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What Precipitating Factors May Lead To Dka?

Sa Fam Pract 2007:49(10) 15

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 >>

Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Precipitating Factors For Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis And Hypersmolar Non-ketotic Coma

Diabetic Ketoacidosis And Hypersmolar Non-ketotic Coma

Diabetic Ketoacidosis and Hypersmolar Non-ketotic coma Diabetic Ketoacidosis and Hypersmolar Non-ketotic coma Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious acute metabolic complications of diabetes. Recent data indicate there are more than 144,000 hospital admissions per year for DKA in the United States and the number of cases show an upward trend, with a 30% increase in the annual number of cases between 1995 and 2009. Treatment of DKA utilizes a large number of resources with an annual medical expense of $2.4 billion. The rate of hospital admissions for HHS is lower than for DKA, accounting for less than 1% of all diabetes-related admissions. Although DKA and HHS are often discussed as separate entities, they represent points along a spectrum of hyperglycemic emergencies due to poorly controlled diabetes. Both DKA and HHS are characterized by insulinopenia and severe hyperglycemia. Clinically, they differ only by the degree of dehydration and the severity of metabolic acidosis. DKA has long been considered a key clinical feature of type 1 diabetes (T1D), but in contrast to popular belief, DKA is more common in patients with type 2 diabetes (T2D). T2D now accounts for up to one half of all newly diagnosed diabetes in children ages 10-21 years. In the U.S., the SEARCH for Diabetes in Youth Study found that 29.4% of participants under 20 years of age with T1D presented with DKA, compared with 9.7% of youth with T2D. In community-based studies more than 40% of patients with DKA are older than 40 and more than 20% are older than 55. Patients with T2D may develop DKA under stressful conditions such as trauma, surgery or infections. In addition, in recent years an increasing number of unprovoked ketoacidosis cases without preci 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 >>

Prime Pubmed | Sglt2 Inhibitors: A Systematic Review Of Diabetic Ketoacidosis And Related Risk Factors In The Primary Literatur

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 >>

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

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: [email protected] 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 >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Acute hyperglycemia, or high blood glucose, may be either the initial presentation of diabetes mellitus or a complication during the course of a known disease. Inadequate insulin replacement (e.g., noncompliance with treatment) or increased insulin demand (e.g., during times of acute illness, surgery, or stress) may lead to acute hyperglycemia. There are two distinct forms: diabetic ketoacidosis (DKA), typically seen in type 1 diabetes, and hyperosmolar hyperglycemic state (HHS), occurring primarily in type 2 diabetes. In type 1 diabetes, no insulin is available to suppress fat breakdown, and the ketones resulting from subsequent ketogenesis manifest as DKA. This is in contrast to type 2 diabetes, in which patients can still secrete small amounts of insulin to suppress DKA, instead resulting in a hyperglycemic state predominated simply by glucose. The clinical presentation of both DKA and HHS is one of polyuria, polydipsia, nausea and vomiting, volume depletion (e.g., dry oral mucosa, decreased skin turgor), and eventually mental status changes and coma. In patients with altered mental status, fingerstick glucose should always be checked in order to exclude serum glucose abnormalities. Several clinical findings pertaining only to DKA include a fruity odor to the breath, hyperventilation, and abdominal pain. HHS patients, in contrast to those with DKA, will present with more extreme volume depletion. The treatment of both DKA and HHS is primarily IV electrolyte and fluid replacement. Insulin for hyperglycemia may be given with caution and under vigilant monitoring of serum glucose. Other treatment options depend on the severity of symptoms and include bicarbonate and potassium replacement. Osmotic diuresis and hypovolemia Hypovolemia resulting from DKA can lead to acute Continue reading >>

Precipitating Factors

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 >>

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises in Adult Patients With Diabetes Abbas E. Kitabchi, PHD, MD; Guillermo E. Umpierrez, MD; John M. Miles, MD; Joseph N. Fisher, MD The most common precipitating factor in the development of DKA and HHS is infection[ 1 , 4 , 10 ]. Other precipitating factors include discontinuation of or inadequate insulin therapy, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs[ 10 , 13 , 14 ]. In addition, new-onset type 1 diabetes or discontinuation of insulin in established type 1 diabetes commonly leads to the development of DKA. In young patients with type 1 diabetes, psychological problems complicated by eating disorders may be a contributing factor in 20% of recurrent ketoacidosis. Factors that may lead to insulin omission in younger patients include fear of weight gain with improved metabolic control, fear of hypoglycemia, rebellion against authority, and stress of chronic disease. Before 1993, the use of continuous subcutaneous insulin infusion devices had also been associated with an increased frequency of DKA[ 23 ]; however, with improvement in technology and better education of patients, the incidence of DKA appears to have reduced in pump users. However, additional prospective studies are needed to document reduction of DKA incidence with the use of continuous subcutaneous insulin infusion devices[ 24 ]. Underlying medical illness that provokes the release of counterregulatory hormones or compromises the access to water is likely to result in severe dehydration and HHS. In most patients with HHS, restricted water intake is due to the patient being bedridden and is exacerbated by the altered thirst response of the elderly. Because 20% of these patients have no history of diabetes, delayed recognition of hyperglycemic symptoms may h Continue reading >>

