Diabetic Ketoacidosis Patients Research Articles

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study.

IntroductionWe aimed to examine the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on diabetic ketoacidosis (DKA) rates in children with type 1 diabetes (T1D).MethodsA retrospective cross-sectional study of 11 Israeli pediatric emergency departments (ED) was conducted. Children with T1D who attended the ED between March 1, 2020 and May 31, 2020 were compared with those who attended the ED between March 1, 2019 and May 31, 2019.ResultsOverall, 150 and 154 children with T1D attended the EDs during the 3-month study periods in 2020 and 2019, respectively. Among patients with established T1D, DKA rates significantly increased in 2020 compared to 2019 [38/64 (59.3%) vs 31/74 (41.9%); p < 0.043]. There was a non-statistically significant trend toward a higher rate of DKA in patients with newly diagnosed T1D [46/86 (53.4%) vs 31/80 (38.7%); p = 0.063]. No differences were observed in the rates of severe DKA in 2020 compared to 2019 among patients with established T1D [10/64 (15.6%) vs 6/74 (8.1%); p = 0.184], and newly diagnosed T1D [16/86 (18.6%) vs 14/80 (17.5%); p = 0.858]. No differences were observed in the rates of intensive care unit admissions in 2020 compared to 2019 among patients with established T1D [14/64 (21.8%) vs 14/74 (18.9%); p = 0.672], and newly diagnosed T1D [26/86 (30.2%) vs 21/80 (26.2%); p = 0.977].ConclusionsIncreased rates of DKA in children with established T1D were observed during the first 3 months of the outbreak in Israel. The findings suggest that the severity of DKA at ED presentation in children with T1D was not influenced by the pandemic.

Diabetic Ketoacidosis in Patients with End-stage Kidney Disease: A Review.

Diabetes mellitus is a highly prevalent disease. Chronic kidney disease is one of its chronic complications, and diabetic ketoacidosis is one of the most dreaded acute complications. The increasing prevalence of diabetes mellitus and renal failure has resulted in physicians increasingly encountering diabetic ketoacidosis in this complicated subgroup of patients. This review discusses the pathophysiologic understanding of diabetic ketoacidosis in patients with renal failure, its varying clinical presentation, and management and prevention. We have also highlighted the role of patient weight and proximity to dialysis as tools to assess and manage fluid status in this challenging group of patients.

Stewart (physicochemical) approach versus conventional anion gap approach for resolution of metabolic acidosis in diabetic ketoacidosis

Diabetic ketoacidosis (DKA) frequently requires emergency admission. The anion gap approach is conventionally used for the diagnosis and documenting the resolution of acidosis during treatment. However, it fails to detect hyperchloremic acidosis during the resolution and may result in the prolongation of treatment. To determine the role of the Stewart approach of acid-base disorder during DKA management for the prediction of an earlier resolution. A prospective comparative study was conducted between January 2017 and December 2017 at a single academic hospital in north India. Patients aged above 12 years with a diagnosis of DKA were randomly divided into two groups—the conventional group and the Stewart group, according to the approach used for DKA resolution. The primary outcome was the time duration required for resolution. The secondary outcomes were the therapeutic requirement of intravenous fluid, insulin, and potassium, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of resolution, and hospital stay. Forty-four DKA patients were equally distributed in the two groups with comparable baseline parameters. The Stewart group had early resolution of DKA (mean, 32.4±17.5 h versus 41.7±19.6 h; p value <0.001) at similar APACHE II scores. The duration of hospital stay was reduced but was not statistically significant (mean, 5.6±3.2 days versus 7.0±3.8 days; p value 0.16). The therapeutic requirement of fluid, insulin, and potassium was similar in groups. The Stewart approach may be a better alternative to the conventional anion gap approach for guiding the resolution of DKA.

