Precipitating Factors
Once DKA or HHS is diagnosed, identification of the cause or precipitating factor(s) is an important next step as these conditions rarely occur de novo. Obtaining a thorough history and physical examination is essential to guide a diagnostic testing and treatment plan. DKA is most commonly caused by omission of insulin therapy, but both conditions may occur with concomitant infection or rarely with other clinical events such as silent myocardial infarction or cerebrovascular accident. Pancreatitis, trauma, alcohol abuse, and illicit drug (cocaine) use are other possible causes. Less often, drugs that affect carbohydrate metabolism may lead to DKA or HHS. These include the use of glucocorticoids, thiazide diuretics, sympathomimetic agents, or second-generation antipsychotics. In elderly patients, restricted access to water intake or altered thirst response increases risk of dehydration and, therefore, HHS. Identification of the cause of DKA or HHS may be complicated by the manifestations of the disease process itself. For example, while infection is an important trigger to consider, typical signs and symptoms may be masked in the setting of DKA. Due to peripheral vasodilatation, patients can often be normothermic or mildly hypothermic despite having an ongoing infection. Conversely, leukocytosis is often seen in DKA in the absence of infection. Thus, when infection is suspected, additional diagnostic testing such as chest x-rays, urinalysis, blood cultures, or analysis of cerebrospinal fluid must be obtained accordingly. Another important consideration is neurologic pathology. While patients with HHS and a serum osmolality of >320 mOsm/kg (320 mmol/kg) are often obtunded or comatose, altered mental status is rarely seen in patients with a lower serum osmolality. In such Continue reading >>
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Epidemiology Of Infection As A Precipitating Factor For Diabetic Ketoacidosis At Tanta University Hospital Hamed Zs, Gawaly Am, Abbas Km, El Ahwal Lm - Tanta Med J
Infection is the main precipitating factor of DKA in patients of Tanta University Hospital. Keywords:diabetes mellitus, diabetic ketoacidosis, infection Hamed ZS, Gawaly AM, Abbas KM, El Ahwal LM. Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital. Tanta Med J 2017;45:68-72 Hamed ZS, Gawaly AM, Abbas KM, El Ahwal LM. Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital. Tanta Med J [serial online] 2017 [cited2018 Mar 28];45:68-72. Available from: Diabetic ketoacidosis (DKA) is a metabolic derangement with three main presentations, hyperglycemia, ketosis, and acidosis, which occurs in the presence of low effective insulin. It is one of the common emergencies in patients with diabetes mellitus (DM) [1] . DKA affects more than 8 per 1000 diabetics annually. It is associated with significant morbidity and mortality, with a worldwide mortality rate of 210% [1] . DKA frequently occurs in type 1 diabetes as this type of diabetes is presented with an absolute lack of insulin production by the Islets of Langerhans More Details . In type 2 diabetes, the production of insulin is insufficient to meet the bodys requirements due to insulin resistance leading to activation of lipid metabolism with production of acidic ketone bodies that cause most of the symptoms and complications [2] . Many cases of DKA are triggered by insulin cessation due to social, psychological, and economic reasons especially in developing countries. Infection, new onset of diabetes, and other comorbid states such as stroke, acute pancreatitis, and chronic renal failure are implicated in the development of DKA [3] . Appropriate management of the precipitating factors of DKA decreases the mortality rate Continue reading >>
Precipitating Factors Of Diabetic Ketoacidosis At A Public Hospital In A Middle-income Country
Volume 96, Issue 1 , April 2012, Pages 29-34 Precipitating factors of diabetic ketoacidosis at a public hospital in a middle-income country Author links open overlay panel Letcia S.Weinerta To study precipitating factors of diabetic ketoacidosis (DKA) at a public hospital in a middle-income country. Eighty patients with type 1 diabetes who had an emergency hospitalization for DKA between January 2005 and March 2010 at a tertiary care teaching hospital in Southern Brazil were studied. Data were collected by reviewing medical records and telephone calls. Treatment non-adherence was defined as the precipitating factor if there was diet abuse or insulin therapy noncompliance without identifiable infection. The mean age of patients was 2613 years. The majority (91.5%) of the patients had unsatisfactory metabolic control before the hospitalization. The most common DKA precipitating factor was treatment non-adherence: 39% of cases when all patients were evaluated and 49% when only patients with previous type 1 diabetes diagnosis were analyzed. Comparison between patients with DKA precipitated by treatment non-adherence and by other causes showed that the former group had more episodes of previous DKA and more frequently reported insulin omission previous to DKA. Treatment noncompliance is the leading precipitating factor of DKA in Southern Brazil. Further efforts to reduce the occurrence of DKA should focus on patients with prior reports and evidence of treatment non-adherence. Continue reading >>
