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management ketoacidosis

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https://www.readbyqxmd.com/read/29135618/pathway-for-the-management-of-hyperglycemia-in-the-cardiac-care-unit
#1
Seyed Hamed Hosseini Dehkordi, Jeanine Albu, Emad F Aziz, Eyal Herzog
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29111277/resolution-of-ketoacidosis-in-children-with-new-onset-diabetes-evaluation-of-various-definitions
#2
Julia E von Oettingen, Erinn T Rhodes, Joseph I Wolfsdorf
AIMS: Data are sparse concerning use of serum electrolyte parameters as compared to venous blood gas (VBG) measurements to monitor acid-base status during treatment of diabetic ketoacidosis (DKA). We explored the utility of various parameters to define DKA resolution by investigating the relationship of venous pH (vpH), anion gap (AG), serum bicarbonate (HCO3), and glucose concentration during management of DKA in children with new onset diabetes mellitus (NODM). METHODS: We included all patients with NODM presenting with DKA to Boston Children's Hospital from 10/1/07-7/1/13...
October 27, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29109609/end-stage-renal-disease-increases-rates-of-adverse-glucose-events-when-treating-diabetic-ketoacidosis-or-hyperosmolar-hyperglycemic-state
#3
Caitlin M Schaapveld-Davis, Ana L Negrete, Joanna Q Hudson, Jagannath Saikumar, Christopher K Finch, Mehmet Kocak, Pan Hu, Megan A Van Berkel
IN BRIEF Treatment guidelines for diabetic emergencies are well described in patients with normal to moderately impaired kidney function. However, management of patients with end-stage renal disease (ESRD) is an ongoing challenge. This article describes a retrospective study comparing the rates of adverse glucose events (defined as hypoglycemia or a decrease in glucose >200 mg/dL/h) between patients with ESRD and those with normal kidney function who were admitted with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS)...
October 2017: Clinical Diabetes: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29105262/evaluation-of-novorapid-infusion-as-a-treatment-option-in-the-management-of-diabetic-ketoacidosis
#4
Raylene Kwok, Shoshana Sztal-Mazer, Ria E Hopkins, Susan G Poole, Louise Grannell, John Coutsouvelis, Duncan J Topliss
This study evaluates the clinical efficacy and safety of NovoRapid (insulin aspart) compared to Actrapid™ (human neutral insulin) for diabetic ketoacidosis (DKA). In this retrospective study involving 40 patients, no statistically significant differences were observed between biochemical variables, infusion duration or complications in patients treated with insulin aspart or human neutral insulin. These results support the use of insulin aspart as an effective and safe alternative to human neutral insulin in DKA...
November 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29081625/sodium-glucose-transporter-2-inhibitors-and-diabetic-ketoacidosis-in-three-patients-with-diabetes-underlying-causation
#5
Jordan L Kelley, Matthew Strum, Daniel M Riche, Andrew M Chandler
Sodium glucose transporter 2 inhibitors (SGLT2i) inhibit the reabsorption of glucose in the renal tubules reducing glycemia and increasing glucosuria. The increased glucosuria causes a shift in normal flora and colonization of pathogenic microorganisms leading to an increase in mycotic genital infections. Recent Food and Drug Administration reported cases of diabetic ketoacidosis (DKA) after initiation of SGLT2i probes the question of safety with such agents. The mechanisms of ketoacidosis and the breakdown of lipids are often misunderstood, and blame is placed on lack of insulin or on medications used to treat diabetes...
July 2017: Journal of Pharmacology & Pharmacotherapeutics
https://www.readbyqxmd.com/read/29079259/endoscopic-endonasal-transsphenoidal-drainage-of-a-spontaneous-candida-glabrata-pituitary-abscess-case-report-intraoperative-video
#6
Ben A Strickland, Martin Pham, Joshua Bakhsheshian, John Carmichael, Martin Weiss, Gabriel Zada
Noniatrogenic pituitary abscesses remain a rare clinical entity, and are the indication for surgery in <1% of transsphenoidal approaches. Correct diagnosis of this rare entity is often delayed. Without timely treatment, morbidity and mortality are high. Of the 200 cases reported, less than half have identified a causative organism. We report the second case of a pituitary abscess caused by Candida species, and further provide intraoperative video of endoscopic management of this pathology. A 33-year-old woman presented with headache, hypopituitarism, and vision loss in the setting of diabetic ketoacidosis, and was found to have multiple abscesses in the liver, lung, kidney, and uterus...
