Variation In Resource Use And Readmission For Diabetic Ketoacidosis In Children’s Hospitals
Abstract OBJECTIVE: We sought to characterize variation in hospital resource utilization and readmission for diabetic ketoacidosis (DKA) across US children’s hospitals. METHODS: The study sample included a retrospective cohort of children aged 2 to 18 years with a diagnosis of DKA at 38 children’s hospitals between 2004 and 2009. The main outcomes were resource utilization as determined by total standardized cost per hospitalization, overall and non-ICU length of stay (LOS), and readmission for DKA within 30 and 365 days. RESULTS: There were 24 890 DKA admissions, and 20.3% of these were readmissions within 1 year. The mean hospital-level total standardized cost was $7142 (range $4125–$11 916). The mean hospital-level LOS was 2.5 days (1.5–3.7), and the non-ICU portion was 1.9 days (0.7–2.7). The mean hospital-level readmission within 365 days was 18.7% (6.5%–41.1%) and within 30 days was 2.5% (0.0%–7.1%). Hospital bed days overall, and in particular the non-ICU portion, accounted for the majority of the total standardized cost per hospitalization (overall 57%; non-ICU 36%) and explained most of the variation in resource use. Even after adjusting for difference in patient characteristics across hospitals, widespread differences existed across hospitals in total standardized cost, LOS, and readmission rates (P < .001). CONCLUSIONS: Readmission for DKA within a year of hospitalization is common. US children’s hospitals vary widely in resource use, hospital LOS, and readmission rates for patients with DKA. Our study highlights the need for additional research to understand these differences and to identify the most cost-effective strategies for managing diabetes across the continuum of care. Diabetic ketoacidosis (DKA) is a short-term complication of type 1 Continue reading >>
What Can You Do That Nobody Else Can Do? How Is Your Ability Unique?
Simple, Take a Notebook and Write down from Age 5 to the Age now , what were the things that you did that made you extremely happy ( only happiness ) in each page for each age and the level of happiness that it gave. Example: ( The below is to give an idea. Please go in details filling each page) Age 5: Playing with cars and toys , watching tom and jerry Age 6: Playing with cars and toys, watching popeye , Playing with water Age 7: Playing cricket, watching cartoons, Doing Maths Age 8: Studying Maths, Travelling, Listening to fantasy stories from daddy, Age 9: Playing football, Travelling, watching Captain Planet Age 10: Roller skating , Doing Abacus , watching Swat cats Age 11: Dancing, Roller skating and Sketching cartoons Age 12: Dancing and Playing shuttle badminton, Reading Books Age 13: harry Potter Books , Playing video games in computer , Portrait paintings Age 14: Winning competitions in Roller skating and Playing Video Games (Fantasy) Age 15: Playing football with friends in the evening , Watching WWE, Sketching Age 16: Watching WWE, Seeing Disney Animation Movies ( Finding Nemo, I luvd it) Age 17: Hanging out with friends, Crush and Listening to Music Age 18: Reading History books and Techie Stuffs , Watching Pokemon and Anime Age 19: Learning android programming , and design softwares like Photoshop Age 20: Watching Dragon ball Z and Anime, Design softwares and Games Age 21: Playing Games , Programming and Designing, Playing Pokemon Go From the above you can easily find out the major chunk that has come along your life in keeping you happy to extremes. Passion is not about a job or a designations. Passion is the field/thing that has always kept you happy and is gonna keep you happy no matter whatever struggles will come in the way. All these years it was som Continue reading >>
Readmission Rates For Children With Diabetic Ketoacidosis (dka)
Background: Ketoacidosis is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Criteria for admission varies and could influence the rate of readmissions. Objective: To describe the population and compare readmission rates of patients treated at Cook Children’s ED for DKA. Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – August 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection. Results: 313 children were seen in the ED with a diagnosis of DKA. Of the total patients seen in the ED, 14% were discharged for home management after initial assessment and treatment; 86% were admitted to the hospital. Of the patients discharged, a median 5.2 hours was spent in the ED. Discharged patients had a median glucose of 285 mg/dL (nl. 74-120 mg/dL), median pH of 7.3 (nl. 7.35-7.45), and median HCO3 of 20.4 mEq/L (nl. 22-28 mEq/L). Of the patients admitted, a median 3.6 hours was spent in the ED. Admitted patients had a median glucose of 437 mg/dL, median pH of 7.2, and median HCO3 of 11.2 mEq/L. Conclusions: DKA is defined as 1) metabolic acidosis (pH < 7.3; HCO3 < 15 mEq/L); 2) hyperglycemia (serum glucose > 200 mg/dL); and 3) ketonemia/ketonuria. It occurs frequently among youth with diabetes and is the main cause of mortality in individuals with diabetes < 24 years of age. DKA is more common in those with T1D, but can also be seen in children with T2D. The metabolic changes in DKA usually occur rapidly and can be fatal, primarily due to cerebral edema. Of the 313 children seen in the ED from September 2011 — August 2014, a large majority Continue reading >>
