Diagnosis Of Diabetic Ketoacidosis Research Articles

Diabetic acidosis with severe fetal hypoxia in pregnancy: Narrative review and case study.

Diabetic ketoacidosis (DKA) in pregnancy could be a disastrous event with increased maternal and perinatal morbidity and mortality. DKA can occur with a normal blood glucose level, known as euglycemic DKA. It particularly affects pregnant women with type I diabetes. Here, we report the case of a 28 year-old primigravid patient, with a diagnosis of type 1 diabetes for 8 years. This patient consulted our department at 29 weeks of gestation with a previous history of headaches, vomiting and diarrhea for 9 h. Blood glucose level was 8.8 mmol/L with a ketone test positive (>15 mg/dL). Blood test showed high anion gap (17.9 mmol/L) with low serum bicarbonate rate (21 mmol/L). Systemic examination and fetal heart rate (FHR) was reassuring. The patient was subsequently discharged. She returned to the clinic 19 h later with further symptoms of nausea, polyuria-polydipsia, asthenia and a weight loss of 4 kg since the day before. Blood sugar was 14.3 mmol/L and a ketone test was strongly positive. Cardiotocography showed fetal tachycardia and repeated late decelerations. A diagnosis of DKA was made and emergency cesarean was performed for fetal distress. At delivery, pH was acidosis (pH: 7.02, lactates: 6.2). The patient was successfully treated with intravenous hydration and insulin. Neonatal evolution was favorable. Pregnant women with type I diabetes can develop euglycemic DKA. Early recognition and prompt treatment could help prevent severe maternal and fetal adverse outcomes. DKA in pregnant women can induce fetal acidosis with abnormal FHR. In this situation, a cesarean can be performed to improve neonatal outcome even inducing a premature delivery. Prolonged pregnancy can lead to irreversible neonatal brain abnormalities.

The Assessment of Diabetic Ketoacidosis Awareness Among Diabetic Patients and Their Caregivers in Makkah, Saudi Arabia: A Cross-Sectional Study.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). It occurs due to a decrease in the level of insulin and an increase in the level of glucose in the blood, which makes cells unable to use glucose as an energy source and begin to break fat into ketones; an overload of ketones levels in the blood can lead to DKA.The aim of the study is to assess awareness of DKA among diabetic patients and their caregivers in Makkah City, Saudi Arabia. This study is a cross-sectional study collected through an online questionnaire of diabetic patients and their caregivers in Makkah City. A self-reported questionnaire designed in Arabic and English through the use of Google Forms, it distributed electronically via social media to the target population with the objectives of the survey. A total of 400 participants were included, 73%of them were males, while 27%were females. A 9%of the participants have been diagnosed with DKA. A high awareness level about DKA was found in 32.5%of participants, while 67.5%had a poor awareness level. Factors associated with a high level of awareness towards DKA are young age, being single, students and having a previous DKA diagnosis. Regarding our participants who have poor awareness of DKA, further education for diabetic patients and their caregivers about DKA is crucial to prevent life-threatening complications, and improve quality of life for these patients.

Diagnosis and Intensive Care in Children’s Diabetic Acidosis: an Interdisciplinary Viewpoint

Diabetic ketoacidosis (DKA) is the main cause of death and disability in children with type I diabetes mellitus (T1DM). Children’s mortality from T1DM reaches 1% in developed countries and 13% in developing countries. The main cause of death in DKA is cerebral edema, clinical manifestations of which develop in 0.5–0.9% of children with DKA, while mortality riches 24%.Objective. Developing recommendations to prevent life-threatening complications of children with DKA using analysis of literature data and consolidated opinion of experts on the issues of intensive care in children with T1DM.Materials and methods. We analyzed and discussed studies in diagnosis and treatment of DKA in children with type 1 diabetes and 1200 literature sources since January 1970, published in Russian peer-reviewed scientific journals and international publications presented in the online repository Medline (Pubmed). The search for publications was carried out using the keywords: «children», «DKA», «DM1», «dehydration», «cerebral edema».Results. We considered issues of epidemiology, pathogenesis, clinical manifestations, diagnosis, intensive care for DKA, as well as clinical and diagnosis, treatment, prevention of cerebral edema issues in children. Limitations of the study were the small number of modern studies with a high level of evidence (randomized controlled trials, meta-analyses) over the past 5 years on DKA in children.Conclusion. Taking into account the national and international experience, joint recommendations on a consensus format were developed and formulated for the diagnosis of DKA, its leading complications and treatment recommendations for children with T1DM and DKA. Timely and accurate diagnosis of DKA, intensive therapy options based on proven therapeutic efficacy, laboratory and clinical monitoring are warranted to interrupt the DKA pathogenesis, prevent the development of life-threatening conditions, and improve treatment outcomes for children with DKA.

