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State of Ohio Overview of the diabetic ketoacidosis (DKA)/ hyperglycemic hyperosmolar state (HHS) episode of care CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission is strictly prohibited. CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission is strictly prohibited. December 23, 2016 | 1 Overview of the diabetic ketoacidosis (DKA)/hyperglycemic hyperosmolar state (HHS) episode of care 1. CLINICAL OVERVIEW AND RATIONALE FOR DEVELOPMENT OF THE DKA/HHS EPISODE 1.1 Rationale for development of the DKA/HHS episode of care DKA and HHS are among the most serious acute complications of diabetes. Clinically, DKA and HHS differ only by the degree of dehydration and the severity of metabolic acidosis. Both require prompt diagnosis and treatment. According to the American Diabetes Association, DKA accounts for more than $1 of every $4 spent on direct care for adult patients with Type I diabetes, and $1 of every $2 spent on patients experiencing multiple morbidities.1 In the United States, approximately 145,000 hospitalizations occur for DKA each year with an average cost of $17,500 per patient.2 The direct and indirect total annual cost of hospitalizations is estimated to be $2.4 billion.3 While the hospitalization rate for HHS is less than one percent of all diabetes-related admissions, death occurs in an estimated 5-16 percent of these patients, a rate 10 times higher than that of DKA.4 The complex pathophysiology of both DKA and HHS requires careful selection of approaches to restore glycemic control and deficiencies in intravascular volume and electrolytes. Appropriate treatment also includes the diagnosis and management of the underlying precipitating event. Death in patients with DKA/HHS is typically caused by the und Continue reading >>
Incidence Of Diabetic Ketoacidosis At Diagnosis Of Type 1 Diabetes In Colorado Youth, 1998-2012
Diabetic ketoacidosis (DKA) at time of type 1 diabetes (T1D) diagnosis is life threatening and has detrimental long-term effects. It may reflect delayed access to health care, lower quality of care, or income inequality.1 In Scandinavian countries, incidence of DKA at diagnosis has decreased below 20%.2 Little is known about long-term trends in the United States. We examined the temporal trends in DKA at T1D diagnosis between 1998 and 2012 in Colorado and factors associated with DKA. Between 1998 and 2012, youth diagnosed with T1D before age 18 years at any medical facility were included if a Colorado resident and followed up at the Barbara Davis Center for Diabetes in Denver, which serves more than 80% of youth with diabetes in Colorado with no change in referral patterns over time. Standard criteria3 were used to define DKA. Data were extracted from medical records. Information was insufficient to determine DKA status in 2.8% of patients. The change in incidence over time was analyzed by fitting a linear term for calendar year in logistic regression models. Logistic regression analysis was used to identify factors associated with DKA. The insurance × year interaction was analyzed for a period with the most rapid increase in incidence (2007-2012). Statistical analysis was performed using SAS version 9.2 (SAS Institute Inc). P < .05 was considered significant (2-sided). The University of Colorado multiple institutional review board approved this study and granted waiver of informed consent. Diabetic ketoacidosis was present in 1339 of 3439 youth (38.9%) at T1D diagnosis. Youth with DKA had a median age of 9.4 years (interquartile range, 5.6-12.6 years), 53.8% were male, and 75.7% were white. The proportions with DKA increased significantly, especially after 2007 (29.9% Continue reading >>
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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 >>
Diabetic Ketoacidosis (dka)
Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>
Master Diabetic Ketoacidosis (dka) Diagnosis And Labs With Picmonic For Medicine
With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing. Dyed-bead-pancreas with Key-to-acidic-lemon and Diagnostic-computer with Test-tubes Picmonic Diabetic ketoacidosis (DKA) is a medical emergency and complication of diabetes. Patients have increased insulin requirements, which leads to a shortage. As a response, the body begins burning excess fat (and fatty acids), causing ketone body buildup Lab values seen in DKA include blood sugars above 250 mg/dL, and anion gap metabolic acidosis with pH below 7.3 and bicarbonate below 18. Patients will also show present plasma ketones. Due to an extracellular shift, patients may be hyperkalemic. Picmonic for Medicine (MD/DO) covers information that is relevant to your entire Medical (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help. Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores. "[Picmonics] correlate directly with what is in First Aid so you know it is essential information that will show up on the exam. The number of questions I got right in biochemistry and microbiology were mainly due to this resource." James, Texas Tech University Health Sciences Center School of Medicine, 274 on Step 1 TRY IT FREE Continue reading >>
What You Should Know About Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>
Diabetic Ketoacidosis
As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Diabetic ketoacidosis (DKA) is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes. People with type 2 diabetes can also develop DKA, but it is less common. It is usually triggered by uncontrolled blood sugar, missing doses of medicines, or a severe illness. Continue reading >>