Felix, a 10 year old male neutered cat, presented to North Coast Veterinary Specialist and Referral Centre for management of Diabetic Ketoacidosis. He had a long history of weight loss in which he lost approx. 20% of his bodyweight. He presented to the emergency vets at Animal Emergency Services Sunshine Coast, collapsed and weak with severe electrolyte and metabolic disturbances. Diabetic Ketoacidosis is a life-threatening complication when a second disease compromises a patient with diabetes mellitus. Common secondary diseases are Urinary Tract Infections, Pancreatitis, Hyperadrenocorticism and Hepatic Lipidosis, but any disease can be a trigger. After a full diagnostic work up including biochemistry, blood gas analysis, urinalysis, CBC, chest radiographs and abdominal ultrasound, Felix was diagnosed with DKA triggered by hepatic lipidosis. Hepatic lipidosis is caused by rapid weight loss in cats as the liver tries to remove the fat from the blood stream by incorporating it into hepatocytes. Felix had an elevated ALT and Bilirubin with a marked diffuse, hyperechoic hepatomegaly on ultrasound. Ketoacidosis occurs when a decrease in nutrition plane results in rapid muscle catabolism and ketones are produced as an energy source but accumulate faster than they can be utilised. Felix had severe electrolyte disturbances with hypokalaemia, hyponatraemia, hypochloraemia and hypophosphataemia. He was hyperglycaemic with glucosuria. He received intensive care with a continuous rate infusion of crystalline insulin, aggressive electrolyte supplementation (including phosphorus), and critically, nutrition support via an oesophagostomy feeding tube. Reversing the catabolic state requires insulin supplementation beyond the normalisation of blood glucose levels, so a glucose infusion Continue reading >>
Diabetic ketoacidosis, sometimes called DKA, is a condition caused when you have a high blood sugar level, and not enough insulin in your body to break it down to use for energy. As a result, the body starts burning its stores of fat for energy instead. This process produces by-products called ketones. As the level of ketones in the body increases, it can lead to dehydration and confusion. If not treated, people with ketoacidosis can become unconscious. DKA usually occurs in people with type 1 diabetes. It is rare in type 2 diabetes. The symptoms of diabetic ketoacidosis include high blood glucose, high levels of ketones in the urine, and: quick breathing flushed cheeks breath that smells like sweet acetone (similar nail polish remover) dehydration. DKA is a serious condition that requires immediate assessment. If someone you know has diabetes and becomes confused or unconscious, or has the symptoms listed above, call triple zero (000) for an ambulance. If you have diabetes and you find your blood sugar level is higher than it should be, it’s important that you follow the advice provided by your doctor or diabetes nurse or educator. You may also find it useful to read the advice provided in the article on hyperglycaemia (high blood sugar). Continue reading >>
Trends In The Prevalence Of Ketoacidosis At Diabetes Diagnosis: The Search For Diabetes In Youth Study
Abstract OBJECTIVE: To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence. METHODS: Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002–2003, 2004–2005, and 2008–2010). Logistic regression was used to determine factors associated with DKA. RESULTS: In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002–2003, 29.1% in 2004–2005, and 31.1% in 2008–2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002–2003 to 5.7% in 2008–2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001). CONCLUSIONS: The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time. Diabetic ketoacidosis (DKA) is a life-threatening condition and often the presenting symptom of newly diagnosed type 1 or type 2 diabetes in youth. SEARCH previously reported that the prev Continue reading >>
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Diabetic Ketoacidosis And Cerebral Edema
Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology Stanford University Medical Center Introduction In 1922 Banting and Best introduced insulin into clinical practice. A decade later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by Dillon, Riggs and Dyer writing in the pathology literature. While the syndrome of cerebral edema complicating DKA was either not seen, ignored, or was unrecognized by the medical community until 3 decades later when the complication was again reported by Young and Bradley at the Joslin Clinic, there has since been a flurry of case reports in the 1960's and 1970's and basic and clinical research from the 1970's to the 1990's leading to our present day acceptance of this as a known complication of DKA, or of the management of DKA. In fact, we now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients (1), accounting for 31% of deaths associated with DKA and 20% of all diabetic deaths, having surpassed aspiration, electrolyte imbalance, myocardial infarction, etc. Furthermore, diabetes mellitus remains an important cause of hospitalization of young children. The prevalence rate of diabetes continues to grow in all Western developed nations, nearly doubling every decade, resulting in 22,000 hospital admissions in children under 15 years of age for diabetes in the United States in 1994, the majority of which were due to ketoacidosis. With approximately 4 hospital admissions of children for DKA per 100,000 population per year (2), every PICU located in a major metropolitan center will conti Continue reading >>
Pediatric Diabetic Ketoacidosis
Practice Essentials Diabetic ketoacidosis, in pediatric and adult cases, is a metabolic derangement caused by the absolute or relative deficiency of the anabolic hormone insulin. Together with the major complication of cerebral edema, it is the most important cause of mortality and severe morbidity in children with diabetes. Signs and symptoms Symptoms of acidosis and dehydration include the following: Symptoms of hyperglycemia, a consequence of insulin deficiency, include the following: Patients with diabetic ketoacidosis may also have the following signs and symptoms: Cerebral edema Most cases of cerebral edema occur 4-12 hours after initiation of treatment. Diagnostic criteria of cerebral edema include the following: Major criteria include the following: Minor criteria include the following: See Clinical Presentation for more detail. Laboratory studies The following lab studies are indicated in patients with diabetic ketoacidosis: Imaging studies Head computed tomography (CT) scanning - If coma is present or develops Chest radiography - If clinically indicated Electrocardiography Electrocardiography (ECG) is a useful adjunct to monitor potassium status. Characteristic changes appear with extremes of potassium status. See the images below. Consciousness Check the patient’s consciousness level hourly for up to 12 hours, especially in a young child with a first presentation of diabetes. The Glasgow coma scale is recommended for this purpose. See Workup for more detail. Management Replacement of the following is essential in the treatment of diabetic ketoacidosis: Insulin - Continuous, low-dose, intravenous (IV) insulin infusion is generally considered the safest and most effective insulin delivery method for diabetic ketoacidosis Potassium - After initial resuscitatio Continue reading >>
Do Microbes Live Also In Human Brain?
There was an established dogma that the brain is normally a sterile site. It was long thought to be a kind of fortress, separated from the body by a virtually impenetrable barrier of specialized cells. Now, that view is beginning to shift, with increasing evidence that intruders can, and do, sneak in. Mechanisms used by microbes to enter the CNS are usually divided according to the cellular route involved and whether the organisms breach endothelial cells of blood-brain barrier or specialized epithelial cells of blood-choroid barriers. These routes of entry are commonly referred to as (i) intercellular, i.e., passing between cells, (ii) transcellular, i.e., passing through cells, (iii) leukocyte facilitated, i.e., a Trojan horse-like mechanism, or (iv) nonhematogenous. The most common routes of entry for extracellular bacteria are the intercellular and transcellular routes. Viruses: Unlike other organs such as liver where the specific location within the liver infected by the virus does not substantively alter the symptoms, the precise region in the brain that is infected plays a key role in the type of resulting dysfunction. Limbic infections will manifest a completely different syndrome than infections of motor or sensory systems. Viruses such as cytomegalovirus, rubella, and lymphocytic choriomeningitis virus cause serious abnormalities if the developing brain is infected, and depending on the site and age of fetal infection, can generate overlapping but distinct symptoms such as deafness, blindness, epilepsy, hydrocephalus, and/or reduced IQ in a manner directly related to what part of the brain was infected. Fig: Congenital CMV. Microcephaly and smooth cortex, abnormal gyral pattern, hydrocephalus, and perivantricular calcificatiions. The age of the infected indivi Continue reading >>
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What Are Ketones And What Do They Have To Do With Diabetes?