Practical method in the diagnosis of diabetic ketoacidosis: end-tidal carbon dioxide

Objectives: Diabetic ketoacidosis (DKA) poses a life-threatening risk in uncontrolled diabetes. Current diagnostic criteria rely on invasive measures, leading to potential delays in treatment initiation. This study aimed to assess the diagnostic utility of noninvasive end-tidal carbon dioxide (EtCO2) measurements in DKA patients. Methods: A prospective, cross-sectional study was conducted in a tertiary-level Emergency Medicine Clinic from January 2021 to January 2023. Participants included adults with DKA symptoms and those with stable vital signs as controls. EtCO2 levels were measured using a capnograph device. Diagnostic criteria for DKA were blood glucose ≥250 mg/dL, ketonuria, ketonemia, and metabolic acidosis (pH<7.3 or bicarbonate <15 mEq/dL). Statistical analysis was performed using SPSS Statistics. Results: Of 730 participants, 120 had DKA, 410 did not, and 200 served as controls. EtCO2 levels significantly differed between DKA, non-DKA, and control groups (P<0.05). EtCO2 correlated with pH, lactate, base deficit, and bicarbonate (P<0.05). ROC analysis showed an AUC of 0.86 for EtCO2 in diagnosing DKA (P<0.01), with 91.67% sensitivity and 74.39% specificity at a cut-off value 23.7. Conclusion: This study suggests that EtCO2 measurement is a valuable noninvasive tool for diagnosing and assessing the severity of DKA in the emergency department. An EtCO2 threshold of <23.7 could prompt consideration of DKA in patients with elevated blood glucose levels. More extensive multicenter studies are warranted to validate these findings further. EtCO2 measurement could facilitate early DKA diagnosis and improve patient outcomes.

A case report on diabetic ketoacidosis in 5 years old female child

Diabetic ketoacidosis is characterised by an insulin deficiency, metabolic acidosis and increased ketone concentration in the body which can be normalised by insulin replacement and electrolyte replacement therapy. One in three children suffers with type 1 diabetes (T1D), across the US and globally, the incidence of the disease is rising among the paediatrics by over 3% annually. The diagnosis of diabetic ketoacidosis (DKA) was based on the presence of hyperglycaemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L) and ketonuria (urine ketone ≥1+). Gestational diabetes is a common abnormality of glucose metabolism during pregnancy which affects foetal development and an alteration in the balance of glucagon and insulin is affected due to an overproduction of glucose and ketones in the liver, with free release of fatty acids from adipose tissue. A case of 5 years old female child presented with increased urination, increased appetite and sudden weight loss since 1 month and her RBS range was found to be 426mg/dl. Child underwent laboratory investigations, GRBS monitoring every 3 and assessed as Diabetic ketoacidosis with uncontrolled sugars. The child was treated with insulin supplementation for 3 days, recovered and child was hemodynamically stable and got discharged.

Diabetic Ketoalkalosis: A Case Report.

Diabetic ketoacidosis (DKA) is a common diagnosis in the emergency department (ED). However, one must consider other causes for acid-base disturbances when the pattern is not consistent with typical presentation. A 52-year-old female with a history of insulin-dependent diabetes mellitus type 2 presented to the ED with abdominal pain, nausea, and vomiting for three days. Her diagnostic workup revealed diabetic ketoacidosis but with concurrent metabolic alkalosis. Standard treatment for DKA was initiated, and there was improvement of her mentation and resolution of metabolic derangements. Overlooking a diagnosis of DKA because of alkalosis on venous blood gas testing could lead to inappropriate treatment and, therefore, increased risk of morbidity and mortality in the affected patient.

Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

ObjectivesThis systematic review and meta-analysis aimed to assess the magnitude and determinants of diabetic ketoacidosis (DKA) among patients with diabetes mellitus (DM) in Ethiopia.DesignSystematic review and meta-analysis.ParticipantsAge 15 and above...