Diabetic Ketoacidosis Is A Dire Diagnosis
Michelle Gerhard Jasny, V.M.D. has been practicing veterinary medicine on the Vineyard since 1982 and writing the Visiting Vet column for more than 25 years. She lives and works in West Tisbury. She can be reached at [email protected]. Yves had always been a cat who liked to eat. A seasonal resident, I saw him every summer. When he was four years old, I suggested reducing the amount he was being fed. At six, I advised a prescription weight loss diet. It was a difficult regimen for his owners to maintain. Yves lived strictly indoors and didn’t get much exercise, and the other cat in the household had different health problems, requiring different food. By 11 years old, Yves was tipping the scale at 21 pounds. “He’s at risk for all kinds of diseases, especially diabetes,” I said, not unsympathetically, considering how many years I have struggled with my own battle of the bulge. His family committed again to helping him lose weight and last winter we sent them off with more diet food, recommending monthly weigh-ins with their winter veterinarian. Spring arrived. Seasonal folks began returning. Memorial Day weekend, Yves’s mother called. “We’ve been here two weeks,” she said. Yves had been fine until yesterday. “I am worried he might have some kind of blockage. He’s been vomiting and crying and he’s not eating.” “He’s still an indoor cat?” I asked. Cats who go out have greater risk of ingesting things that may upset their tummies, anything from mice to antifreeze, but Yves never ventured to the great outdoors. “Any flowers like lilies in the house?” I asked. Ingestion of houseplants is a common cause of gastroenteritis for indoor cats and lilies in particular are extremely toxic to cats, leading to potentially fatal kidney failure. “No, Continue reading >>
Genetic Screening, Follow-up May Decrease Dka At Diabetes Diagnosis
The frequency of diabetic ketoacidosis precipitating diagnosis of type 1 diabetes in children may be decreased with genetic screening and follow-up for the disease, according to study findings published in Pediatric Diabetes. Anne M. Hekkala, MD, PhD, of the department of pediatrics at the University Oulu in Finland, and colleagues evaluated children born at Oulu University Hospital since 1995 who were diagnosed with type 1 diabetes when they were younger than 15 years by 2015 (study cohort 1; n = 517) and all children diagnosed with type 1 diabetes younger than 15 years from 2002 to 2014 (study cohort 2; n = 579). Since 1995, newborns in the region have been recruited to be assessed for genetic risk for type 1 diabetes by screening for human leukocyte antigen (HLA) in umbilical cord blood. Researchers sought to determine the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and whether participation in screening follow-up studies decreased the risk for DKA. In study cohort 1, overall frequency of DKA was 17.6%, and the frequency of severe DKA was 3.5% at the diagnosis of type 1 diabetes; 55.7% had been screened for HLA-conferred risk. Participants with an increased genetic risk who were followed in a prospective diabetes study had the lowest frequency of DKA at diagnosis (5%) compared with participants without HLA-screening (22.7%), participants with HLA-conferred risk but no follow-up (23.4%) and participants without HLA-conferred risk (26.7%; P < .001). In study cohort 2, DKA was present at diagnosis for 18.5% of participants and severe DKA for 3.5%. Increasing age at diagnosis increased the frequency of DKA (13% in participants aged < 5 years; 14% in participants aged 5-9 years; 28.6% participants in participants aged 10-14 years; P < .001), a Continue reading >>
Type 1 Diabetes Mellitus With Ketoacidosis Without Coma
E10.10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This is the American ICD-10-CM version of E10.10 - other international versions of ICD-10 E10.10 may differ. Approximate Synonyms Diabetes type 1 with ketoacidosis Ketoacidosis in type 1 diabetes mellitus Ketoacidosis in type i diabetes mellitus ICD-10-CM E10.10 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0): Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016): No change 2018 (effective 10/1/2017): No change Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Continue reading >>
Diagnosis And Treatment Of Diabetic Ketoacidosis
Val Wilson describes how emergency nurses should diagnose and treat the effects of severe insulin deficiency in people with type 1 diabetes Diabetic ketoacidosis (DKA) is an acute and serious metabolic complication of type 1 diabetes. Caused by severe insulin deficiency leading to hyperglycaemia, DKA is the most common cause of mortality in people with type 1 diabetes under the age of 40. It causes nausea and vomiting, hypothermia, hypotension, cardiac arrhythmia, tachycardia, deep and rapid breathing and, if untreated, can lead to cerebral oedema, coma and death. The survival of patients with DKA can depend, therefore, on the ability of emergency nurses to recognise its signs and symptoms. The most urgent treatment outcomes in emergency settings are the reversal of ketosis and hyperglycaemia, and the prevention of hypokalaemia and hyponatraemia, and these should be followed by hourly biochemical tests to determine treatment alterations. This article describes DKA and how patients with the condition usually present, and outlines its treatment by emergency nurses. Correspondence [email protected] Published in print on 08 November 2012 Peer review This article has been subject to double blind peer review Conflict Of Interest None declared You need a subscription to read the full article Continue reading >>