DKA in patients with pre-existing type 2 diabetes mellitus related to COVID-19: a case series

SummaryThe first case of the novel coronavirus infection (COVID-19) in Peru was reported on March 6, 2020. As of September 7, 2020, about 700 000 cases of COVID-19 resulting in 29,976 deaths have been confirmed by the Ministry of Health. Among COVID-19 patients with co-morbidities, type 2 diabetes mellitus (T2DM) has been recognized as a risk factor for severe disease. Patients with T2DM may experience diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic (HHS) if infected with the coronavirus 2 (SARS-CoV-2). Regular blood analysis including arterial blood gas is essential in monitoring the care of patients with T2DM infected with COVID-19. We report five cases of DKA in patients with underlying T2DM that presented with severe COVID-19 infection.Learning pointsCOVID-19 may cause acute metabolic dysregulations in patients with T2DM.It is important to monitor basic metabolic panel (BMP) and arterial blood gases (ABGs) in patients with COVID-19 since metabolic complications can develop unexpectedly.Patients with T2DM develop an inflammatory syndrome characterized by severe insulin resistance and B cell dysfunction that can lead to DKA.

Evaluation of Early Administration of Insulin Glargine in the Acute Management of Diabetic Ketoacidosis.

Few studies have evaluated the early use of insulin glargine in the management of diabetic ketoacidosis (DKA) patients. Early insulin glargine use in DKA was safe and associated with a trend towards faster DKA resolution. To evaluate the efficacy and safety of early insulin glargine administration for acute management of DKA in critically ill patients. This single-center retrospective cohort study included patients, who were >18 years of age with DKA, admitted to the intensive care unit (ICU) for at least 12 h, and received intravenous insulin infusion for at least 6 h. The primary endpoint was the association between the time to insulin glargine administration and time to DKA resolution. Linear and logistic regression analyses were performed. Of the 913 patients evaluated, 380 were included in the study. The overall mean age was 45±17 years, 196 (51.6%) were female, and 262 (70%) patients had type 1 diabetes mellitus. The mean blood glucose level was 584.9±210 mg/dL, pH was 7.16±0.17, anion gap was 28.17±6.9 mEq/L, and serum bicarbonate level was 11.19±5.72 mEq/L. Every 6-h delay in insulin glargine administration was associated with a 26-min increase in time to DKA resolution (95% confidence interval [CI], 14.76-37.44; p<0.0001), 3.2-h increase in insulin infusion duration (95% CI, 28.8-36; p<0.0001), and 6.5-h increase in ICU LOS (95% CI, 5.04-7.92; p<0.0001). Early administration of insulin glargine is potentially safe and may be associated with a reduction in time to DKA resolution and a shorter duration of insulin infusion.

Serum Triglycerides as Dignostic Marker of Acute Pancreatitis in patients with DKA

Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. Acute pancreatitis is a potentially lethal disease with varying widely Done clinical offers What's more seriousness which extend starting with gentle and confined toward oneself on a quickly progressive sickness prompting various organ disappointment Furthermore demise. Extreme hypertriglyceridemia may be A large portion usually went with by intense pancreatitis. This study pointed with survey the serum level of triglycerides Likewise symptomatic markers to intense pancreatitis for kids with DKA. This cross sectional ponder might have been directed once patients going to Benha college Hospitals, eighty four members were selected Similarly as DKA bunches. Patients the middle of 4-10 quite some time of age for kind 1 diabetes mellitus dependent upon criteria for american diabetes affiliation. Those selected patients and their groups were 1st interviewed on report a full restorative history for their state and perform a careful clinical examination. Lab Investigations: incorporated serum triglycerides, creatinine Also ABG. DKA for AP indicated essentially higher tce The point when contrasted with DKA without AP. TG might have been altogether higher over DKA with AP The point when contrasted with DKA without AP subgroups. TG demonstrated noteworthy sure connection for tce. Applying roc bend to identify symptomatic properties of triglycerides for their unoriginality for intense pancreatitis clinched alongside DKA patients, auc for triglycerides were 0. 755 (p < 0. 0001), suggesting fundamentally predictive qualities to identifying intense pancreatitis On DKA patients. Triglycerides camwood make symptomatic markers for suspecting intense strike for pancreatitis done kids for DKA.

Biochemical Parameters of Diabetes Ketoacidosis in Patients with End-stage Kidney Disease and Preserved Renal Function.

Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß-hydroxybutyrate in patients with ESKD (eGFR < 15 mL/min/1.73 m2), moderate renal failure (eGFR 15-60), or preserved renal function (eGFR > 60). This observational study included adults (18-80 years) with diabetes ketoacidosis (DKA), admitted to Emory University Hospitals between January 1, 2006 to December 31, 2016. DKA and renal stages were confirmed on admission laboratory values. Admission bicarbonate levels (13.9 ± 5 vs 13.4 ± 5.3 vs 13.8 ± 4.2 mmol/L, P = 0.7), and pH levels (7.2 ± 0.3 vs 7.2 ± 0.2 vs 7.2 ± 0.2, P = 0.8) were similar among groups. Patients with ESKD had lower mean ß-hydroxybutyrate level (4.3 ± 3.3 vs 5.6 ± 2.9 vs 5.9 ± 2.5 mmol/L, P = 0.01), but higher admission glucose (852 ± 340.4 vs 714.6 ± 253.3 mg/dL vs 518 ± 185.7 mg/dL, P < 0.01), anion gap (23.4 ± 7.6 vs 23 ± 6.9 vs 19.5 ± 4.7 mmol/L, P < 0.01), and osmolality (306 ± 20.6 vs 303.5 ± vs 293.1 ± 3.1mOsm/kg, P < 0.01) compared with patients with moderate renal failure and preserved renal function, respectively. The sensitivity of ß-hydroxybutyrate > 3 mmol/L for diagnosing DKA by bicarbonate level < 15 and <18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure, and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels < 10, 10-15, <18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively. Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level > 3 mmol/L may assist with confirmation of DKA diagnosis.

On-label use of sodium-glucose cotransporter2 inhibitors might increase the risk of diabetic ketoacidosis in patients with type1 diabetes.

Aims/IntroductionThis study aimed to investigate the risk of diabetic ketoacidosis (DKA) in insulin‐treated type 1 diabetes patients administered sodium–glucose cotransporter 2 (SGLT2) inhibitors in real‐world clinical practice.Materials and MethodsWe carried out a real‐world, retrospective, observational cohort study using Japanese Medical Data Vision, a diagnosis procedure combination database. We identified insulin‐treated adult type 1 diabetes patients enrolled from December 2018 to October 2019. We assessed the incidence and risk of DKA in type 1 diabetes patients using SGLT2 inhibitors in an ‘on‐label’ manner. Cox multivariate regression analyses were carried out to determine clinical factors linked to SGLT2 inhibitor‐associated DKA.ResultsOf 11,475 type 1 diabetes patients, 1,898 (16.5%) were prescribed SGLT2 inhibitors. DKA occurred in 139 (7.3%) of these patients, with 20.2 incidences per 100 person‐years. These patients also showed significantly higher DKA rates than did those not receiving SGLT2 inhibitors (hazard ratio 1.66, 95% confidence interval 1.33–2.06; P < 0.001). The mean time until DKA onset in SGLT2 inhibitor‐treated type 1 diabetes patients was 30.6 ± 30.1 days. The risk of SGLT2 inhibitor‐associated DKA increased in type 1 diabetes patients irrespective of sex, age or body mass index. However, the risk did not increase in type 1 diabetes patients receiving continuous subcutaneous insulin infusion, which warrants further investigation because of the small number of type 1 diabetes patients receiving continuous subcutaneous insulin infusion.Conclusions‘On‐label’ SGLT2 inhibitor use might increase DKA risk among insulin‐treated type 1 diabetes patients irrespective of sex, age or body mass index. Both type 1 diabetes patients and healthcare providers should be wary of DKA, especially during the first month of initiating SGLT2 inhibitors.

Euglycemic diabetic ketoacidosis associated with empagliflozin in patients hospitalized with acute pulmonary embolism

Euglycemic diabetic ketoacidosis (Eu-DKA) is a rare but life-threatening complication in diabetic patient treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i). A 71-year-old diabetic female treated with empagliflozin presented to the ED with shortness of breath. Diagnosis of acute pulmonary embolism was confirmed initially. She was treated conservatively with subcutaneous enoxaparin 60 mg bidaily. and oxygen therapy. Respiratory distress associated with anion gap — metabolic acidosis and ketosis developed on the following days however her blood glucose levels were always within normal limit. Clinical recovery was gained after stopping the drug, administering rehydration, and insulin drip. Complica-tion of DKA without hyperglycaemia should be consid-ered while evaluating ketoacidosis in diabetic patients treated with SGLT2i, particularly in critical illness cases.

COVID-19 and Diabetic Ketoacidosis: A Single Center Experience.

Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center tertiary hospital experience.Materials and Methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1st and June 15th, 2020 with DKA and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection known as COVID-19. We compared the baseline characteristics, laboratory data, and clinical course between survivors and nonsurvivors to identify the risk factors associated with mortality in the patients with DKA.Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ± 6.13 vs 46 ± 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ± 3.20 mcg/mL vs 6.15 ± 3.66 mcg/mL; p< 0.006) and peak ferritin values (2763.66 ± 1105.32 ng/mL vs 835.16 ± 257.07 ng/mL; p= 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.

Management of diabetic ketoacidosis: Role of Rapid Acting Insulin Analogs in comparison to regular intravenous insulin.

Background: Diabetic ketoacidosis (DKA) is an acute metabolic healthcare crisis in patients with diabetes mellitus. The current study aimed to compare the effectiveness of rapid-acting insulin analog administered subcutaneously with regular insulin infused intravenously among the DKA patients.&#x0D; Methodology: In this prospective open labelled study, 100 consecutive DKA patients were randomly assigned to two groups. Group 1 patients were admitted to the intensive care unit (ICU) and treated with intravenous regular insulin infusion. Group 2 patients were managed in the emergency medical ward with subcutaneous rapid-acting insulin. Response to the therapy was assessed by the follow-up investigations of the biochemical parameters, including blood glucose concentration, serum ketones, pH, serum electrolytes including bicarbonates, sodium and potassium concentration until the resolution of DKA. Furthermore, the overall duration of therapy (blood glucose level &lt; 250 mg/dl), time and amount of insulin administered until the resolution of DKA, were also assessed.&#x0D; Results: The baseline clinical and biochemical parameters were similar between the two treatment groups except for blood glucose and sodium concentration. The mean random blood sugar (RBS), acid-base parameters and concentration of ketone bodies were significantly improved from admission until the resolution of DKA. There was no significant difference in the duration of therapy (p=0.07). While the time and amount of insulin therapy required until resolution of DKA were significantly reduced among the patients treated subcutaneously with rapid-acting insulin, i.e. 16.36 ± 6.92 hrs and 59.28 ± 30.05 units (p&lt;0.05).&#x0D; Conclusion: The patients with less complicated DKA can be managed with rapid-acting insulin analog in the medical wards obviating the need for admission to the ICU. With relatively better outcomes, it is an effective alternative to regular intravenous insulin infusion for DKA resolution.

Clinical Analysis of Electrolyte Disorders in Patients with Diabetic Ketoacidosis.

The changes in the electrolyte profiles in patients with diabetic ketoacidosis (DKA) have rarely been reported. This study reports the abnormalities in the electrolyte profile, such as serum potassium, sodium, chloride, calcium, magnesium, and phosphorus. Forty individuals in each of the DKA, diabetic ketosis (DK), nonketotic diabetes mellitus, and healthy control groups were included in this study to evaluate their clinical indicators, such as blood glucose, glycated hemoglobin (HbA1c), renal function, electrolytes, and arterial blood gas concentrations. Compared with the other three groups, patients in the DKA group had a longer course of diabetes; significantly higher levels of blood glucose, HbA1c, and serum creatinine (p < 0.05 or p < 0.001); lower estimated glomerular filtration rate (eGFR) (p < 0.001); and higher levels of serum potassium, sodium, phosphorus, magnesium, and effective osmotic pressure (p < 0.05). In the DKA patients, the incidences of hyperkalemia and hypokalemia were 32.5% (p < 0.05 or p < 0.001 vs. the other groups) and 7.5%, respectively. In the DKA patients, type 1 diabetes patients were younger and had higher blood glucose than type 2 patients (p < 0.05), but the electrolyte profiles were not significantly different. There were no significant differences in the serum electrolyte profile between mild to moderate DKA patients and severe DKA patients. Serum potassium was negatively correlated with eGFR (r = -0.378, p = 0.018). Regression analysis showed that eGFR was an important factor affecting serum potassium (β = -0.378, p = 0.018). When DKA occurs in diabetes patients, the renal function deteriorates significantly because the electrolytes are generally elevated due to hemoconcentration. Hyperkalemia is the main manifestation, and it is necessary to prevent the decrease in serum potassium during the treatment.