Validation of the Diagnostic Accuracy Levels of International Classification of Diseases, 10th Revision Codes for Diabetic Ketoacidosis: A Multicentre, Cross-sectional Study of Adults

ObjectivesInternational Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA. MethodsWe conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA. ResultsWe identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%. ConclusionICD-10 codes can identify patients with DKA among those admitted to general internal medicine.

The effect of serum biochemical parameters on clinical prognosis in children presenting with diabetic ketoacidosis.

The aim of this study was to determine whether diabetes mellitus has a high risk of diabetic ketoacidosis-related complications. Biochemical parameters affect the resolution time of diabetic ketoacidosis. The present study is based on a retrospective evaluation of the records of patients who presented to the Pediatrics Clinic of Adiyaman University Hospital between January 1, 2017, and October 1, 2022, with a diagnosis ofdiabetic ketoacidosis. The demographic characteristics, serum biochemical parameters, blood gas results, and time to transition to subcutaneous insulin therapy were all recorded. This study included 49 (49%) female and 51 (51%) male patients aged 1-17 years (mean age: 9.05±4.33 years). The average time to clinical improvement of the sample, that is, transition to subcutaneous insulin therapy, was 21.04±7.8 h. An evaluation of the presence of acute kidney injury based on serum urea and creatinine levels and eGFR values revealed no significant effect on the rate of clinical recovery (respective p-values: p=0.076, p=0.494, and p=0.884). A univariate analysis identified blood glucose (p=0.025), blood gas pH (p<0.001), and blood bicarbonate (p=0.004) values as prognostic factors, while a multivariate analysis revealed pH values had an independent and significant effect on the resolution time of diabetic ketoacidosis. Serum glucose, pH, and bicarbonate levels are the most important determinants of clinical prognosis in patients with diabetic ketoacidosis. These findings can serve as a guide for clinicians in the follow-up and treatment of such patients.

Outcome of adults with diabetic ketoacidosis admitted to intensive care unit: a retrospective study.

Background: Numerous advancements in diabetes care have been made over the past 20 years. Few studies discussed the outcome and predictors of diabetic ketoacidosis (DKA) necessitating admission to intensive care units (ICU). We, therefore, performed a retrospective analysis of DKA patients admitted to King Saud Medical City\&amp;apos;s ICU between August 2022 and August 2023 to examine trends in outcome and predictors. Method: Patients with DKA episodes who visited the emergency room at King Saud Medical City in Riyadh, Saudi Arabia, between August 2022 and August 2023 were included in this retrospective analysis. Every adult patient, who met the American Diabetes Association\&amp;apos;s requirements for DKA diagnosis and was at least 18 years old, was included. Results In the final analysis, we included 218 patients with DKA, of whom 56 (25.6) were under ICU care. The patients admitted to the ICU had higher BMI and were more likely to be male than non-ICU patients, they were also having advanced age. DKA patients with type 2 diabetes mellitus (T2DM) had a higher likelihood of ICU admission than those with T1D. In patients with DKA needed ICU care, WBC counts were higher, as were urea level, and CRP. Compared to patients who did not need ICU admission, those who needed to be admitted had lower venous pH level and bicarbonate levels. Furthermore, 3.5% of ICU-admitted patients died in hospital, compared to 0 deaths among non-ICU admitted patients. Conclusion: Of all patients with DKA, 25.6% needed ICU. Some factors that indicate a patient\&amp;apos;s likelihood of needing an ICU were; T2DM, advanced age, an infectious cause, newly diagnosed diabetes, and moderate or severe DKA.

Associations Between Postdischarge Care and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults With Diabetes.

Patients with severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) experience high hospital readmission after being discharged. Cognitive impairment (CI) may further increase the risk, especially in those experiencing an interruption of medical care after discharge. This study examined the effect modification role of postdischarge care (PDC) on CI-associated readmission risk among U.S. adults with diabetes initially admitted for DKA or SH. We used the Nationwide Readmissions Database (NRD) (2016-2018) to identify individuals hospitalized with a diagnosis of DKA or SH. Multivariate Cox regression was used to compare the all-cause readmission risk at 30 days between those with and without CI identified during the initial hospitalization. We assessed the CI-associated readmission risk in the patients with and without PDC, an effect modifier with the CI status. We identified 23,775 SH patients (53.3% women, mean age 65.9 ± 15.3 years) and 140,490 DKA patients (45.8% women, mean age 40.3 ± 15.4 years), and 2,675 (11.2%) and 1,261 (0.9%), respectively, had a CI diagnosis during their index hospitalization. For SH and DKA patients discharged without PDC, CI was associated with a higher readmission risk of 23% (adjusted hazard ratio [aHR] 1.23, 95% confidence interval 1.08-1.40) and 35% (aHR 1.35, 95% confidence interval 1.08-1.70), respectively. However, when patients were discharged with PDC, we found PDC was an effect modifier to mitigate CI-associated readmission risk for both SH and DKA patients (P < 0.05 for all). Our results suggest that PDC can potentially mitigate the excessive readmission risk associated with CI, emphasizing the importance of postdischarge continuity of care for medically complex patients with comorbid diabetes and CI.

