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Dka Diagnosis Criteria Uk

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

A Rare Case Of Diabetic Ketoacidosis (dka) In A Patient With Genetically Confirmed Maturity Onset Diabetes Of Young (mody)

Maturity Onset Diabetes of the Young (MODY) accounts for upto 2% of all patients with diabetes. Hepatocyte Nuclear Factor 1 alpha (HNF1-A) MODY is the most common subtype accounting for 30–70% of all MODY cases. Typically, it presents in young adults below the age of 45, frequently < 25 with autosomal dominant family history of diabetes, absence of autoimmune markers and insulin resistance and c-peptide positivity. DKA is a rare complication of MODY particularly in situations of non-compliance. We describe a case of DKA in a genetically confirmed HNF1-A MODY patient presented to our hospital. A 26-year-old female was admitted with severe vomiting. She had a background history of HNF1- alpha MODY diagnosed at the age of 15 when she was found to have hyperglycaemia during pregnancy. She was on Gliclazide 40mg daily but stopped taking it about a year ago. Her pH was 6.96, blood glucose of 31.4 mmol/L and blood Ketones of 5.8 mmol/L. This was consistent with DKA which was successfully treated. There was no evidence of sepsis. Her HbA1c was high at 101mmol/mol suggesting poor glycaemic control. She had uneventful recovery and was discharged home on Gliclazide with appropriate follow up arranged. The presence of DKA was previously considered an exclusion criterion for MODY according to the International Society for Paediatrics and Adolescent Diabetes (IPSAD) 2009 guidelines. It is presumed that patients with MODY do not develop DKA due to the presence of residual insulin production that prevents ketogenesis. However, this was withdrawn in the 2014 update due to several case reports of DKA in confirmed MODY patients. The majority of patients with genetically proven MODY are initially incorrectly diagnosed as Type 1 or Type 2 diabetes. Exclusion of DKA from the diagnostic cri 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 >>

Updated Feb 2017 J Clayton

Updated Feb 2017 J Clayton

NUH Management of Diabetic Ketoacidosis in Adults (18 years old & over) (Please see the Paediatric guidelines for patients under 18 years) If in doubt, call someone more senior. KETOACIDOSIS CAN KILL. Use in conjunction with the NUH pathway of care for DKA in adults (insulin prescription, administration and monitoring chart). 1. DIAGNOSIS All three required 1. Raised blood glucose>11mmol /L or known diabetes 2. Capillary ketones > 3 mmol/L (or Ketones >2+ in urine) 3. Venous pH < 7.35 or venous bicarb < 15mmol/L 2. ESSENTIAL INVESTIGATIONS Arterial puncture NOT routinely needed  U+E, creatinine, blood glucose  Venous blood gas for bicarbonate, potassium and pH (analyse on machine on B3, ED, HDU, ITU)  ECG/CXR/MSU/blood cultures/pregnancy test depending on clinical suspicion Raised WCC and serum amylase are common in DKA and do not usually suggest pancreatitis. 4. IMMEDIATE TREATMENT START IN EMERGENCY DEPT / ASSESSMENT UNIT OR THEIR CURRENT LOCATION. DELAY IN STARTING TREATMENT MAY BE FATAL. 1. Insert venflon 2. 1L 0.9% sodium chloride infusion over 1hr if systolic BP>90 (If systolic BP<90 give repeated boluses of 500ml 0.9% sodium chloride over 10-15 minutes) 3. Start IV insulin infusion: 50 units human soluble (ACTRAPID®) insulin added to 49.5 mls 0.9% sodium chloride to give a 1 unit/ml solution via syringe driver at 0.1 units/ kg / hr (estimated or actual weight) 3. SEVERITY (Venous bicarbonate or pH) >14 mmol/l or pH >7.3 Mild 10-14 mmol/l or pH 7.1-7.3 Moderate < 10 mmol/l or pH <7.1 Severe 5. TRANSFER NO PATIENT WITH DKA SHOULD BE TRANSFERRED BETWEEN HOSPITALS URGENT CRITICAL CARE/HDU REVIEW if any of: Venous bicarbonate < 10 mmol/l or pH<7.1, drowsy (P or U on AVPU), fluid balance problems, pregnancy, co morbidities, sats<94% on 40% O2, p Continue reading >>

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis.

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis.