974: The Impact Of Infection As A Precipitating Factor Of Diabetic Ketoacidosis
Introduction: Although one of the main treatment strategies of diabetic ketoacidosis (DKA) is aimed against precipitating factors, there are no studies regarding the association of precipitating factors and DKA prognosis. Therefore, we aimed to reveal the same in our study. Methods: We performed retrospective analysis of a cohort of DKA patients admitted to the intensive care unit (ICU) of the National Disaster Medical Center, Japan, between January 2005 and April 2012. Results: A total of 67 patients (mean age, 51.9 18.3 years; 41 males and 26 females) were included in the present study. Main precipitating factors were infection (n = 23, 34.3%), poor compliance (n = 22, 32.8%), and myocardial infarction (n = 2, 3.0%). Eight patients (11.9%) died. No significant differences were observed regarding age, lactic acidosis level, or APACHE II scores between patients with and without infections, although there were significant differences in mortality between these two groups (26.1% vs. 4.5%, P = 0.016). Conclusions: The precipitating factor of infection in DKA is associated with poor outcome; therefore, infection status should be evaluated at the earliest and appropriate sepsis management must be administered to DKA patients with infections. 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins Continue reading >>
Precipitating Factors For Diabetic Ketoacidosis | Naveed | Khyber Medical University Journal
PRECIPITATING FACTORS FOR DIABETIC KETOACIDOSIS Danish Naveed, Nighat Bilal, Bilal Nasir, Bazil Rehman Lodhi Objective; To determine the frequency of various precipitating factors for Diabetic Ketoacidosis (DKA). Material and Methods: This descriptive, cross-sectional study based on purposive sampling method was conducted at Medical ward VI, Islamabad Hospital, Pakistan Institute of Medical Sciences, Islamabad from 15th July 2005 to 14th January 2006. Forty Two patients of type 2 diabetes mellitus who at the time of admission had diabetic ketoacidosis were analyzed to sort out the precipitating factor by history, physical examination and investigations both laboratory and radiological. Results; Out of 42 patients 19 (45%) were male while 23 (55%) were female. 21(50%) had infection, 11(26.19 %) were non-compliant to the treatment, 09 (21.40%) had other co-morbidity (stroke, acute pancreatitis etc) as precipitating factor while one (2.3%) had his first presentation of diabetes mellitus as diabetic ketoacidosis. A mortality of 7.15% was recorded in the study. Conclusion: Infection, non-compliance to treatment and comorbid conditions are the major precipitating factors for diabetic ketoacidosis. Continue reading >>
Profile Of Precipitating Factors In Diabetic Ketoacidosis: Data From A Rural Teaching Hospital | Amol Hartalkar And Krithika Peshwe - Academia.edu
Profile of precipitating factors in Diabetic Ketoacidosis: Data from a rural teaching hospital Original Research Profile of precipitating factors in Diabetic Ketoacidosis: Data from a rural teaching hospital Amol Hartalkar1,*, Sheetal Hartalkar2, Krithika Peshwe3, Bhola Nath4 1 Associate Professor, 3Intern, Department of General Medicine, Rural Medical College 2Periodontologist, Department of Periodontics, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, 4Associate Professor, Department of Community Medicine, Govt. Medical College, Srinagar (Uttarakhand) *Corresponding Author: Email: [email protected]: Diabetic ketoacidosis (DKA) is a known presenting clinical feature of type 1 Diabetes mellitus (T1DM). It is acommon acute medical complication in already known patients of all types DM, especially after altering / stopping the therapyand any infective etiology.Objective: To describe the profile of precipitating factors of DKA.Methods: This retrospective descriptive study was done in Department of Medicine, of a rural teaching hospital. Precipitatingfactors were identified by clinical examination & laboratory investigation in hospitalized & diagnosed cases of DKA.Results: Among 50 patients, 22 were males. The mean age was 38.3 15.7 years. 10 patients (20%) were diagnosed as DM forthe first time during hospitalization and rest were already known diabetic.Severe DKA was not common. A Major precipitating factor was an infection (40%) and next was noncompliance (28%). Lesscommon factors included acute pancreatitis, myocardial infarction, surgery and stroke. No definite factor could be found in 14%patients.Conclusion: Commonest precipitants of DKA were infection &non-compliance. Hence, it may be stated that wi Continue reading >>
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Prime Pubmed | Sglt2 Inhibitors: A Systematic Review Of Diabetic Ketoacidosis And Related Risk Factors In The Primary Literatur