Impact of COVID-19 Lockdown on Occurrence of Acute Complications of Type 1 and Type 2 Diabetes and Overall Glycemic Management

ObjectivesThe association of diabetes, and COVID-19 infection has been studied extensively; however, the occurrence of diabetic ketoacidosis (DKA) or hyperglycemic/hyperosmolar states (HHS) in adults during the lockdown has not been well characterized. In this study, we aimed to identify the impact of the lockdown on occurrence and severity of DKA/HHS admissions and glycemic management. MethodsA retrospective chart review was conducted of patients admitted to Hamilton Health Sciences with a diagnosis of DKA or HHS from April to September 2019 (pre-lockdown) and from April to September 2020 (lockdown). Adult (≥18 years old) nonpregnant patients with a single admission in the study period were included for study. ResultsThere were 229 admissions related to diabetes, with 171 admissions meeting the inclusion criteria (n=92 pre-lockdown, n=79 lockdown). In the lockdown group, 51.8% of the patients had type 2 diabetes mellitus, with 96.2% of admissions secondary to DKA. When comparing the 2 periods, the lockdown group trended toward higher rates of death (5.4% vs 10.1%, p=0.247) and euglycemic DKA (17.6% vs 24.4%, p=0.403). There were more new diagnoses of type 1 diabetes mellitus in the lockdown group compared with the pre-lockdown group (7.3% vs 16.7%, p=0.230). The average glycated hemoglobin was lower in the lockdown group compared with the pre-lockdown group (11.8% vs 10.4%, p=0.032). ConclusionsOverall, this study is among the first in Canada to assess the impact of the COVID-19 lockdown on admissions due to DKA and HHS. Although no significant differences were noted in severity of admissions, there was a trend toward more new diagnoses of type 1 diabetes mellitus presenting in DKA during the lockdown period.

THU343 Potential Association Among Enteroviruses, Acute Flaccid Myelitis And Type 1 Diabetes

Abstract Disclosure: T.A. Nguyen: None. K. Huynh: None. M. Azad: None. J.P. Perdomo Rodriguez: None. Non-polio enteroviruses, like EV-D68, caused a nationwide outbreak of respiratory illness in the US in 2014, most recently in the fall of 2021. It has been shown that EV-D68 plays a role in causing acute flaccid myelitis (AFM). In addition, the association between enterovirus infections and type 1 diabetes (T1DM) has been widely studied and established. We report a case in which a 19-year-old male consulted for progressively ascending bilateral weakness in the lower extremities. Four weeks prior, he was diagnosed with T1DM and diabetic ketoacidosis (DKA). On exam, he had decreased sensation to light touch, vibration, and temperature below the knees, decreased motor strength 2/5 in bilateral lower extremities, and absence of patellar and Achille reflexes. Thyroid tests, Creatinine Kinase, Aldolase, and vitamin B12 were all normal. Spine MRI showed an enhancement along the L5 and sacral roots. CSF studies were significant for the positive oligoclonal band, the elevated protein level (87gm/dL), and no white blood cell count. CSF gram stain was negative for any organisms. EBV, HSV, and HIV testing were negative. A nonspecific respiratory panel only performed at the time of diagnosis with AFM was negative. The electromyogram did not show any type of acute inflammatory demyelinating polyneuropathy or evidence of myopathy. CT abdomen/pelvis demonstrated mild splenomegaly with small swollen lymph nodes of the periaortic and mesenteric area, which are commonly seen in viral infections. A Digital Subtraction Angiography study did not show any abnormality in spinal vessels. The patient received immunoglobulin and steroid, which was stopped early due to bradycardia and hyperglycemia. Neurology diagnosed the patient with AFM secondary to viral infection, in which the patient may have been infected prior to his diagnosis of DKA. The patient’s weakness resolved, and he was discharged with basal-bolus insulin and is to follow up with neurology and endocrinology outpatient. Enterovirus infection has been associated with T1DM and AFM. While the Respiratory PCR Panel was negative, it was only obtained several weeks after the onset of symptoms. Pathogenesis of extra-respiratory complications of enteroviruses may associate with viremia and systemic dissemination of the virus, which may not be detected by a respiratory PCR panel. Infection by an enterovirus remains the most likely etiology for both immune-mediated disorders, especially during a nationwide outbreak. We recommend providers consider enterovirus infection as a potential cause of AFM, and autoimmune diabetes in order to perform a throughout workup. In a patient with hyperglycemia and flaccid paralysis, T1DM should be suspected. Presentation: Thursday, June 15, 2023

