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Dka Kidney Failure

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Abstract 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 admission were searched for. Results 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 [1.020–1.100], p<0.01), blood glucose (odds ratio 1.101 [1.039–1.166], p<0.01) and serum protein (odds ratio 0.928 [0.865–0.997], 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 admission. Figures Citation: Orban J-C, Maizière E-M, Ghaddab A, V Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is a dangerous complication of diabetes caused by a lack of insulin in the body. Diabetic ketoacidosis occurs when the body is unable to use blood sugar (glucose) because there isn't enough insulin. Instead, it breaks down fat as an alternative source of fuel. This causes a build-up of a by-product called ketones. Most cases of diabetic ketoacidosis occur in people with type 1 diabetes, although it can also be a complication of type 2 diabetes. Symptoms of diabetic ketoacidosis include: passing large amounts of urine feeling very thirsty vomiting abdominal pain Seek immediate medical assistance if you have any of these symptoms and your blood sugar levels are high. Read more about the symptoms of diabetic ketoacidosis. Who is affected by diabetic ketoacidosis? Diabetic ketoacidosis is a relatively common complication in people with diabetes, particularly children and younger adults who have type 1 diabetes. Younger children under four years of age are thought to be most at risk. In about 1 in 4 cases, diabetic ketoacidosis develops in people who were previously unaware they had type 1 diabetes. Diabetic ketoacidosis accounts for around half of all diabetes-related hospital admissions in people with type 1 diabetes. Diabetic ketoacidosis triggers These include: infections and other illnesses not keeping up with recommended insulin injections Read more about potential causes of diabetic ketoacidosis. Diagnosing diabetic ketoacidosis This is a relatively straightforward process. Blood tests can be used to check your glucose levels and any chemical imbalances, such as low levels of potassium. Urine tests can be used to estimate the number of ketones in your body. Blood and urine tests can also be used to check for an underlying infec 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 >>

Case Report €¢ Observations De Cas

Case Report €¢ Observations De Cas

Diabetic ketoacidosis in the dialysis-dependent patient: two case reports and recommendations for treatment Jamie Blicker, MD; Anthony M. Herd, MD; Joanne Talbot, MD Introduction Diabetic ketoacidosis (DKA) is a complex medical disor- der characterized by abnormalities in electrolyte, acid-base and volume status. DKA management is particularly chal- lenging in patients with chronic renal failure on hemodial- ysis. Although the management of DKA is well-estab- lished,1,2 there is a paucity of literature describing DKA management in patients with concomitant renal failure re- quiring hemodialysis. A Medline search using a variety of search terms including “DKA AND renal failure,†“DKA AND chronic renal failure,†“DKA AND dialysis†and “DKA AND hemodialysis†returned only 2 relevant cita- tions.3,4 This article describes 2 dialysis-dependent patients who presented to the emergency department (ED) with DKA, 1 patient with volume overload and 1 with dehydration. Pre- sentation of these 2 case reports is followed by a discus- sion of key therapeutic issues. Case 1 A 32-year-old woman with insulin dependent diabetes mellitus and chronic renal failure on thrice-weekly he- modialysis presented to our ED with nausea, vomiting and abdominal pain. She had taken no insulin for 24 hours be- cause of anorexia. On presentation she had marked ketotic halitosis with Kussmaul’s respirations. Her vital signs in- cluded a temperature of 36.0°C, heart rate of 94 beats/min, respiratory rate of 20 breaths/min, blood pressure of 178/108 mm Hg, and oxygen saturation of 93%. Clinical examination was unremarkable apart from bilateral lung crackles, an S4 gallop and distended jugular veins. Her hematocrit was 0.255 g/L, and total white blood cell co Continue reading >>

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis.

Severe Acute Renal Failure In A Patient With Diabetic Ketoacidosis.

Abstract 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 im-prove 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. Continue reading >>