Type your tag names separated by a space and hit enter SGLT2 Inhibitors: A Systematic Review of Diabetic Ketoacidosis and Related Risk Factors in the Primary Literature. Currently only minimal information is available regarding risk factors for the development of sodium glucose cotransporter-2 inhibitor (SGLT2i)-related diabetic ketoacidosis (DKA). We aim to identify individual patient characteristics associated with cases of SGLT2i-related DKA to better describe potential risk factors. Thirty-four case reports of patients with type 1 and type 2 diabetes mellitus who developed DKA while receiving an SGLT2i. This systematic review investigated the relationship between SGLT2i and DKA in patients with diabetes. The existing literature was reviewed with a primary outcome to identify patient-specific factors contributing to the incidence of ketoacidosis in patients with diabetes who were treated with a SGLT2i. Numerous databases were searched to identify appropriate primary literature. Search terms included canagliflozin, dapagliflozin, empagliflozin, SGLT2, sodium glucose cotransporter-2 inhibitor, diabetic ketoacidosis, ketoacidosis, metabolic acidosis, and acidosis. Primary literature was analyzed via descriptive statistics. Thirty-four individual case reports were identified via the primary literature search. Two-thirds (25 cases) involved patients with a diagnosis of type 2 diabetes mellitus (T2DM). The average blood glucose on presentation for SGLT2i-induced DKA was 265.6140.7mg/dl (14.77.8mmol/L), with common symptoms including nausea, vomiting, and abdominal pain. Common precipitating factors included patients who were diagnosed with T2DM and were subsequently found to have latent autoimmune diabetes of adulthood, patients who had recently undergone major surgery, o Continue reading >>
Sa Fam Pract 2007:49(10) 15
Abstract Background Despite improvements in therapy and disease monitoring, diabetic ketoacidosis (DKA) remains a potentially fatal conse- quence of diabetes. This retrospective study was undertaken to establish and identify those risk factors that are responsible for the onset of DKA. Methods The medical records of 77 patients from Addington Hospital, who satisfied the criteria for inclusion in the study of DKA, were reviewed (60 type 1 diabetes mellitus (DM) patients and 17 type 2 DM patients). Results More juveniles were admitted for multiple DKA episodes (65%) than non-juveniles (35%). DKA was present in 23% of newly diagnosed type 1 DM patients on first presentation. Infection was present in 40% of type 1 DM patients with single DKA episodes, and in 45% of type 1 DM patients with multiple DKA episodes. A total of 23.2% of all admissions for single DKA involved non-compliance with medication usage and was implicated in 32% of multiple DKA episodes. Family and/or school problems presented in 7% of single DKA episodes and in 4% in multiple DKA episodes. In the present study, the overall mortality rate was 2.5% (n=2). Conclusions This study showed that the most important risk factors implicated in DKA are infection, non-compliance and newly diagnosed diabetes, followed by family and/or school problems, low socio-economic status and omission of insulin. SA Fam Pract 2007;49(10):15 The full version of this article is available at: www.safpj.co.za P This article has been peer reviewed Original Research An identification of the risk factors implicated in diabetic ketoacidosis (DKA) in type 1 and type 2 diabetes mellitus Mudly S, MMed Sc Department of Pharmacology, University of KwaZulu-Natal Rambiritch V, PhD Department of Pharmacology, University of KwaZulu-Natal Mayet L, Continue reading >>
Comparison Of Incidences, Hospital Stay And Precipitating Factors Ofdiabetic Ketoacidosis In Ramadan And The Following Month In Threemajor Hospitals In United Arab Emirates. A Prospective Observationalstudy
Received date January 25, 2015; Accepted date February 21, 2015; Published date February 28, 2015 Citation: Abdelgadir EIE, Hafidh K, Basheir AMK, Afandi BO, Alawadi F, et al. (2015) Comparison of Incidences, Hospital Stay and Precipitating Factors of Diabetic Ketoacidosis in Ramadan and the Following Month in Three Major Hospitals in United Arab Emirates. A Prospective Observational Study. J Diabetes Metab 6:514. doi:10.4172/2155-6156.1000514 Copyright: 2015 Abdelgadir EIE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1.7 billion Muslims worldwide obey religious commands of fasting for a month. This may increase morbidity in people with diabetes. Objective: Comparing the rate and duration of admissions with diabetic ketoacidosis and the leading precipitating factors during Ramadan and in the following month (Shawal) were our primary and secondary endpoints, respectively. Design and methods: This was a prospective study that included all Muslims who were admitted with DKA to three major hospitals in United Arab Emirates during Ramadan and Shawal. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points. Results: 48 patients were admitted during the study duration, 20 were admitted during Ramadan and 28 in Shawal. All those admitted during Ramadan were people with type1 diabetes while 4 of those admitted during Shawal were people with type 2 diabetes. 75% of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Urinary tract infections represented the commonest Continue reading >>
Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus.
