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Dka Causing Aki

Acute Kidney Injury Differential Diagnoses

Acute Kidney Injury Differential Diagnoses

Diagnostic Considerations Although acute kidney injury (AKI) is a potentially reversible condition, it can occur in patients with chronic renal failure. Every effort should be made to identify reversibility, even if improvement in renal function is marginal. The best way to identify reversibility is by tracking the rate of deterioration of renal function. If there is an acceleration of the rate at which the patient’s renal function is worsening, the cause should be sought and treated. Differentials to consider in AKI include the following: Urine output in differential diagnosis Changes in urine output generally correlate poorly with changes in the glomerular filtration rate (GFR). Approximately 50-60% of all causes of AKI are nonoliguric. However, the identification of anuria, oliguria, and nonoliguria may be useful in the differential diagnosis of AKI, as follows: Anuria (< 100 mL/day) - Urinary tract obstruction, renal artery obstruction, rapidly progressive glomerulonephritis, bilateral diffuse renal cortical necrosis Nonoliguria (>400 mL/day) - Acute interstitial nephritis, acute glomerulonephritis, partial obstructive nephropathy, nephrotoxic and ischemic ATN, radiocontrast-induced AKI, and rhabdomyolysis Differential Diagnoses Workup Continue reading >>

Predictors And Outcome Of Acute Kidney Injury In Children With Diabetic Ketoacidosis

Predictors And Outcome Of Acute Kidney Injury In Children With Diabetic Ketoacidosis

To identify predictors and outcome of acute kidney injury (AKI) in children with diabetic ketoacidosis (DKA) admitted to a Pediatric Intensive Care Unit (PICU). Methods: Retrospective case review of 79 children with DKA admitted between 2011-2014. Results: 28 children developed AKI during the hospital stay; 20 (71.4%) recovered with hydration alone. Serum chloride at 24 hours was independently associated with AKI. Children with AKI had prolonged acidosis, longer PICU stay, and higher mortality. Conclusions: Majority of children with AKI and DKA recover with hydration. Hyperchloremia at 24 hours had independent association with AKI, although cause-effect relation could not be ascertained. Diabetes, Hyperchloremia, Outcome, Renal failure. iabetic ketoacidosis (DKA) is a life-threatening complication of diabetes with a reported frequency ranging from 15-70% across different study populations. Mortality from DKA in developing countries is still high (3.4%-13%), due to putative reasons like cerebral edema, sepsis, venous thrombosis and dyselectrolytemias [1-3]. Although renal injury is frequently encountered in hyperglycemic hyperosmolar state, it is not so well reported in DKA [4]. Furthermore, renal injury can be masked in children with DKA, due to osmotic diuresis and spurious elevations in creatinine secondary to ketonemia. We undertook this study to evaluate the predictors and outcome of AKI in children with DKA admitted to a Pediatric Intensive Care Unit (PICU). Electronic medical records of children with DKA admitted consecutively to our PICU from 2011-2014 were accessed retrospectively after seeking ethical clearance. DKA was diagnosed using standard definitions [5]. Rehydration was based on sum of 6.5% deficit and maintenance over 36 hours. Additional bolus of 20 m Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be very challenging. These cases highlight the importance of early recognition of AKI (rising plasma creatinine, oliguria, haematuria) and discussion with paediatric nephrologist to formulate individualised fluid therapy in order to prevent deterioration in renal function. It is uncertain if recent modification in fluid man Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Childhood Ketoacidosis article. Diabetic ketoacidosis (DKA) is a medical emergency with a significant morbidity and mortality. It should be diagnosed promptly and managed intensively. DKA is characterised by hyperglycaemia, acidosis and ketonaemia:[1] Ketonaemia (3 mmol/L and over), or significant ketonuria (more than 2+ on standard urine sticks). Blood glucose over 11 mmol/L or known diabetes mellitus (the degree of hyperglycaemia is not a reliable indicator of DKA and the blood glucose may rarely be normal or only slightly elevated in DKA). Bicarbonate below 15 mmol/L and/or venous pH less than 7.3. However, hyperglycaemia may not always be present and low blood ketone levels (<3 mmol/L) do not always exclude DKA.[2] Epidemiology DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA.[2] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Malaise, generalized weakness, and fatigability Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia Rapid weight loss in patients newly diagnosed with type 1 diabetes History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: 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, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. Are arterial and venous samples clinically equivalent for the estimation Continue reading >>