Medications And Kidney Complications, Symptoms Of Diabetic Ketoacidosis

Medications And Kidney Complications, Symptoms Of Diabetic Ketoacidosis

Your kidneys are two organs located on either side of your backbone just above your waist. They remove waste and excess fluid from the blood, maintain the balance of salt and minerals in the blood, and help regulate blood pressure, among other functions. 1 If damaged, they can cause you to have health issues. Acute Renal Injury A sudden loss of kidney function can be caused by: lack of blood flow to the kidneys, direct damage to the kidneys, or blockage of urine from the kidneys. Common causes of these losses of function may include: traumatic injury, dehydration, severe systemic infection (sepsis), damage from drugs/toxins or pregnancy complications. 2 Chronic Kidney Disease When kidney damage and decreased function lasts longer than three months, it is called chronic kidney disease (CKD). CKD can be dangerous, as you may not have any symptoms until after the kidney damage, which may or may not be able to be repaired, has occurred. High blood pressure and diabetes (types 1 and 2) are the most common causes of CKD. 3 Causes of Chronic Kidney Disease There are also other causes of CKD. These can include: Immune system conditions (e.g., lupus) Long-term viral illnesses (HIV/AIDS, hepatitis B, hepatitis C) Pyelonephritis (urinary tract infections within the kidneys) Inflammation in the kidney’s filters (glomeruli) Polycystic kidney disease (fluid-filled cysts form in the kidneys) Congenital defects (malformations present at birth) Toxins, chemicals Type 2 Diabetes Symptoms People with uncontrolled type 2 diabetes have high levels of sugar (glucose) building up and circulating in the blood. This high blood sugar can cause heart disease, stroke, kidney disease, blindness and nerve damage, among other complications. 5 You may have no type 2 diabetes symptoms, or symptoms ma Continue reading >>

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. INTRODUCTION — Chronic kidney disease (CKD) is associated with insulin resistance and, in advanced CKD, decreased insulin degradation. The latter can lead to a marked decrease in insulin requirement or even the cessation of insulin therapy in patients with type 2 diabetes. Both of these abnormalities are at least partially reversed with the institution of dialysis. (See "Carbohydrate and insulin metabolism in chronic kidney disease".) Because of the uncertainty in predicting insulin requirements, careful individualized therapy is essential among patients who have advanced CKD or are initiating dialysis. The insulin requirement in any given patient depends upon the net balance between improving tissue sensitivity and restoring normal hepatic insulin metabolism. In addition, among patients on peritoneal dialysis, glucose contained in peritoneal dialysate tends to increase the need for diabetes therapy. Changes in dietary intake and exercise (ie, reduced intake due to anorexia prior to starting dialysis) can also affect the response to administered insulin. Furthermore, the uremic environment can affect methods used to assess glycemic control, and the metabolism of most oral diabetes agents is prolonged, making them more difficult to use. This topic reviews glycemic targets, methods of monitoring glycemic control, and suggested treatment regimens for patients on hemodialysis and peritoneal dialysis. The treatment of diabetes Continue reading >>

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Diabetic Ketoacidosis In Chronic Kidney Disease Masquerading As Acute Pancreatitis

Robin George Manappallil Department of Medicine, Mar Baselios Medical Mission Hospital, Kothamangalam, Ernakulam, Kerala, India. Abstract Diabetic ketoacidosis (DKA) is a life threatening acute complication of type 1 diabetes. Since diabetic patients may have hypertriglyceridemia, they are at risk of developing acute pancreatitis (AP). Hyperamylasemia may suggest a diagnosis of AP, but levels may be elevated in DKA. Hence, serum lipase levels correlate better with the diagnosis of AP. However, pancreatic enzymes are excreted by the kidneys and their levels are elevated in patients with chronic kidney disease (CKD). This report describes a patient with type 1 diabetes and CKD stage 4, not on hemodialysis, who presented with DKA and had very high levels of pancreatic enzymes in the absence of pancreatitis. Keywords : Diabetes Ketoacidosis, Kidney, Renal Insufficiency, Pancreatitis, Hypertriglyceridemia. Introduction Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas. In 10-15% cases, the condition is life threatening. Epigastric pain is the predominant symptom, which may radiate to the back, chest, flanks or lower abdomen. Serum amylase and lipase levels are elevated in AP. Abdominal contrast enhanced computed tomography (CT), abdominal ultrasound, magnetic resonance imaging (MRI) are radiological methods which aid in diagnosis of AP [1]. However, elevated pancreatic enzyme levels have been noted in CKD patients [2,3]. Features like epigastric pain and elevated pancreatic enzymes are also seen in DKA [4]. Moreover, AP can present or coexist with DKA [5,6]. This case report aims to highlight the importance of elevated pancreatic enzymes in DKA and CKD, and the diagnostic dilemma posed by such elevations in patients with these two illnesses. Case Repo Continue reading >>

Editorial Review Diabetic Ketoacidosis: Role Of The Kidney In The Acid-base Homeostasis Re-evaluated

Editorial Review Diabetic Ketoacidosis: Role Of The Kidney In The Acid-base Homeostasis Re-evaluated