Diabetic Emergencies: Experience of a Tertiary Endocrine Center

Purpose: In this study, we aimed to retrospectively evaluate the demographic data, clinical features, laboratory data, precipitating causes of diabetic emergencies, complications in the follow-up of adult patients who applied to our hospital due to diabetic emergencies. Methods: The study included patients aged 18 years and older referred to a tertiary endocrine center with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS) hypoglycemia between January 2010 and May 2018. Results: The study was carried out with 165patients, 69(41.8%) males, and 96(58.2%) females. The mean age of the patients was 43.8±20.4(18- 88). Of these patients, 77% (n=127) had DKA, 17% (n=28) had HHS and 6% (n=10) had hypoglycemia. Of the patients 55.2% (n=91) were type 1 DM, 44.8% (n=74) were type 2DM. When the precipitating causes of diabetic emergencies were examined, 32.7%(n=54) poor adherence to treatment and 32.1%(n=53) infection of the patients were involved. The new diagnosis was DM in 10.9% of the patients (n=18). The most common complication after treatment was hypopotassemia with 38.7% (n=60), but no complication was observed in the majority of patients (54.8%). In our study, total mortality was 1.8% and 11.1% in HHS patients. No mortality was found in DKA and hypoglycemia patients. Conclusion: Diabetic ketoacidosis is more common in DM patients than in other diabetic emergencies. Approximately 11% of patients do not have a known diagnosis of diabetes. Poor adherence to treatment and infection are the most important precipitating causes of the diabetic emergency. The mortality rate is very low with early diagnosis and correct treatment.

Lactic Acidosis in Diabetic Ketoacidosis: A Marker of Severity or Alternate Substrate for Metabolism.

Purpose:The lactate level is being increasingly used as a marker of severity of illness and prognosis in multitude of critical conditions. However, its role in diabetic ketoacidosis (DKA) is not well defined.Aim:To determine the prevalence and clinical importance along with the underlying role of metformin in lactic acidosis (LA) in patients admitted with DKA.Methods:A 2-year prospective and observational study involving 62 consenting in hospital DKA patients. Plasma lactate level on arrival, its clinical significance and relationship with morbidity and mortality in patients with DKA was evaluated.Results:The prevalence of LA (lactate ≥2.5 mmol/l) among the study cohort was found to be 55% with significant LA (≥5 mmol/l) documented in 16%. The median lactate level was 2.55 mmol/l (interquartile range, 1.70–3.20). No significant difference in the severity of LA was seen with metformin use. Lactate correlated positively with initial plasma glucose (IPG) (P = 0.001) and APACHE-II Score (P = 0.002); correlated negatively with systolic blood pressure (P = 0.003), pH (P = 0.002) and severity of DKA (P = 0.001). After controlling for AKI, APACHE II score and blood pressure, lactate continued to correlate positively with IPG (P = 0.002). No mortality or significant morbidity was documented in the entire cohort.Conclusions:LA has a significant presence in patients with DKA; however, it is not associated with mortality or significant morbidity. Moreover, there was no significant difference in severity of LA with metformin use. Elevated lactate levels may be an adaptation to provide alternate substrate for metabolism in the presence of hypoinsulinemic state. The study results provide rationale for large well-designed studies evaluating in-depth clinical relationship of lactate in DKA.

A retrospective cohort study for the treatment of Asian diabetic ketoacidosis: optimizing initial doses of insulin.

AimAn insulin dose of 0.1 U/kg/h recommended by Western guidelines occasionally induces a precipitous decreasing blood glucose in Asian diabetic ketoacidosis (DKA). It is known that clinical factors, such as insulin sensitivity, differ between Asians and Americans/Europeans. We investigated how treatment options affect the time to DKA resolution to determine the optimal treatment for Asian DKA patients.MethodsThis was a retrospective cohort study from a single institution in Japan. A total of 34 adult DKA patients were observed. Baseline characteristics and treatment‐related parameters were compared between patients whose DKA was resolved within 18 h and those in which it was not.ResultsSignificant differences were observed in the initial insulin dose (mean [standard deviation]: 0.053 [0.021] versus 0.031 [0.014] U/kg/h; P = 0.003) and the baseline β‐hydroxybutyrate (7.2 [3.2] versus 9.9 [2.6] mmol/L; P = 0.024) and HCO3− levels (11.2 [4.1] versus 7.7 [3.1] mmol/L; P = 0.014). Multivariable logistic regression analysis revealed that the initial insulin dose was significantly associated with early resolution of DKA and was independent of basal conditions. Receiver operating characteristic curve analysis indicated that the optimal cut‐off point for the initial insulin dose was 0.051 U/kg/h. With an initial insulin dose of 0.051 U/kg/h or higher, early resolution of DKA was obtained in 92.9% of patients.ConclusionAn initial insulin dose of more than 0.05 U/kg/h provides an early resolution of DKA in Asian patients. Lower insulin doses significantly delay resolution. These results provide practical information for acute phase treatment of Asian DKA.