FRI658 Diabetic Ketoacidosis Masked By Cannabis In Type 2 Diabetes Mellitus

Abstract Disclosure: J. Bosques-Lorenzo: None. S. Velazquez-Acevedo: None. J. Baez-Torres: None. J. Colon-Castellano: None. Background: With the legalization of cannabis in many states, cannabis-related emergency visits have doubled. In recent years, hyperglycemic ketosis and altered glycemic control have been more frequently described in diabetic patients who are also cannabis users. Physicians mostly rely on pH and bicarbonate to diagnose and classify diabetic ketoacidosis (DKA). However, diabetic-cannabis users with typical DKA symptoms may present with alkalosis rather than acidosis. Clinical Case: We present the case of a 71-year-old male patient with a history of insulin-dependent type 2 diabetes mellitus, hypertension, and hyperlipidemia who came to the ED with a chief complaint of increased tiredness, fatigue, polyuria, polydipsia, and a home blood glucose measurement of greater than 500 mg/dl. Labs were remarkable for central blood glucose of 528 mg/dl, b-hydroxybutyrate of 42.1 mg/dl, and anion gap of 18.5mEq/L. Urine was also positive for glucose and ketones. However, arterial blood gasses showed a pH of 7.438 and bicarbonate of 25.5 mmol/l which did not meet the criteria for typical DKA. Upon record review, the patient had prior toxicology tests which were positive for cannabinoids. This admission wasn’t the exception. Studies have suggested that diabetic cannabis users tend to present with metabolic alkalosis despite high anion gap ketosis. Therefore, the patient was managed as per DKA protocol with adequate response and improvement of symptoms. Conclusion: The diagnosis of DKA in cannabis users may be frequently missed due to its differing and conflicting acid-base profile compared with non-cannabis users. Gastric delay and frequent vomiting have been suggested as the likely cause of alkalosis in these patients. Our patient did not present with severe vomiting; therefore, this case suggests that an alternate mechanism for alkalosis is possible and that relying only on pH and bicarbonate can be misleading. This case highlights the importance of screening urine toxicology for cannabis in patients who do not meet the typical criteria for DKA (pH &amp;gt;7.4 and bicarbonate &amp;gt;15 mmol/L) to provide the most effective treatment. Presentation: Friday, June 16, 2023

SAT111 Temporal Trends In Patients Hospitalized With Diabetic Ketoacidosis And Associated Outcomes: Insights From The National Inpatient Sample