Avicenna J Med. 2015 Jan-Mar;5(1):11-5. doi: 10.4103/2231-0770.148503. Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus. Department of Internal Medicine, Damascus University, Damascus, Syria ; Faculty of Medicine, Damascus University, Damascus, Syria. Faculty of Medicine, Damascus University, Damascus, Syria. To study precipitating factors, outcomes, and recurrence of diabetic ketoacidosis (DKA) at a University hospital at Damascus, the capital of Syria. Medical records between 2006 and 2012 were reviewed. One hundred and fifteen admissions for 100 patients with DKA were included. All fulfilled the American Diabetic Association DKA diagnostic criteria. Of 115 admissions of DKA, there were 92 single admission and 23 recurrent admissions (eight patients). The order of precipitating factors of recurrent DKA or single admissions were the same with different percentage. The first and second factors were infection (74% and 48%) and treatment problems (17% and 24%), respectively. Complications rate was significantly higher in the intensive care unit (41.6%), compared to the ward admissions (14.2%). Overall in-hospital mortality rate was 11.3%. The severity of medical conditions that provoke DKA with aging, not the metabolic complications of hyperglycemia or ketoacidosis, were behind this high mortality rate. Patients who died were significantly (P = 0.004) older than patients who were discharged alive. Results concerning precipitating factor were similar to the results of many other studies. However, mortality rate was higher which might be explained by the severity of underlying precipitating illness. DKA; DKA outcomes; DKA precipitating factor; DKA recurrence; Diabetic ketoacidosis Continue reading >>
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Diabetic Ketoacidosis: Clinical Presentation And Precipitating Factors At Kenyatta National Hospital, Nairobi
Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi PK Mbugua, CF Otieno JKKAAASOML. "Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi ." East African Medical Journal. 2005;82(12). Objective: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). Design: Prospective cross-sectional study. Setting: Inpatient medical and surgical wards of KNH. Subjects: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. Results: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c >8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. Conclusion: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic Continue reading >>
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Diabetic Ketoacidosis: Clinical Features And Precipitating Factors At Dempu
Diabetic Ketoacidosis: Clinical Features and Precipitating Factors at DEMPU Amany Ibrahim, Mona Mamdouh Hassan, Noha Arafa & Asmaa Salah Eldin Author affiliations View ePoster Download ePoster Pediatric Department, DEMPU, Faculty of Medicine, Cairo University, Cairo, Egypt Background: Diabetic ketoacidosis (DKA) is an acute complication of type 1 diabetes mellitus (T1DM) that can be fatal if not properly managed. DKA is a leading cause of mortality in these children, early recognition and prompt treatment should substantially reduce childhood mortality in children with T1DM. Objective and hypotheses: We aimed to identify the risk factors and the most common clinical features of newly diagnosed diabetes in children, in addition to the factors related to delayed diagnosis or mismanagement in these children. Method: Over a 3 month period, 99 patients newly diagnosed with T1DM; 53 (24 females and 29 males) of which had DKA and 46 (23 females and 23 males) were hyperglycemic with mean ( ) age of 6.89 (3.63) and 6.75 (3.53) were recruited from the inpatient department of the Diabetic, Endocrine and Metabolic Pediatric Unit (DEMPU), New Children Hospital, Cairo University. Results: Polyuria, polydipsia and weight loss were the most common symptoms preceding the diagnosis (93.8%, 92% and 80.8% respectively). Delayed diagnosis occurred in 98.1% and 58.7% of DKA and hyperglycemic groups respectively. 69.8% of the DKA group were misdiagnosed as respiratory problems, gastroenteritis and urinary tract infections. Mismanagement was detected in 28.3% of DKA group. Multivariate analysis to predict the most significant risk factor(s) associated with the development of DKA at the time of diagnosis of T1DM showed delayed start of insulin therapy was the most significant risk factor assoc Continue reading >>
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Diabetic Ketoacidosis