Abstract The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) (ii) (iii) This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. Continue reading >>

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Treatment Of Diabetic Ketoacidosis (dka)/hyperglycemic Hyperosmolar State (hhs): Novel Advances In The Management Of Hyperglycemic Crises (uk Versus Usa)

Abstract Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. Large-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation. There is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol. UK USA Hyperglycemia >30 mmol/L (540 mg/dL) >33.3 mmol/L (600 mg/dL) Hyperosmolarity >320 mOsm/kg >320 mOsm/kg Calculation 2 × Na (mmol/L) + glucose (mmol/L) + urea (mmol/L) 2 × Na (meQ/L) + glucose (mg/dL)/18 + blood urea nitrogen (mg/dL)]/2.8 Lack of acidosis Ketones Low Low pH >7.3 >7.3 Bicarbonate >15 mmol/L >20 mmol/L Mental status changes Present Present Notes Ketan K. Dhatariya is an employee of the UK National Health Service. Ketan K. Dhatariya is the lead author of the Joint British Diabetes Societies Guideline for the management of DKA. He is also on the Clinical Endpoint Adjudication Committee for the Sotagliflozin trials run by Lexicon Pharmaceuticals. Priyathama Vellanki has received consulting fees from Merck & Co. This article does not contain any studies with human or animal subjects performed by any of the authors. Continue reading >>

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

Joint British Diabetes Societies Guideline For The Management Of Diabetic Ketoacidosis

The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: (i) (ii) (iii) This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter. (ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response. (iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers. (iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only. Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved. (ii) When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed-rate insulin to be continued. (iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus(®), Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir(®), Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses. Delivery of care (i) The diabetes specialist team should be involved as soon as possible. (ii) Patients should be nursed in areas where staff are experienced in the management of ketoacidosis. Continue reading >>

Type 1 Diabetes In Adults: Diagnosis And Management – Nice Guideline (update)

Type 1 Diabetes In Adults: Diagnosis And Management – Nice Guideline (update)

This National Institute for Health and Care Excellence (NICE) guideline covers the care and treatment of adults (aged 18 and over) with type 1 diabetes. Education and information Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis. [new 2015] Blood glucose management Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the risk of long‑term vascular complications. [new 2015] Agree an individualised HbA1c target with each adult with type 1 diabetes, taking into account factors such as the person's daily activities, aspirations, likelihood of complications, comorbidities, occupation and history of hypoglycaemia. [new 2015] Support adults with type 1 diabetes to test at least four times a day, and up to 10 times a day if any of the following apply: desired target for blood glucose control, measured by HbA1c level, is not achieved frequency of hypoglycaemic episodes increases legal requirement to do so (such as before driving, in line with the Driver and Vehicle Licensing Agency (DVLA) during periods of illness before, during and after sport when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy) if there is a need to know blood glucose levels more than four times a day for other reasons (for example, impaired awareness of hypoglycaemia, high‑risk activities). [new 2015] Advise adults with type 1 diabetes to aim for: fasting plasma glucose level of 5–7 mmol/litre on waking plasma glucose level of 4–7 mmol/litre before meals at other times of the day. [new 2015] Insulin therapy Offer multiple da Continue reading >>

Joint British Diabetes Societies (jbds) For Inpatient Care Group

Joint British Diabetes Societies (jbds) For Inpatient Care Group

The Joint British Diabetes Societies (JBDS) for Inpatient Care group was created in 2008 to ‘deliver a set of diabetes inpatient guidelines and proposed standards of care within secondary care organisations’, with the overall aim of improving inpatient diabetes care through the development and use of high quality evidence based guidelines, and through better inpatient care pathways. The JBDS – IP group was created and supported by Diabetes UK, ABCD and the Diabetes Inpatient Specialist Nurse (DISN) UK group, and works with NHS England, TREND-UK and with other professional organisations. The 2017 Rowan Hillson Inpatient safety award For information about this click here Guidelines The guidelines produced by the JBDS – IP group (including those planned for the future) are listed below and for those already published click the live link on the date to view: No Guideline Date 1 Hospital management of hypoglycaemia in adults with diabetes March 2010 1a Hospital management of hypoglycaemia in adults with diabetes - revised - second edition 2013 Sept. 2013 2 The management of diabetic ketoacidosis (DKA) in adults March 2010 2a The management of diabetic ketoacidosis (DKA) in adults - revised - second edition 2013 Sept. 2013 2b Adult diabetic ketoacidosis emergency care pathway to use in the case notes - accompanies the DKA revised guideline 2013 Sept. 2013 2c JBDS DKA condensed management charts accompanies the DKA revised guideline 2013 August 2017 3 Management of adults with diabetes undergoing surgery March 2011a March 2011b 3a Management of adults with diabetes undergoing surgery – full document March 2016 3b Management of adults with diabetes undergoing surgery - summary March 2016 3c Management of adults with diabetes undergoing surgery – changes to 2011 guid Continue reading >>