People with Type 1 Diabetes, or people with advanced Type 2 Diabetes, do not produce, enough, or any Insulin at all and Insulin is a pancreas produced hormone that is required to metabolise the blood sugar and when the body has insufficient Insulin, it cannot get glucose from the blood into the body's cells to use as energy. Glucose is the primary fuel that the body uses for energy and a lack of energy makes the body think that you do not have enough glucose present in the blood, so the body starts to burn body fat in order to create more glucose; however, this does not create more Insulin and so the body still cannot get glucose from the blood into the body's cells to use as energy; this creates a vicious circle, in which the body burns even more fat. Unfortunately, when the body burns too much fat, it also creates Ketones, which is an acid that is released into the bloodstream and if there is insufficient Insulin present to help fuel the body’s cells, the Keytones start to build up; therefore, high levels of Ketones are more common in people with Type 1 Diabetes, or people with advanced Type 2 Diabetes. The Symptoms Of Ketoacidosis: Symptoms of Ketoacidosis include Slow, Deep Breathing; Ketones give the breath a sickly, fruity odour like nail varnish remover or pear drops; Confusion; Frequent Urination 'Polyuria'; Poor Appetite and eventually Loss of Consciousness; a good indication is if you can taste nail varnish or pear drops when licking your lips. How Do I Test For Ketones? Ketone testing can be carried out at home; there are several products that test for Ketones in the urine and there are blood glucose meters which can also test for Ketones as well as test the blood glucose levels; although, you will probably only need to use ketone testing if you are ill or Continue reading >>
Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>
What Is Ketoacidosis? A Comprehensive Guide
Ketoacidosis is lethal. It is responsible for over 100,000 hospital admissions per year in the US with a mortality rate of around 5%. In other words, ketoacidosis is to blame for about 5,000 deaths per year. The cause? A deadly combination of uncontrolled hyperglycemia, metabolic acidosis, and increased ketone body levels in the blood (more on this deadly combination later). Luckily, this lethal triad rarely affects individuals who don’t have diabetes. However, the majority (80%) of cases of diabetic ketoacidosis occur in people with a known history of diabetes mellitus (any form of diabetes). Ketoacidosis vs. Diabetic Ketoacidosis — What’s The Difference? At this point, you may have noticed that I used ketoacidosis and diabetic ketoacidosis interchangeably. This is because it is difficult for the body to get into a state of ketoacidosis without the blood sugar control issues that are common in people with diabetes. Hence, the term diabetic ketoacidosis. (However, there is another form of ketoacidosis called alcoholic ketoacidosis. This occurs in alcoholics who had a recent alcohol binge during a period of time when they didn’t eat enough.) Ketoacidosis tends to occur the most in people who have type 1 diabetes. Somewhere between 5 and 8 of every 1,000 people with type 1 diabetes develops diabetic ketoacidosis each year. Type 2 diabetics also run the risk of ketoacidosis under stressful situations, but it is much rarer because type 2 diabetics have some remaining insulin production (type 1 diabetics do not). If you are not part of the 422 million people worldwide that have diabetes, your risk of getting ketoacidosis is negligible. You would have to put yourself through years of stress, inactivity, and unhealthy eating habits before you experience ketoacidosis. ( Continue reading >>
Malignant Somatostatinoma Presenting With Diabetic Ketoacidosis And Inhibitory Syndrome: Pathophysiologic Considerations