October 24, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29078811/dengue-hemorrhagic-fever-complicated-with-transient-diabetic-ketoacidosis-a-case-report
#7
Chamara Dalugama, Indika Bandara Gawarammana
BACKGROUND: The increasing global prevalence of both dengue and diabetes may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. Dengue illness is rarely known to precipitate diabetic ketoacidosis among diabetic patients. Both type 1 and type 2 diabetes increase the release of pro-inflammatory cytokines by various mechanisms and increase the risk of plasma leak in dengue fever. Acute pancreatitis is an atypical and rare presentation of dengue fever...
October 28, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29073302/potential-clinical-benefits-of-a-two-bag-system-for-fluid-management-in-pediatric-intensive-care-unit-patients-with-diabetic-ketoacidosis
#8
Jacqueline P Velasco Md, Joshua Fogel PhD, Robert L Levine Md PhD, Peter Ciminera Md, David Fagan Md, Renee Bargman Md
INTRODUCTION: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that requires appropriate treatment with insulin and intravenous fluids. Both one-bag and two-bag systems of fluid management are used to treat pediatric diabetic ketoacidosis. AIM OF THE STUDY: We compare the one-bag and two-bag systems of fluid managementwith regard to incidence of hypoglycemia, serum bicarbonate correction, pH correction and discharge from the pediatric intensive care unit (PICU)...
2017: Pediatric Endocrinology, Diabetes, and Metabolism
https://www.readbyqxmd.com/read/29058835/-diabetes-and-ramadan-consequences-of-fasting-and-practical-aspects-of-management
#9
S Bessemans, N Paquot
A lot of diabetic Muslims choose to fast during Ramadan, despite recommendations that advise some patients to abstain according to established risk factors. Fasting exposes the diabetic subject to acute major complications, including diabetic ketoacidosis and severe hypoglycaemia. Patients with diabetes, therefore, had to benefit from individualized care already before Ramadan, including a risk assessment, a specific education integrating in particular the adaptation of the pharmacological treatment in order to limit the occurrence of these acute complications...
October 2017: Revue Médicale de Liège
https://www.readbyqxmd.com/read/29039237/sglt2-inhibitors-are-they-safe
#10
Sebastian Filippas-Ntekouan, Theodosios D Filippatos, Moses S Elisaf
Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics...
October 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/29034986/access-to-a-youth-specific-service-for-young-adults-with-type-1-diabetes-mellitus-is-associated-with-decreased-hospital-length-of-stay-for-diabetic-ketoacidosis
#11
Kharis Burns, Kaye Farrell, Rickie Myszka, Kris Park, Deborah Jane Holmes-Walker
BACKGROUND: Management of Type 1 diabetes mellitus (T1DM) in youth with diabetes is complex and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay for diabetic ketoacidosis (DKA). AIMS: This study aimed to assess the impact of a youth specific diabetes service for youth with diabetes (YWD) on DKA admissions in two adjacent local health districts (LHDs)...
October 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29026743/management-of-diabetic-ketosis-and-ketoacidosis-with-intramuscular-regular-insulin-in-a-low-resource-family-medicine-setting
#12
Sudhakar Basetty, G S Yeshvanth Kumar, Martina Shalini, Ruby Pricilla Angeline, Kirubah Vasandhi David, Sunil Abraham
BACKGROUND: India is facing an epidemic of diabetes mellitus (DM). Effective management of complications of DM is a challenge in resource-poor areas of India. This study addresses the need to explore low-cost methods to manage diabetic ketosis (DK) and diabetic ketoacidosis (DKA). OBJECTIVES: To demonstrate the use of intramuscular (IM) regular insulin as a safe alternative method to control DK and DKA in a family practice setting. MATERIALS AND METHODS: A retrospective chart review was done for 34 patients admitted with DK and DKA in a family medicine unit for the urban poor over 5 years...
January 2017: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28989879/root-cause-analysis-of-diabetic-ketoacidosis-admissions-at-a-tertiary-referral-pediatric-emergency-department-in-north-india
#13
Muralidharan Jayashree, Rohit Sasidharan, Sunit Singhi, Karthi Nallasamy, Mullai Baalaaji
OBJECTIVES: To identify system-based factors contributing to Emergency Department (ED) admissions of children with diabetic ketoacidosis (DKA) and related complications with emphasis on parental and physician awareness and prereferral management. MATERIALS AND METHODS: A prospective observational root cause analysis study of all consecutive admissions of children with DKA to pediatric ED of a tertiary care referral hospital in northern India over a period of 1 year (July 2010-June 2011)...