Prevalence Of Diabetic Ketoacidosis At Diagnosis
A recent analysis of youth with type 1 or type 2 diabetes shows that the incidence of DKA continues to be high…. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes caused by the build-up of ketone bodies secondary to insulin deficiency. While it occurs predominantly in type 1 diabetic patients, at the time of diagnosis, it can also happen in type 2 diabetes when medications are inadequately managed. Using data from the registry component of the SEARCH for Diabetes in Youth Study, researchers estimated temporal changes in the prevalence of diabetic ketoacidosis at the time of diagnosis of type 1 and type 2 diabetes. Researchers assessed the trend in the prevalence of diabetic ketoacidosis over 3 time period by calculating the period prevalence of diabetic ketoacidosis at diagnosis with 95% confidence intervals based on age group, gender and ethnicity/race. Logistic regression was used to analyze factors associated with diabetic ketoacidosis. A total of 5,615 youth with type 1 diabetes and 1,425 with type 2 diabetes were included in the analysis. Diabetic ketoacidosis was defined as a bicarbonate level of less than15 mmol/L and/or a venous pH of less than 7.25 or an arterial or capillary pH of less than 7.30. The prevalence of DKA type 1 diabetic youth was stable having a P-trend=0.42 (CI=95%) with prevalence of 30.2%, 29.1% and 31.1% during the years 2002-2003, 2004-2005 and 2008-2010, respectively). Prevalence was notably higher in those diagnosed at a younger age (P<0.0001), with the overall prevalence being highest in those between the ages of 0 and 4 (~39%) and lowest in those between the ages of 15 and 19 years old (~23%). Researchers found the prevalence of diabetic ketoacidosis to be higher in those of minority race (P=0.019) Continue reading >>
Diabetic Ketoacidosis (dka) - Topic Overview
Diabetic ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy because there is not enough insulin. When the sugar cannot get into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood and remove it from the body through urine. Because the cells cannot receive sugar for energy, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis. Ketoacidosis can be caused by not getting enough insulin, having a severe infection or other illness, becoming severely dehydrated, or some combination of these things. It can occur in people who have little or no insulin in their bodies (mostly people with type 1 diabetes but it can happen with type 2 diabetes, especially children) when their blood sugar levels are high. Your blood sugar may be quite high before you notice symptoms, which include: Flushed, hot, dry skin. Feeling thirsty and urinating a lot. Drowsiness or difficulty waking up. Young children may lack interest in their normal activities. Rapid, deep breathing. A strong, fruity breath odor. Loss of appetite, belly pain, and vomiting. Confusion. Laboratory tests, including blood and urine tests, are used to confirm a diagnosis of diabetic ketoacidosis. Tests for ketones are available for home use. Keep some test strips nearby in case your blood sugar level becomes high. When ketoacidosis is severe, it must be treated in the hospital, often in an intensive care unit. Treatment involves giving insulin and fluids through your vein and closely watching certain chemicals in your blood (electrolyt Continue reading >>
Diabetic Ketoacidosis: Incidence, Biochemical Abnormalities, Pathophysiology, And Diagnosis
Abstract The incidence of diabetes in industrial societies is increasing at an alarming rate, and the most common cause of mortality in individuals with type I diabetes, under the age of 40 years, is diabetic ketoacidosis (DKA). Continue reading >>
High Frequency Of Diabetic Ketoacidosis In Children With Newly Diagnosed Type 1 Diabetes
Copyright © 2016 Agnieszka Szypowska et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Aim. The aim of this study was to evaluate the incidence of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in 2006-2007 and 2013-2014. Method. The study group consisted of 426 children aged 0–18 years with type 1 diabetes onset admitted to our hospital in 2006-2007 (group A) and 2013-2014 (group B). The study comprised the analysis of medical and laboratory records from patients’ medical charts and the electronic database. Results. There was no difference between groups A and B in the percentage of children admitted with diabetic ketoacidosis (25% versus 28%, resp., ). Among children with diabetic ketoacidosis, severe metabolic decompensation (pH < 7.1) appeared in similar frequency in groups A and B (28% versus 30%, resp., ). In group B, children with diabetic ketoacidosis were statistically younger compared to patients without ketoacidosis and had higher HbA1c levels . In both groups, a 2-fold increase in diabetic ketoacidosis was noted in children under the age of 3, compared to overall frequency. Conclusion. No decrease in diabetic ketoacidosis has been noted in the recent years. Although the prevalence and severity of diabetic ketoacidosis remain stable, they are unacceptably high. The youngest children are especially prone to ketoacidosis. 1. Introduction The incidence rate of type 1 diabetes has increased worldwide, with the greatest rise in annual incidence among children under the age of five. The overall incidence rate in the region of Silesia in Poland Continue reading >>