Abstract Disclosure: M. Chaudhary: None. J. Jung: None. A. Farooq: None. J. Heersink: None. Background: Patients hospitalized with Diabetic Ketoacidosis (DKA) exhibit increased risk for mortality and morbidity. Previous work has illustrated concerns for DKA incidence increasing further highlighting the burden it may present to the US healthcare system. We aim to demonstrate the current baseline characteristics in hospitalized DKA patients and to identify and stratify risk factors that lend to deleterious patient outcomes. Methods: Patient data was collected for years 2011-2018 from the National Inpatient Sample (NIS) using International Classification of Disease-Revision Codes (ICD-9 and 10). We selected patients hospitalized with a principal diagnosis of DKA with ICD Coding. Multivariate logistic regression was used to determine adjusted odds ratios (AOR). Mann-Whitney U testing was utilized to calculate mean differences in age, length of stay (LOS), and total hospital charges. Additionally temporal trends were tabulated with linear regression models to determine any significant changes over time in select risk factors and outcomes. Results: A total of 313,608 patients were included in our data analysis. Self-pay patients had a 28.3% (CI 1.020-1.613, P&amp;lt;0.05) increase in mortality rate compared to Medicare payers. Asians had 60.5% (CI 1.039-2.479, P&amp;lt;0.05) increased risk of mortality compared to Caucasians. Increased mortality rates were seen in patients with following comorbid conditions: ESRD (149%) (CI 1.986-3.140, P&amp;lt;0.05), Obesity (70.5%) (CI 1.425-2.040, P&amp;lt;0.05)and CAD (25%) (CI 1.057-1.478, P&amp;lt;0.05). Females with DKA had a decreased risk of mortality by 21%(Cl 0.697-0.894, P&amp;lt;0.05). Patients in the highest quartile median zip code income had a decreased mortality risk of 18.7% compared to patients in the 1st quartile (add the P value). There was a 25.6% (CI 1.069-1.505, P&amp;lt;0.05) decreased mortality rate in hospitals with large bed size and a 30.8% decreased mortality rate in urban located teaching hospitals (CI 1.062-1.612, P&amp;lt;0.05). We observed decreases in LOS and over time P&amp;lt;0.05 and increase in Hospital Charges over time P&amp;lt;0.05. Conclusion: We observed correlation between socio-economic and demographic factors and mortality outcomes in patients hospitalized with DKA. Based on our analysis, we found patients with ESRD, Obesity, and CAD to exhibit the highest mortality risk. Decreased LOS over time may exhibit incremental improvements in quality of care of patients hospitalized with DKA and would beget further analysis in comparison with available longitudinal studies with more granular data. Increased total charges may represent an increasing patient complexity and this warrants further investigation. Further research in community-based hospital settings is needed and it is important to note that targeted prevention measures, such as diabetes education, may help prevent life-threatening diabetic complications such as DKA from arising. Presentation: Saturday, June 17, 2023

THU352 Troponin Elevation On The Outcomes Of Hospitalized Patients With Diabetic Ketoacidosis: Analysis Of National Inpatient Sample

Abstract Disclosure: S. Karki: None. R. Gajjar: None. E. Krishnaraju: None. R. Soon-Shiong: None. A. Jamshed: None. Background: Cardiac troponins are preferred biomarkers for acute myocardial infarction, however, its role in prognosis of patients with Diabetic Ketoacidosis (DKA) is still not well-established. We aim to compare the clinical outcomes of patients admitted for DKA with and without Acute Myocardial Infarction (AMI). Methods: Data was extracted from the National Inpatient Sample (NIS) 2020 Database. Adults admitted with a principal diagnosis of DKA were identified and further stratified based on presence of secondary diagnosis of Acute Myocardial Infarction (AMI) using International Classification of Diseases -10 codes. AMI includes ST elevation MI (STEMI) , Non ST elevation MI (NSTEMI) and MI type 2 along with nonspecific ones. The primary outcomes assessed were inpatient mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes include inpatient complications (sepsis, acute kidney injury (AKI), acute respiratory failure (ARF), need for mechanical ventilation (MV), intubation, and vasopressors). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and to analyze the outcomes. Results: A total of 206,315 adult patients were hospitalized with DKA out of which 4,575 (2.21%) had evidence of AMI in the form of troponin elevation. The majority were middle aged (45-65 years) with a mean age of 60 years, half of them were females, and more than 50% patients had coexisting dyslipidemia and coronary artery disease. Our analysis revealed that patients who were hospitalized with DKA and developed AMI were associated with significantly higher adjusted odds of inpatient mortality (aOR 4.61, 95%CI 3.15-6.77,p&amp;lt;0.001), increased mean LOS by 1.62 days (95% CI 1.09-2.14, p&amp;lt;0.001), and higher mean THC ($39,883, 95% CI 29,921-49,845, p&amp;lt;0.001). Additionally complications such as sepsis(aOR 3.03 , 95%CI 2.26-4.06), AKI(aOR 2.15, 95%CI 1.83-2.54), ARF(aOR 3.03, 95%CI 2.45-3.75), need for MV(aOR 4.04, 95%CI 3.15-5.17), intubation(aOR 3.64, 95%CI 2.80-4.76), and vasopressors support(aOR 3.53, 95%CI 2.11-5.89) were significantly higher in DKA patients who had AMI compared to patients without AMI. Conclusion: It is well established that the presence of poorly controlled diabetes increases patients’ risk for cardiovascular events including AMI. Troponin elevation can occur in patients with DKA in the absence of CAD. This arises due to myocardial necrosis from factors such as severe acidosis, concomitant infection, and significant dehydration leading to supply/demand mismatch etc. Regardless, patients with troponin elevation admitted for DKA have increased mortality ,longer hospital stay, increased total hospital charges along with several inpatient complications compared to those without any evidence of troponin elevation. Presentation: Thursday, June 15, 2023