Diabetes Mellitus - Hyperglycaemic States

Diabetes Mellitus - Hyperglycaemic States

Diabetes mellitus - Hyperglycaemic states Globally the incidence of diabetes is likely to exceed 250 million people by 2025 that is a measure of the scale of the problem this condition is likely to present in the future. It is evidence of how diabetes will be one of the foremost public health challenges facing the world in the decades ahead. Recently, the series has been focusing on some of the acute complications that can occur with diabetes and this month Rita Forde discusses problems that arise from hyperglycaemic states. The last module focused on hypoglycaemia and this article will address hyperglycaemic states. Hyperglycaemic states present in the form of diabetic ketoacidosis (DKA) or hyper osmolar non ketotic acidosis (HONK). DKA is associated with a mortality rate of less than 5% in experienced centres while HONK has a much high mortality rate of approximately 15%. The prognosis of both is worsened by age and in the presence of coma and hypotension.2 DKA is associated with people with type 1 diabetes. It is defined as the triad of hyperglycaemia, acidosis and ketosis. The primary cause of this is insulin deficiency. This metabolic disturbance is associated with type 2 diabetes. It is characterised by an increase in serum osmolality, extreme hyperglycaemia and dehydration and the absence of ketones. It is caused by inadequate insulin levels. The pathophysiology of severe hyperglycaemia should be considered in relation to the glucose metabolism, acid-base balance, electrolyte changes and ketone body metabolism (DKA). The underlying mechanism for both of these conditions is relatively similar; a reduction in the circulating insulin and an elevation of the counter regulatory hormones. The counter regulatory hormones are glucagon, adrenaline, nor adrenaline, cortis Continue reading >>

Causes And Risk Factors Of Diabetic Ketoacidosis

Causes And Risk Factors Of Diabetic Ketoacidosis

Causes and Risk Factors of Diabetic Ketoacidosis Causes and Risk Factors of Diabetic Ketoacidosis We know by now that we need to eat the right foods, need to work out, and do stuff that is healthy for us. Because maintaining good health does not happen by accident, it requires work and smart lifestyle choices. But sometimes when we wake up at 6 am to hit the gym before work or shunning the donuts in breakfast, its easy to lose sight of for what are we doing all these. So here are some top articles choices that can keep you motivated to lead a healthy lifestyle and keep diseases at bay. Causes and Risk Factors of Diabetic Ketoacidosis Diabetic ketoacidosis is serious complication of diabetes . This problem occurs when there is low insulin level in blood, that lead to inability of body to use sugar/glucose as energy source. This in turn leads to utilization of fats as energy and breakdown of fats for energy. Breakdown of fats lead to accumulation acid (by product of fat metabolism) known as ketones (these are acidic substances), which makes blood acidic and lead to systemic acidosis and in case of diabetes it is called diabetic ketoacidosis. Excess ketones in blood spill over to urine and it can be detected in urine using simple test kit to detect ketones in urine. Hence, the main cause of diabetic ketoacidosis is low level of insulin in blood as is the case in type-1 diabetes where the patient is unable to produce any insulin because of lack of insulin producing beta cells in pancreas. However, diabetic ketoacidosis can also occur among patients with type-2 diabetes, who are receiving insulin for blood glucose control (because these patients are unable to produce adequate insulin even by using oral hypoglycemic drugs), if they miss one or more doses of insulin or if the Continue reading >>

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than 100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for <1% of all primary diabetic admissions.1 Most patients with DKA have type 1 diabetes; however, patients with type 2 diabetes are also at risk during the catabolic stress of acute illness.2 Contrary to popular belief, DKA is more common in adults than in children.1 In community-based studies, more than 40% of African-American patients with DKA were >40 years of age and more than 2 Continue reading >>

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Infection As A Trigger Of Diabetic Ketoacidosis In Intensive Care—unit Patients

Together with hyperglycemic coma, diabetic ketoacidosis (DKA) is the most severe acute metabolic complication of diabetes mellitus [ 1 ]. Defined by the triad hyperglycemia, acidosis, and ketonuria, DKA can be inaugural or complicate known diabetes [ 2 ]. Although DKA is evidence of poor metabolic control and usually indicates an absolute or relative imbalance between the patient's requirements and the treatment, DKA-related mortality is low among patients who receive standardized treatment, which includes administration of insulin, correction of hydroelectrolytic disorders, and management of the triggering factor (which is often cessation of insulin therapy, an infection, or a myocardial infarction) [ 3–8 ]. Although there is no proof that diabetics are more susceptible to infection, they seem to have more difficulty handling infection once it occurs [ 9 , 10 ]. Indeed, several aspects of immunity are altered in diabetic patients: polymorphonuclear leukocyte function is depressed, particularly when acidosis is present, and leukocyte adherence, chemotaxis, phagocytosis, and bactericidal activity may also be impaired [ 11–15 ]. Joshi et al. [ 10 ] reported recently on the lack of clinical evidence that diabetics are more susceptible to infection than nondiabetic patients. Nevertheless, infection is a well-recognized trigger of DKA. Earlier studies have investigated the prevalence of infection as a trigger of DKA and the impact of antimicrobial treatment [ 2 , 15–18 ]. However, none of these studies were of intensive care unit (ICU) patients only. Furthermore, most were descriptive, included small numbers of patients, used univariate analysis only, and did not designate infection as the sole outcome variable of interest. Efforts to identify correlates of infection h Continue reading >>

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