The development of diabetic ketoacidosis (DKA) involves a series of closely interrelated derangements of intermediary metabolism and of body fluid volume and composition whose fundamental nature has not been completely unraveled [1–8]. The composite clinical picture in full-blown DKA on admission includes hyperglycemia with hyperosmolality, metabolic acidosis due to the accumulation of ketoacids, extracellular and intracellular fluid (ECF and ICF, respectively) volume depletion, and varying degrees of electrolyte deficiency, particularly of potassium and phosphate [9–11]. Since proper correction of the alterations in volume status, acid-base, and electrolyte composition is critical for survival, a clear understanding of the pathogenesis of these derangements is essential for the adequate management of DKA. The present review will focus on the role of the kidney in the pathogenesis of the different patterns of electrolyte and acid-base composition observed on admission for and during recovery from DKA. Special emphasis will be placed on the role of the kidney in the defense of acid-base homeostasis during the recovery phase. Other aspects of the alterations that develop in DKA have been reviewed in detail elsewhere [12–14]. Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were 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 >>

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

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 In Patients With Chf And/or Renal Failure

Diabetic Ketoacidosis In Patients With Chf And/or Renal Failure

Diabetic Ketoacidosis in Patients With CHF and/or Renal Failure How do you manage diabetic ketoacidosis (DKA) in patients with congestive heart failure (CHF) and/or renal failure? Response from Zachary T. Bloomgarden, MD Mortality from DKA persists at 3% to 4% and is primarily due to either presentation late in the course of the syndrome, concurrent cardiac illness, or infection.[ 1 ] Crucial aspects of DKA management involve adequate replacement of fluids and electrolytes, particularly potassium, and the continuous administration of insulin. As DKA typically leads to profound dehydration, it tends not to be associated with overt CHF. If individuals with impaired cardiac function develop DKA, hemodynamic assessments must be made in an intensive care setting in order to administer adequate quantities of fluid while avoiding overhydration. Of interest, it has been reported that DKA is sometimes associated with respiratory distress syndrome, so that under these circumstances clinical assessment alone can be misleading and the finding of rales with respiratory symptoms may be due to capillary-alveolar leak rather than to CHF per se.[ 2 ] It should be noted that the administration of sodium bicarbonate for acidosis is especially detrimental in these patients in view of the accompanying sodium burden. As such, treatment with sodium bicarbonate appears to paradoxically increase acetoacetate and beta-hydroxybutyrate[ 3 ] and in general it should be avoided in DKA management. Renal failure occurs with increased frequency in patients with diabetes. Fortunately, the coincidence of type 1 diabetes with DKA and acute renal failure is uncommon.[ 4 ] The management of DKA in this setting clearly requires intensive monitoring, as volume overload and hyperkalemia may complicate the con Continue reading >>

Title: Challenges In Management Of Diabetic Ketoacidosis In Haemodialysis Patients, Case Presentation And Review Of Literature, Towards Management Guidelines

Title: Challenges In Management Of Diabetic Ketoacidosis In Haemodialysis Patients, Case Presentation And Review Of Literature, Towards Management Guidelines

Ayman Aly Seddik was born in 1972,Graduated from in Shams University school of medicine 1996 very good with honour ,interenship and residency programm in Internal medicine and Nephrology 1997-2001 Assistant lecturere and Nephrology specialist in ain Shams University hospital , Nasser institute for research 2001-2006 , after obtaining md degree in Internal Medicine & Nephrology 2006 ain Shams University , work as consultant Nephrologist and lecturer Nephrologist in Ain Shams University hospitals ,senior specialist Nephrologist king fahd armed force hospital jeddah saudia arabia 2006-2008,consultant Nephrologist Northeren area armed force hospital 2009-2011 , programme director of Internal medicine residency programme in northeren area armed force hospital ,degree of assistant profeessor of Internal Medicine and Nephrology Ain Shams University, cairo, egypt 2012.Currently working as Nephrologist , Dubai hospital - Dubai health authority 2011-present . Chronic kidney disease is associated with accumulation of uremic toxins that increases insulin resistance which will lead to blunted ability to suppress hepatic gluconeogenesis and reduce peripheral utilization of insulin. (1) CKD patients fail to increase insulin secretion in response to insulin resistance because of acidosis, 1,25 vitamin D deficiency, and secondary hyperparathyroidism. (2-4) Hemodialysis causes further fluctuations in glycemic control due to alterations in insulin secretion, clearance and resistance. DKA is uncommon in hemodialysis patients because of the abscense of glycosuria and osmotic diuresis which accounts for most of the fluid and electrolyte losses seen in DKA, anuric patients may be somewhat protected from dehydration and shock, although still subject to hyperkalemia and metabolic acidosis. (5) Continue reading >>

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