THU326 Subcutaneous Insulin Aspart Every 4 Hours In the Treatment Of COVID-19 Patients With Diabetic Ketoacidosis: A Retrospective Study

Abstract Disclosure: D. Chiewchalermsri: None. C. Wanittansirichok: None. C. Sriphrapradang: None. SUBCUTANEOUS INSULIN ASPART EVERY 4 HOURS IN THE TREATMENT OF COVID-19 PATIENTS WITH DIABETIC KETOACIDOSIS: A RETROSPECTIVE STUDY Introduction: COVID-19 infection increases the risk of diabetic ketoacidosis (DKA). To limit the healthcare workers’ exposure when taking care of the COVID-19 patients, treatment of DKA with subcutaneous (SC) rapid-acting insulin analogs every 4 hours was suggested in many professional recommendations. However, the evidence to support this strategy is lacking. We aimed to report the efficacy and safety of SC insulin aspart every 4 hours in the management of DKA in COVID-19 patients. Methods: We retrospectively reviewed all confirmed COVID-19 patients aged &amp;gt;15 years who developed mild-moderate DKA between July 2020 and October 2021 in our institution. Insulin aspart was delivered 0.4 units/kg SC every 4 hours. When blood glucose (BG) decreased to &amp;lt;250 mg/dL, the dose of insulin aspart was reduced to 0.2 units/kg every 4 hours until resolution of DKA. SC Basal insulin 0.15-0.2 units/kg was also initiated at the time of DKA diagnosis. Result: A total of 7 patients had mean age of 67.43±13.19 years with body mass index of 25.49±3.42 kg/m2. Most was 71.4% of female and all had pre-existing type 2 diabetes mellitus. All patients received high-dose steroid for COVID-19 treatment. Initial biochemical parameters were BG of 449±157.3 mg/dL, hemoglobin A1c of 10.58±2.81%, pH of 7.34±0.07, beta-hydroxybutyrate of 4.0±1.51 mmol/L, and HCO3 of 15.5±2.17 mmol/L. Time to resolution of DKA were 12.7±5.82 hours. Conclusion: From our cohort, SC rapid-acting insulin administered every 4 hours could be applied in the selected COVID-19 patients with mild-moderate DKA. Presentation: Thursday, June 15, 2023

Profil Pasien Ketoasidosis Diabetikum di Rumah Sakit Rujukan Tersier di Bali, Indonesia

Introduction. Diabetic ketoacidosis (DKA) is one of life-threatening acute complication of diabetes mellitus (DM) characterized by hyperglycemia, ketosis, and acidosis. The prevalence of DM is increasing, therefore the incidence of DKA is predicted to continue to increase. The aim of this study was to obtain the profile of DKA patients in RSUP Prof. Dr. IGNG. Ngoerah (RSPN), Denpasar, Bali as a tertiary refferal hospital of Bali and Nusa Tenggara region. Methods. This study was a cohort retrospective study. All patients aged 18 years or older with a diagnosis of DKA during Januari 2022 to February 2023 at RSPN, were included in this study. Data were obtained from medical records then analyzed using the SPSS version 26 program. Results. There were a total of 41 patients with DKA with mean of age was 50,59 (SD 16,87) years, most of them were female (51,2%) and came alone without referral (58,5%). Based on the clinical profile, most patients presented with decreased consciousness (36,5%), infection (90,2%) mostly urinary tract infection (UTI) (40,5%), have a history of insulin use (34,1%), and impaired of renal function (85,4%). The mean of blood glucose was 468,95 (SD 207,78) mg/dL, potassium level 4,19 (SD 1,17) mmol/L, bicarbonate level 12,85 (SD 6,27) mmol/L, and HbA1c 11,5% (7,1-14). The median duration of hospitalization was 7 (1-30) days and 19,5% of them were passed away during treatment, mostly within the first 72 hours. Conclusions. Most patients in this study are female with age less than 60 years. The most common precipitating factor of DKA are UTI and poor glycemic control. A total of 19,5% of patients with DKA were passed away in this study. Thus, clinicians should be more aggressive in the management of DKA, particularly in the first 72 hours.

