk of death and/or morbidity especially with delayed treatment. The prognosis of DKA is worse in the extremes of age, with a mortality rates of 5-10%. With the new advances of therapy, DKA mortality decreases to > 2%. Before discovery and use of Insulin (1922) the mortality was 100%. Epidemiology DKA is reported in 2-5% of known type 1 diabetic patients in industrialized countries, while it occurs in 35-40% of such patients in Africa. DKA at the time of first diagnosis of diabetes mellitus is reported in only 2-3% in western Europe, but is seen in 95% of diabetic children in Sudan. Similar results were reported from other African countries . Consequences The latter observation is annoying because it implies the following: The late diagnosis of type 1 diabetes in many developing countries particularly in Africa. The late presentation of DKA, which is associated with risk of morbidity & mortality Death of young children with DKA undiagnosed or wrongly diagnosed as malaria or meningitis. Pathophysiology Secondary to insulin deficiency, and the action of counter-regulatory hormones, blood glucose increases leading to hyperglycemia and glucosuria. Glucosuria causes an osmotic diuresis, leading to water & Na loss. In the absence of insulin activity the body fails to utilize glucose as fuel and uses fats instead. This leads to ketosis. Pathophysiology/2 The excess of ketone bodies will cause metabolic acidosis, the later is also aggravated by Lactic acidosis caused by dehydration & poor tissue perfusion. Vomiting due to an ileus, plus increased insensible water losses due to tachypnea will worsen the state of dehydr Continue reading >>

Case Study 1: Patient With Newly Diagnosed Type 1 Diabetes

Case Study 1: Patient With Newly Diagnosed Type 1 Diabetes

Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes Authors: Author: Zachary T. Bloomgarden, MD This activity is intended for physicians and pharmacists. This article reviews the physiologic consequences of diabetes mellitus and presents evidence that supports the benefits of aggressive intervention to achieve glycemic control. Real-life clinical scenarios will be presented to illustrate the practical clinical applications of insulin preparations in patients with diabetes. On completion of this continuing medical education offering, participants will be able to: Describe the physiologic consequences of diabetes mellitus. Outline the importance of maintaining glycemic control in reducing the risk of diabetic complications. Detail specific clinical applications of insulin therapy to achieve both basal and meal-related glycemic control. Manage a patient's glycemic status by continuously refining the therapeutic approach. Disclosure: Zachary T. Bloomgarden, MD, has disclosed that he receives research grant support from Hoechst Marion Roussel, Novartis, and TCPI Inc. He has consulting agreements with Hoechst Marion Roussel, Novartis, Parke-Davis, Bristol-Myers Squibb Company, Novo Nordisk, Pfizer Inc., Eli Lilly and Company, Takeda, and GlaxoSmithKline. Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medical Education Collaborative designates this educational activity for a maximum of 1 hour in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Medical Education Collaborative, Inc. has Continue reading >>

Diabetic Ketoacidosisclinical Presentation

Diabetic Ketoacidosisclinical Presentation

Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early symptoms of diabetic ketoacidosis (DKA). Malaise, generalized weakness, and fatigability also can present as symptoms of DKA. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. A history of rapid weight loss is a symptom in patients who are newly diagnosed with type 1 diabetes. Patients may present with a history of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons. Decreased perspiration is another possible symptom of DKA. Altered consciousness in the form of mild disorientation or confusion can occur. Although frank coma is uncommon, it may occur when the condition is neglected or if dehydration or acidosis is severe. Among the symptoms of DKA associated with possible intercurrent infection are fever, dysuria, coughing, malaise, chills, chest pain, shortness of breath, and arthralgia. Acute chest pain or palpitation may occur in association with myocardial infarction. Painless infarction is not uncommon in patients with diabetes and should always be suspected in elderly patients. A study by Crossen et al indicated that in children with type 1 diabetes, those who have had a recent emergency department visit and have undergone a long period without visiting an endocrinologist are more likely to develop DKA. The study included 5263 pediatric patients with type 1 diabetes. [ 15 ] Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smi Continue reading >>

More in ketosis