Overview Of The Management Of Acute Kidney Injury In Adults

Overview Of The Management Of Acute Kidney Injury In Adults

INTRODUCTION Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). This results in an elevation of serum blood urea nitrogen (BUN), creatinine, and other metabolic waste products that are normally excreted by the kidney. The term AKI, rather than acute renal failure (ARF), is increasingly used by the nephrology community to refer to the acute loss of kidney function. This term also highlights that injury to the kidney that does not result in "failure" is also of great clinical significance. In this topic review, the acute loss of kidney function will be referred to as AKI. The initial assessment of patients with AKI and management of the major complications of AKI are discussed here. The incidence, causes, diagnosis, and prevention of AKI are presented separately. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Kidney and patient outcomes after acute kidney injury in adults" and "Possible prevention and therapy of ischemic acute tubular necrosis".) PATHOGENESIS AKI has multiple possible etiologies. Among hospitalized patients, AKI is most commonly due to either prerenal etiologies (volume depletion, "third spacing," effective volume depletion from heart failure or cirrhosis) or acute tubular necrosis (ATN) from ischemia, nephrotoxin exposure, or sepsis [1]. The pathogenesis of ATN is discussed elsewhere. (See "Pathogenesis and etiology of ischemic acute tubular necrosis" and "Pathogenesis, clinical features, and diagnosis of contrast-induced nephropathy".) Other frequent causes of AKI among either ambulatory or hospitalized patients include volume depletion, urinary obstruction, rapidly progressive glomerulonephritis, and acute interstitial nephritis. The path Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Go to: Introduction The incidence of diabetes mellitus is increasing worldwide affecting both types of the disease. The most frequent acute diabetic complications are hyperglycemic crises, namely diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. Diabetic ketoacidosis results from an absolute insulin deficiency. Classical presentation associates a triad of uncontrolled hyperglycemia, metabolic acidosis and high ketone bodies concentration. Similarly to diabetes, the incidence of DKA increases over time [1], [2]. This may be a life-threatening condition due to severe clinical and biological impairments and treatment associated complications (cerebral edema, acute respiratory distress syndrome, hypokalaemia, hypophosphatemia). However, mortality is low and most of the time, death is related to the precipitating factor [3]–[6]. For this reason, admission of these patients in ICU is still debated. A grading system for severity of DKA was described previously [7]. Patients presenting the most severe grades or common severity criteria were considered for ICU admission. However this grading system is not recommended for clinical practice, resulting in wide variations in ICU utilisation for DKA, depending on the national practices, the number of DKA admitted in the units and the severity of the clinical status [8]. Interestingly, in the absence of randomised trials, there are no data showing any impact of the level of care on DKA mortality. To help clinicians, guidelines for DKA management are published and updated by the American Diabetic Association [6]. Their effect on clinical outcome is unclear as compliance to guidelines is poor in diabetes care and ICU [9], [10]. However, implementation of a local mandatory protocol seems more efficient to decrease ICU a Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis

1 King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia, Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada, Canada 2 Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada Click here for correspondence address and email Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may improve the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA. How to cite this article: Al-Matrafi J, Vethamuthu J, Feber J. Severe acute renal failure in a patient with diabetic ketoacidosis. Saudi J Kidney Dis Transpl 2009;20:831-4 Diabetic ketoacidosis (DKA) occurs in 10 to 70% of children with type 1 diabetes mellitus (DM1) and has a significant risk of mortality, mostly due to cerebral edema. [1] Other potential complications of DKA include hypokalemia, hypophosphatemia, hypoglycemia, intracerebral and peripheral venous thrombosis, mucormycosis, rhabdomyolysis, acute pancreatitis, acute renal failure (ARF) and sepsis. The development of ARF with rhabdomyolysis is a rare but potentially lethal diso Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demo Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

pital Saint-Roch, CHU de Nice, Nice, France, 2IRCAN, Faculte 3Laboratoire de Biochimie, CHU de Nice, Nice, France Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.0201.100], p,0.01), blood glucose (odds ratio 1.101 [1.0391.166], p,0.01) and serum protein (odds ratio 0.928 [0.8650.997], p = 0.04). Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admissi Continue reading >>