Evaluation of children with type 1 diabetes in Kırıkkale

Aims: The aim of this study is to evaluate the clinical laboratory and demographic characteristics of children aged 0-18 with Type 1 Diabetes who applied to Kırıkkale University Hospital. Methods: Patients who applied to Kırıkkale University Medical Faculty Hospital between January 2011 and January 2021 and were diagnosed with Type 1 diabetes mellitus were included in the study. From file information; age at admission, age at diagnosis and laboratory values at admission were recorded. Results: Of the children, 48 (48.5%) were boys and 51 (51.5%) were girls. The mean age of all patients was 14.4±2.1 years. It was observed that its frequency increased during the adolescence period. It appeared that patients frequently increased in the autumn and winter months. Vitamin D was low in 74.4% of the patients. Statistical significance was found between HbA1c of those who applied to the hospital with a diagnosis of diabetic ketoacidosis. Conclusion: It is instructive to investigate the regional characteristics of the disease in terms of genetic and environmental factors that have an important place in the etiology. The findings of our study were consistent with similar studies and literature.

Diabetic Ketoacidosis Complications and Management in Pediatrics: A Narrative Review

Diabetic ketoacidosis (DKA) is an endocrine emergency that affects both newly diagnosed and long-term type I diabetic patients as a result of decreasing insulin levels in the blood, insulin resistance, and elevated levels of counter-regulatory hormones. A common and deadly acute consequence in kids with diabetes mellitus is diabetic ketoacidosis. When type I diabetes is newly diagnosed, it can be accompanied by diabetic ketoacidosis. It can also happen when type I diabetes is already present, such as when the demands of an acute illness are more than usual or when insulin administration is decreased as a result of missed doses or insulin pump failure. Furthermore, there are more reports of diabetic ketoacidosis events in kids with type II diabetes mellitus. Although the diagnosis is typically simple in a patient with established diabetes and the anticipated symptoms, a sizable portion of patients with new-onset diabetes initially present with diabetic ketoacidosis. Children with diabetic ketoacidosis are typically treated in an emergency room for the first time. The differential diagnosis of pediatric metabolic acidosis must take diabetic ketoacidosis into account as a significant factor. The pathogenesis, therapy, and probable consequences of this illness will be explained to emergency medicine doctors in this review) Heddy, 2021). The management of pediatric patients draws attention to the uncommon but fatal occurrence of cerebral edema and the excessive use of fluid boluses that may or may not be related to it. Guidelines for managing DKA in adults should not be applied to children and adolescents. The diagnosis of DKA is based on clinical suspicion and subsequent laboratory confirmation: Hyperglycemia (sugar level greater than 11 mmol/L): diabetes warning sign. pH 7.3 and 15 mmol/L of bicarbonate indicate metabolic acidosis. Ketosis, which may include ketonuria or ketonaemia. The severity of DKA depends on the acidity level: Mild: pH 7.3 and/or 15 mmol/L of bicarbonate; Moderate: pH 7.2 and/or 10 mmol/L of bicarbonate. Ketoacidosis associated with diabetes (DKA) Extremely severe: pH 7.1 and/or 5 mmol/L of bicarbonate. DKA can have various deadly consequences. Acute hypoglycemia (during treatment or as a result of utilizing an excessive amount of insulin pump) Cerebral edema, Acute hypokalemia, Acute hypoglycemia, Spontaneous pneumonia. A, B, and C for initial CPR If at all possible, weigh the patient and then use that weight in all calculations. Use an estimated weight from a centile chart or a weight from a recent medical visit as an alternative. Make sure the airway is open. Insert an airway if a child is unconscious (Glasgow Coma Scale Score of 8). In the event that the patient is vomiting or has a reduced level of awareness, insert NGT, aspirate, and place on free drainage. B. An oxygen-only face mask. Draw blood when an IV cannula is in place. Only if the patient is shocked (poor peripheral pulses, poor capillary filling with tachycardia, and/or hypotension) should you provide a bolus of 10 ml/kg 0.9% sodium chloride. Repeat the fluid bolus only after contacting a doctor or pediatric endocrinologist if shock symptoms continue.