437: Safety Assessment of Insulin Protocol for Diabetic Ketoacidosis Patients in the Emergency Department

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Factors affecting in-hospital mortality of diabetic ketoacidosis patients: A retrospective cohort study

AimsWith advances in the diagnosis and treatment of diabetic ketoacidosis (DKA), its rate of in-hospital mortality has declined. However, the risk factors for in-hospital mortality in patients with DKA remain to be elucidated. MethodsUsing a Japanese national inpatient database from 01 July 2010 to 31 March 2018, we performed multivariable logistic regression analyses to identify factors associated with in-hospital mortality of DKA patients. ResultsWe identified 25,627 DKA patients and 839 (3.3%) in-hospital deaths. Factors associated with increased in-hospital mortality included higher Charlson comorbidity index (≥4) (odds ratio, 3.38; 95% confidence interval, 2.30–4.96; p < 0.001), sepsis (odds ratio, 3.09; 95% confidence interval, 2.38–4.00; p < 0.001), type 2 diabetes mellitus (odds ratio, 2.67; 95% confidence interval, 2.09–3.41; p < 0.001), and obesity (odds ratio, 2.51; 95% confidence interval, 2.05–3.07; p < 0.001). Other factors positively associated with in-hospital mortality included male sex, age ≥ 60 years, consciousness disturbance, lower activities of daily living score at admission, admission requiring ambulance, and admission at non-academic hospital. ConclusionsThe present findings may help clinicians to identify DKA patients at higher risk of in-hospital mortality.

Causes of diabetic ketoacidosis among adults with type 1 diabetes mellitus: insulin pump users and non-users

IntroductionInsulin pumps are increasingly being used as a method of insulin delivery in patients with type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) is a serious complication of T1DM. This...

Inflammatory cytokine and plasma C-reactive protein response to ketoacidosis in adults with type 1 diabetes: Egyptian multicenter study

BackgroundIn adults with diabetic ketoacidosis (DKA), high plasma levels of C-reactive protein (CRP) and inflammatory cytokines such as interleukin-6 (IL-6) were reported to be sensitive markers of infection. However, elevation of both CRP and the pro-inflammatory cytokines which regulate CRP are probable without infection and may act as indicator of systemic inflammatory response (SIR). So, we wanted to determine if increased plasma CRP levels occur in young patients with severe DKA who do not have clinical evidence of infection and to relate observed changes in CRP level to the pro-inflammatory cytokine levels.ResultsUpon admission of 30 DKA patients with age ranging from 17 to 40 years, we found significant elevation of CRP (P = 0.001) and IL-6 (P = 0.001) in DKA patients than control group. After resolution of DKA, there was significant reduction in CRP and IL-6 compared to before DKA correction (P value = 0.054 and 0.001), respectively. There was a significant negative correlation between CRP after correction of DKA and RBCs (P = 0.042), and serum K (P = 0.021) and between CRP prior to DKA correction and PH (P = 0.025).ConclusionsPatients with DKA without infection had increased levels of CRP and inflammatory cytokines. Intensive insulin therapy has a powerful anti-inflammatory effect that, at the time of DKA improvement, can normalize levels of CRP and inflammatory cytokines, and this beneficial effect is greater for IL-6 than CRP.

A Remarkable Elevation in the Procalcitonin Levels Due to Diabetic Ketoacidosis in a Hemodialysis Patient.

Procalcitonin (PCT), a marker of the inflammatory response during infections, can be elevated by diabetic ketoacidosis (DKA). A male patient in his 50s with diabetic nephropathy on hemodialysis presented with vomiting and a reduced level of consciousness and was diagnosed with DKA. His PCT level was markedly elevated, but bacterial cultures (blood, urine, and stool) were negative. The PCT level decreased after DKA improvement. In this patient, DKA probably enhanced the PCT levels. As DKA can increase the PCT levels, an elevation of the PCT levels in DKA patients may not be indicative of infectious diseases, and non-infectious causes of DKA should therefore be considered.