High Rate Of Aki In Children With Diabetic Ketoacidosis

High Rate Of Aki In Children With Diabetic Ketoacidosis

Kidney News Findings High Rate of AKI in Children with Diabetic Ketoacidosis High Rate of AKI in Children with Diabetic Ketoacidosis Nearly two-thirds of children with type 1 diabetes hospitalized for diabetic ketoacidosis (DKA) will develop acute kidney injury (AKI), suggests a study in JAMA Pediatrics. The researchers reviewed all DKA admissions at a Canadian childrens hospital from 2008 to 2013. Complete medical records were available for 165 patients. The median age was 10.6 years; 54% were female. Three-fourths of patients were newly diagnosed with type 1 diabetes. Fifty-five percent were transferred from another hospital and nearly one-fourth were admitted to the ICU. Median initial pH was 7.1 and serum bicarbonate level 7.0 mEq/L. Based on Kidney Disease/Improving Global Outcomes criteria, 64.2% of patients developed AKI while in the hospital. Of affected children, 34.9% had AKI stage 1, 45.3% had AKI stage 2, and 19.8% had AKI stage 3. Two patients required hemodialysis. On adjusted analysis, factors associated with the development of stage 2 or 3 AKI were serum bicarbonate less than 10 mEq/L, adjusted odds ratio (OR) 5.22; and higher initial heart rate, OR 1.22 per increase of 5 beats/min. Odds of stage 1 AKI were increased for children with an initial corrected sodium level of 145 mEq/L or greater, OR 3.29. There were no deaths in children with or without AKI. The study documents a high prevalence of AKI among children with DKA admitted to a tertiary care childrens hospital. This risk appears higher in children with laboratory evidence of volume depletion and severe acidosis. The authors call for prospective studies to clarify the risk factors and long-term implications of AKI in pediatric DKAa group of young patients who already have a high long-term risk of Continue reading >>

Children With Diabetic Ketoacidosis At High Risk Of Aki

Children With Diabetic Ketoacidosis At High Risk Of Aki

A 22% increase in odds of developing AKI was seen for each initial heart rate increase of 5 beats per minute. Among children with type 1 diabetes, new data published in JAMA Pediatrics demonstrate that a high proportion of those who are hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI). The researchers of the study aimed to establish the proportion of children hospitalized for DKA who develop AKI, and to ascertain the clinical and biochemical markers associated with AKI. Overall, the medial record review included all DKA admissions from September 1, 2008, through December 31, 2013, that were conducted at the British Columbia Childrens Hospital in British Columbia, Canada. The researchers included 165 children (age, 18 years; median age, 10.6 years; 53.9% female) with type 1 diabetes and DKA and with complete medical records available for analysis. The primary outcome was AKI, defined via the Kidney Disease/Improving Global Outcomes serum creatinine criteria. The researchers used multinomial logistic regression to determine potential factors associated with AKI. Results indicated that 64.2% of children developed AKI , of whom 34.9% had stage 1, 45.3% had stage 2, and 19.8% had stage 3, and 2 children required hemodialysis . According to the adjusted multinomial logistic regression model, a serum bicarbonate level <10 mEq/L compared with 10 mEq/L yielded a more than 5-fold increase in the likelihood of severe (stage 2 or 3) AKI (adjusted odds ratio [aOR], 5.22; 95% CI, 1.35-20.22). For each initial heart rate increase of 5 beats per minute, the researchers observed a 22% increase in the odds for severe AKI (aOR, 1.22; 95% CI, 1.07-1.39). In addition, compared with an initial corrected sodium level of 135-144 mEq/L, those with a level of 145 m Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Childrens Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the a Continue reading >>

(pdf) Acute Kidney Injury Among Adult Patients With Diabetic Ketoacidosis In A Referral Hospital Of Bangladesh

(pdf) Acute Kidney Injury Among Adult Patients With Diabetic Ketoacidosis In A Referral Hospital Of Bangladesh

Acute Kidney Injury among Adult Patients with Diabetic Ketoacidosis in a Referral Hospital of Bangladesh Rahim MAa*, Ananna MAa*, Zaman Sb, Rouf Rc, Ahmed AUd, Hossain RMe, Chowdhury TAf, Saha SKf, Samad Ta, Mitra Pg, Iqbal Sh, Uddin KNi, Latif ZAj Background: Diabetic ketoacidosis (DKA) is a medical emergency. DKA may be complicated by acute kidney injury (AKI) and may require renal replacement therapy. Early detection and treatment including treatment of underlying cause and complication(s), if present, is important in determining outcome of DKA. This study was designed to evaluate the incidence of AKI among patients with DKA. Methods: This cross-sectional study was done in BIRDEM General Hospital, Dhaka, Bangladesh from 2008 to 2011. AKI was diagnosed by using acute kidney injury network (AKIN) criteria. Results: Total patients were 200 with slight female predominance (56%). Mean age of the study subjects was 37.67.5 years. Incidence of DKA was more in known diabetic patients (71%), more among rural population (53%) and low income group (76.5%). Infection (40.5%) was the commonest precipitating cause followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common causes and aetiology could not be identified in 14% cases. Fifty nine (29.5%) cases were complicated by AKI and among them three (5%) patients required haemodialysis. AKI was more in severe DKA (pH <7) cases and when precipitated by acute pancreatitis and infections. In spite of standard Conclusion: Almost one-third of DKA cases had AKI in this study, more in DKA cases precipitated by acute pancreatitis and sepsis. Fluid resuscitation resolved AKI in most cases but few cases required renal replacement Key words: acute k Continue reading >>

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