September 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28988226/severe-complications-after-initial-management-of-hyperglycemic-hyperosmolar-syndrome-and-diabetic-ketoacidosis-with-a-standard-diabetic-ketoacidosis-protocol
#14
Bimota Nambam, Emily Menefee, Neslihan Gungor, Robert Mcvie
Hyperglycemic hyperosmolar syndrome (HHS) is a clinical entity not identical to diabetic ketoacidosis (DKA), and with a markedly higher mortality. Children with HHS can also present with concomitant DKA. Patients with HHS (with or without DKA) are profoundly dehydrated but often receive inadequate fluid resuscitation as well as intravenous insulin therapy based on traditional DKA protocols, and this can lead to devastating consequences. In this article, we briefly review HHS along with a report of an adolescent who presented with HHS and DKA and was initially managed as DKA...
October 26, 2017: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://www.readbyqxmd.com/read/28984788/concurrent-diabetic-ketoacidosis-in-hypertriglyceridemia-induced-pancreatitis-how-does-it-affect-the-clinical-course-and-severity-scores
#15
Yuchen Wang, Bashar M Attar, Keiki Hinami, Palashkumar Jaiswal, John Erikson Yap, Radhika Jaiswal, Kalpit Devani, Carlos Roberto Simons-Linares, Melchor V Demetria
OBJECTIVES: Concurrent diabetic ketoacidosis (DKA) is highly prevalent in patients with hypertriglyceridemia-induced pancreatitis (HP). Diabetic ketoacidosis could potentially complicate the diagnosis, management, and prognosis of HP. This study aimed to directly compare the clinical course of HP with and without DKA and assess the outcomes of frequently used severity-prediction scores in such population. METHODS: We retrospectively analyzed 140 patients with HP; 37 patients (26...
November 2017: Pancreas
https://www.readbyqxmd.com/read/28979521/therapeutic-challenges-in-the-management-of-diabetic-ketoacidosis
#16
Jaspreet K Sidana, Caroline Phillips, Ayush Sinha, Nicholas Levy
No abstract text is available yet for this article.
November 2016: J Intensive Care Soc
https://www.readbyqxmd.com/read/28978574/in-the-setting-of-paediatric-osteomyelitis-do-not-be-afraid-to-cast-an-eye
#17
Rebecca Anne Russell, Edina Moylett
The case commences with an innocuous right ankle injury (lateral malleolus), for which the patient, a 9-year-old boy, was placed in a temporary cast at his local hospital. Three days following this incident, the patient was diagnosed with new-onset type 1 diabetes mellitus. He was admitted to his local hospital with severe diabetic ketoacidosis appropriately treated and subsequently discharged c.1 week later clinically well. Approximately 1 week later, again he presented for a third time with a significant serosanguinous discharge from the site of the initial injury permeating through the temporary cast in place for c...
October 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28974584/regular-and-frequent-feedback-of-specific-clinical-criteria-delivers-a-sustained-improvement-in-the-management-of-diabetic-ketoacidosis%C3%A2
#18
Punith Kempegowda, Ben Coombs, Peter Nightingale, Joht Singh Chandan, Jaffar Al-Sheikhli, Bhavana Shyamanur, Kasun Theivendran, Anitha Vijayan Melapatte, Umesh Salanke, Mohammed Akber, Sandip Ghosh, Parth Narendran
Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28951345/diabetic-ketoacidosis-in-acromegaly-a-rare-complication-precipitated-by-corticosteroid-use
#19
REVIEW
Jeremy Weiss, Anna J Wood, Jeffrey D Zajac, Mathis Grossmann, Sofianos Andrikopoulos, Elif I Ekinci
Diabetic ketoacidosis has been described in the literature as a rare possible initial presentation of acromegaly before a diagnosis of acromegaly is eventually made. Indeed, diabetic ketoacidosis is a recognised complication of acromegaly. There are a number of factors that can predispose patients with acromegaly to diabetes as well as to diabetic ketoacidosis. These include high levels of growth hormone and insulin-like growth factor 1 in acromegaly and the effect on glycaemia by medications used in the management of acromegaly...
September 19, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28943514/a-novel-kcnj11-mutation-associated-with-transient-neonatal-diabetes
#20
Evangelia Gole, Stavroula Oikonomou, Sian Ellard, Elisa De Franco, Kyriaki Karavanaki
BACKGROUND: Neonatal diabetes mellitus (NDM) is a rare type of monogenic diabetes that presents in the first 6 months of life. Activating mutations in the KCNJ11 gene encoding for the Kir6.2 subunit of the KATP channel can lead to transient (TNDM) or permanent neonatal diabetes mellitus (PNDM). CASE REPORT: A female infant presented at the 22nd day of life with severe hyperglycemia and ketoacidosis (glucose: 907mg/dl, blood gas pH: 6.84, HCO3: 6mmol/l). She was initially managed with intravenous (IV) fluids and IV insulin...
September 25, 2017: Journal of Clinical Research in Pediatric Endocrinology
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