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

Joint British Diabetes Societies Hyperosmolar Hyperglycaemic State Guidelines Group3

CURRENT TOPICS The management of the hyperosmolar hyperglycaemic state in adults with diabetes: a summary of a report from the Joint British Diabetes Societies for Inpatient Care AR SCOTT1 ON BEHALF OF THE JOINT BRITISH DIABETES SOCIETIES FOR INPATIENT CARE2 AND THE Abstract The Joint British Diabetes Societies for Inpatient Care have recently provided guidance on the management of hyper- osmolar hyperglycaemic state (HHS), a medical emergency which differs from diabetic ketoacidosis (DKA) through higher mortality and potential for complication by my- ocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis (the latter possibly precipi- tated by rapid changes in osmolality during treatment). DKA presents within hours of onset, whereas HHS devel- ops over many days, and its associated dehydration and metabolic disturbances are more extreme. A different therapeutic approach is required for HHS than for DKA. The key points in these guidelines are: Monitoring of the response to treatment: • Measure or calculate serum osmolality regularly to monitor the response to treatment • Aim to reduce osmolality by 3–8 mOsm/kg/h Fluid and insulin administration: • Use intravenous 0.9% sodium chloride solution as the principal fluid to restore circulating volume and reverse dehydration • Note that fluid replacement alone will cause a fall in blood glucose; withhold insulin until blood glucose is no longer falling with intravenous fluids alone (unless ketonaemic) • An initial rise in sodium is expected and is not itself an indication for hypotonic fluids • Early use of insulin (before fluids) may be detrimental Delivery of care: • Involve the diabetes specialist team as soon as possible. • Nurse patient Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Management Of Diabetic Ketoacidosis Following Implementation Of The Jbds Guidelines: Where Are We And Where Should We Go?

Abstract Background: The Joint British Diabetes Society (JBDS) consensus guideline published in 2010 has provided the framework for the effective management of diabetic ketoacidosis (DKA) in adults in the UK. Methodology: A retrospective study of 50 patient episodes admitted to our teaching hospital between February and December 2012, with a discharge diagnosis of DKA. Results: Twenty-seven (54%) patients were male, mean (SD) age was 43 (21) years and duration of diabetes was 11 (9) years. In the first 60 minutes from diagnosis, median (interquartile range [IQR]) time to fixed rate intravenous insulin infusion (FRIII) was 49 (29–110) minutes and to intravenous fluids was 19 (0–42) minutes. During ongoing management, 46% of patients developed hypokalaemia and, of those, in 70% potassium supplementation was not prescribed as per protocol. Forty percent of patients experienced hypoglycaemia in the first 24 hours, of whom 80% had 10% dextrose prescribed appropriately according to protocol. Median time to hypoglycaemia from diagnosis was 12 hours 54 minutes. Median (SD) time to resolution of DKA was 12 hours 6 minutes. Eighty six percent of patients were reviewed by the diabetes specialist team during admission. No deaths due to DKA or complications of its management were reported. Median length of hospital stay was two days. Conclusions: Adherence to the JBDS DKA guideline was good in the immediate stage of treatment. Inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern. A high proportion of patients received diabetes specialist nurse input with reduced length of stay and no recorded mortality. Our recommendations as a result of this audit include a strengthened programme of teaching and education for nursing and medical Continue reading >>

Diagnostic Criteria And Classification Of Dka

Diagnostic Criteria And Classification Of Dka

diagnostic criteria The diagnostic criteria for diabetic ketoacidosis are: 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 venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 (1) The American Diabetes Association diagnostic criteria for DKA are as follows: elevated serum glucose level (greater than 250 mg per dL [13.88 mmol per L]) an elevated serum ketone level a pH less than 7.3 and a serum bicarbonate level less than 18 mEq per L (18 mmol per L) (2) classification of diabetic ketoacidosis DKA can be classified according to the severity into mild, moderate and severe (2) criterion mild (serum glucose > 250 mg/dL [13.88 mmol/L]) moderate (serum glucose > 250 mg/dL) severe (serum glucose > 250 mg/dL) anion gap > 10 mEq/L (10 mmol/L) > 12 mEq/L (12 mmol/L) > 12 mEq/L (12 mmol/L) arterial pH 7.24 to 7.30 7.00 to < 7.24 < 7.00 effective serum osmolality variable variable variable mental status alert alert/drowsy stupor/coma serum bicarbonate 15 to 18 mEq/L (15 to 18 mmol/L) 10 to < 15 mEq/L (10 to < 15 mmol/L) < 10 mEq/L (10 mmol/L) serum ketone positive positive positive urine ketone positive positive positive Reference: Continue reading >>