Theodoraki, A; Khoo, B; Hamda, A; Grillo, F; Meyer, T; Bouloux, PMG; (2010) MALIGNANT SOMATOSTATINOMA PRESENTING WITH DIABETIC KETOACIDOSIS AND INHIBITORY SYNDROME: PATHOPHYSIOLOGIC CONSIDERATIONS. ENDOCR PRACT , 16 (5) 835 - 837. 10.4158/EP09131.RAR. Full text not available from this repository. Abstract Objective: To describe a patient with diabetic ketoacidosis secondary to a malignant somatostatinoma.Methods: We present the clinical, laboratory, radiologic, and pathologic findings of a patient with diabetic ketoacidosis secondary to a malignant somatostatinoma. We also review the potential effects of somatostatin on glucose homeostasis and discuss the underlying pathophysiologic mechanisms.Results: A 30-year-old woman presented with diabetic ketoacidosis and had a malignant somatostatinoma with hepatic, bone, and lymph node metastasis. She exhibited features of somatostatinoma "inhibitory syndrome" characterized by mild nonketotic hyperglycemia, hypochlorhydria, cholelithiasis, steatorrhea, anemia, and weight loss. in these tumors, the absence of ketoacidosis is thought to arise from the somatostatin-induced simultaneous suppression of the secretion of insulin and glucagon. The patient's primary tumor could not be located.Conclusions: Diabetic ketoacidosis may occur in somatostatinomas. The secretion of larger molecular weight forms of somatostatin from the tumor may contribute to the ketogenesis. (Endocr Pract. 2010;16:835-837) Type: Article Title: MALIGNANT SOMATOSTATINOMA PRESENTING WITH DIABETIC KETOACIDOSIS AND INHIBITORY SYNDROME: PATHOPHYSIOLOGIC CONSIDERATIONS DOI: 10.4158/EP09131.RAR Keywords: NEUROENDOCRINE TUMORS, PANCREATIC SOMATOSTATINOMA, CLINICAL-FEATURES, GLUCAGON, INSULIN UCL classification: UCL > School of Life and Medical Sciences UCL > School of Continue reading >>
Diabetic Ketoacidosis In An Undiagnosed Diabetic Precipitated By High Altitude Pulmonary Edema.
Abstract A unique case of HAPE precipitating diabetic ketoacidosis in a previously undiagnosed Type 2 diabetic is reported. A 39-year-old male, previously well, was admitted at a hospital situated at a height of 3500 m with complaints of increasing breathlessness on effort, cough, and fever of short duration, 5 days after high altitude reascent. Examination at admission revealed a febrile (38 degrees C) patient with tachycardia (104/min), SaO2 was 82% (on supplemental oxygen), chest examination revealed bilateral crackles in all lung fields, and chest radiograph demonstrated bilateral fluffy heterogeneous opacities in all zones. He was diagnosed as suffering from high altitude pulmonary edema. The patient did not show adequate improvement despite conventional treatment for HAPE with supplemental oxygen and rest. Investigations revealed leucocytosis, and urinalysis revealed glycosuria and ketonuria. Subsequent arterial blood gas analysis revealed that acidemia and serum glucose levels were raised. He was thereafter managed as for HAPE and DKA and recovered in 2 weeks. The patient has been on regular follow-up with satisfactory glycemic control with oral hypoglycemic agents. Continue reading >>
Definition Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is broken down to fuel the body, chemicals called ketones build up in the body. Causes 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. Symptoms Common symptoms can include: Dry skin and mouth Flushed face Fruity-smelling breath Headache Exams and Tests Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample. Ketone testing is usually done when DKA is suspected: Most often, urine testing is done first. If the urine is positive for ketones, most often beta-hydroxybutyrate is measured in the blood. This is the most common ketone measured. Other tests for ketoacidosis include: Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions) Blood glucose test Blood pressure measurement Treatment The goal of treatment is to correct the high blood su Continue reading >>