Initial Evaluation Initial evaluation of patients with DKA includes diagnosis and treatment of precipitating factors (Table 14–18). The most common precipitating factor is infection, followed by noncompliance with insulin therapy.3 While insulin pump therapy has been implicated as a risk factor for DKA in the past, most recent studies show that with proper education and practice using the pump, the frequency of DKA is the same for patients on pump and injection therapy.19 Common causes by frequency Other causes Selected drugs that may contribute to diabetic ketoacidosis Infection, particularly pneumonia, urinary tract infection, and sepsis4 Inadequate insulin treatment or noncompliance4 New-onset diabetes4 Cardiovascular disease, particularly myocardial infarction5 Acanthosis nigricans6 Acromegaly7 Arterial thrombosis, including mesenteric and iliac5 Cerebrovascular accident5 Hemochromatosis8 Hyperthyroidism9 Pancreatitis10 Pregnancy11 Atypical antipsychotic agents12 Corticosteroids13 FK50614 Glucagon15 Interferon16 Sympathomimetic agents including albuterol (Ventolin), dopamine (Intropin), dobutamine (Dobutrex), terbutaline (Bricanyl),17 and ritodrine (Yutopar)18 DIFFERENTIAL DIAGNOSIS Three key features of diabetic acidosis are hyperglycemia, ketosis, and acidosis. The conditions that cause these metabolic abnormalities overlap. The primary differential diagnosis for hyperglycemia is hyperosmolar hyperglycemic state (Table 23,20), which is discussed in the Stoner article21 on page 1723 of this issue. Common problems that produce ketosis include alcoholism and starvation. Metabolic states in which acidosis is predominant include lactic acidosis and ingestion of drugs such as salicylates and methanol. Abdominal pain may be a symptom of ketoacidosis or part of the inci Continue reading >>
Precipitating Factors For Diabetic Ketoacidosis
DKA is the a leading cause of morbidity and mortality in children with diabetes mellitus, it characterized by abiochemical triad of hyperglycaemia, ketonaemia (ketonuria) and academia. In this study, we aimed to determinethe frequency of DKA in newly discovered diabetes, and in established cases, and to describe the clinicalcharacteristics of DKA among these patients. 95 children & adolescents admitted to PICU, Al-Thawra Hospital inAlbaida-Libya with DKA between [January 2016 and December 2017] were reviewed. 42 patients (44%) werenewly discovered diabetes, and 53 patients (56%) were well established diabetes. Male to female ratio was (1 :2.8). The common leading precipitating factors for DKA in our study were psycho-social causes and infectionwhich observed in 49%, and 31% respectively. While the common presenting symptoms of DKA noticed in thestudy were: abdominal pain and vomiting in (98%) and (87%) respectively. DKA is an important cause of PICUadmissions to Al-Thawra Hospital in Albaida-Libya, more effort should be put to prevent and reduce the incidenceof DKA at initial presentation and later. Background: Diabetic ketoacidosis (DKA) is a major complication of type 1 and type 2 diabetes mellitus and is associated with increased risk of morbidity and mortality. Infections, non-compliance and co-morbid states are most important precipitating causes. Proper identification of the precipitating factor is very important in management of DKA. Clinical feature and management of DKA are well known and have been described in many text books and reviews in literature. However, there are a very few published large studies from Bangladesh. For this reason, this study had evaluated fifty children with Diabetic ketoacidosis and to identify their clinical features, precipitating Continue reading >>
Precipitating Factors, Outcomes, And Recurrence Of Diabetic Ketoacidosis At A University Hospital In Damascus
Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus 1Department of Internal Medicine, Damascus University, Damascus, Syria 2Faculty of Medicine, Damascus University, Damascus, Syria 1Department of Internal Medicine, Damascus University, Damascus, Syria 2Faculty of Medicine, Damascus University, Damascus, Syria Address for correspondence: Dr. Zaynab Alourfi, Department of Internal Medicine, Damascus University, Damascus, Syria. E-mail: moc.liamtoh@ifrabanyaz Author information Copyright and License information Disclaimer Copyright : Avicenna Journal of Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. To study precipitating factors, outcomes, and recurrence of diabetic ketoacidosis (DKA) at a University hospital at Damascus, the capital of Syria. Medical records between 2006 and 2012 were reviewed. One hundred and fifteen admissions for 100 patients with DKA were included. All fulfilled the American Diabetic Association DKA diagnostic criteria. Of 115 admissions of DKA, there were 92 single admission and 23 recurrent admissions (eight patients). The order of precipitating factors of recurrent DKA or single admissions were the same with different percentage. The first and second factors were infection (74% and 48%) and treatment problems (17% and 24%), respectively. Complications rate was significantly higher in the intensive care unit (41.6%), compared to the ward admissions (14.2%). Overall in-hospital mortality rate was 11.3%. The severity of m Continue reading >>
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