Refining The Diagnostic Criteria For Diabetic Ketoacidosis

Refining The Diagnostic Criteria For Diabetic Ketoacidosis

Refining the Diagnostic Criteria for Diabetic Ketoacidosis Current consensus criteria for Current consensus criteria for a diagnosis of diabetic ketoacidosis (DKA) include the presence of ketonuria/ketonemia, a serum bicarbonate (HCO3) [le] 18 mEq/L, a pH [le] 7.30, and a glucose [gt] 250 mg/dL. These diagnostic criteria have limitations, however. Measurement of ketone bodies (KB) by the conventional nitroprusside method is not quantitative. Moreover, HCO3 and pH lack sensitivity and specificity due to coexisting acid-base disturbances (e.g., lactic acidosis, renal acidosis, and/or metabolic alkalosis due to HCl loss from vomiting) and variable respiratory compensation. On the other hand, plasma KB anion concentration is a specific indicator of DKA because it is a direct reflection of KB production, which is accompanied by equimolar production of hydrogen ion. In the present study, we sought to develop a diagnostic criterion for DKA using a laboratory-based [beta]-hydroxybutyrate ([beta]OHB) assay, and to evaluate the degree of diagnostic discordance between [beta]OHB and HCO3. Data were retrieved electronically by ICD-9 code and for simultaneous measurement of [beta]OHB and HCO3. A total of 485 separate encounters in 314 patients with diabetes were identified for the years 1994-2006. There was a strong negative correlation between [beta]OHB and HCO3 by regression analysis (r2 = 0.64, P [lt] 0.0001). The [beta]OHB value that corresponded to a HCO3 value of 18 mEq/L was 3.6 mmol/L. Therefore, a [beta]OHB value [ge] 3.6 mmol/L was used to define DKA, and encounters with values [lt] 3.6 mmol/L were considered to be non-DKA. In DKA cases on admission (n=262), [beta]OHB was 7.8 [plusmn] 0.2 mmol/L, HCO3 was 11.5 [plusmn] 0.4 mEq/L, and glucose was 478 [plusmn] 13 mg/dL. The Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus.[1] Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness.[1] A person's breath may develop a specific smell.[1] Onset of symptoms is usually rapid.[1] In some cases people may not realize they previously had diabetes.[1] DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances.[1] Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids.[1] DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies.[3] DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine.[1] The primary treatment of DKA is with intravenous fluids and insulin.[1] Depending on the severity, insulin may be given intravenously or by injection under the skin.[3] Usually potassium is also needed to prevent the development of low blood potassium.[1] Throughout treatment blood sugar and potassium levels should be regularly checked.[1] Antibiotics may be required in those with an underlying infection.[6] In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.[1][6] Rates of DKA vary around the world.[5] In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% a year.[1][5] DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost univ Continue reading >>

Uk And Us Differences In Dka Treatment Highlighted

Uk And Us Differences In Dka Treatment Highlighted

A review has flagged up “important differences” in the treatment of two diabetic emergencies in the UK and US. The differences in diagnosis and treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in both countries have been highlighted in an article published in Current Diabetes Reports. Co-author, Dr Ketan Dhatariya said: “Large-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation.” Dr Dhatariya, who is a diabetes consultant at Norfolk and Norwich University Hospitals NHS Foundation, concluded: “There is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol.” UK USA Mild Moderate Severe “D”—a glucose concentration >11.0 mmol/L (200 mg/dL) or a previous history of diabetes mellitus >13.9 mmol/L (>250 mg/dL) >13.9 mmol/L (>250 mg/dL) >13.9 mmol/L (>250 mg/dL) “K”—the presence of ketones >3.0 mmol/L or significant (>2+) on standard urine ketone sticks Urine or serum ketone positive Urine or serum ketone positive Urine or serum ketone positive “A”—confirmation of an acidosis pH <7.3 7.25 to 7.30 7.00 to <7.24 <7.00 Serum bicarbonate (mmol/L) <15 15 to 18 10 to <15 <10 Anion gap Not applicable >10 >12 >12 To access the paper called Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Continue reading >>

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