Diabetic ketoacidosis primary prevention: Difference between revisions
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{{Diabetic ketoacidosis}} | {{Diabetic ketoacidosis}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Effective measures for the [[primary prevention]] of diabetic ketoacidosis (DKA) include recognition of early signs of DKA, implementation of early and aggressive interventions (especially in patients with recurrent episodes of DKA) and administration of optimum [[Anti-diabetic drug|anti-diabetic medications]] in [[diabetic]] patients. | |||
==Primary Prevention== | ==Primary Prevention== | ||
Primary prevention of diabetic ketoacidosis (DKA) includes the following measures:<ref name="pmid18551826">{{cite journal |vauthors=Vanelli M, Scarabello C, Fainardi V |title=Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. "The Parma campaign" |journal=Acta Biomed |volume=79 |issue=1 |pages=73–8 |year=2008 |pmid=18551826 |doi= |url=}}</ref><ref name="urlManagement of Diabetic Ketoacidosis - American Family Physician">{{cite web |url=http://www.aafp.org/afp/1999/0801/p455.html |title=Management of Diabetic Ketoacidosis - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid4085289">{{cite journal |vauthors=Zhou HC |title=[Preliminary studies of cardiac function in pre-eclamptic patients with echocardiography and systolic time intervals] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=20 |issue=5 |pages=266–9, 317 |year=1985 |pmid=4085289 |doi= |url=}}</ref> | Primary prevention of diabetic ketoacidosis (DKA) includes the following measures:<ref name="pmid18551826">{{cite journal |vauthors=Vanelli M, Scarabello C, Fainardi V |title=Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. "The Parma campaign" |journal=Acta Biomed |volume=79 |issue=1 |pages=73–8 |year=2008 |pmid=18551826 |doi= |url=}}</ref><ref name="urlManagement of Diabetic Ketoacidosis - American Family Physician">{{cite web |url=http://www.aafp.org/afp/1999/0801/p455.html |title=Management of Diabetic Ketoacidosis - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid4085289">{{cite journal |vauthors=Zhou HC |title=[Preliminary studies of cardiac function in pre-eclamptic patients with echocardiography and systolic time intervals] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=20 |issue=5 |pages=266–9, 317 |year=1985 |pmid=4085289 |doi= |url=}}</ref><ref name="urlwww.aace.com">{{cite web |url=https://www.aace.com/files/position-statements/SGLT-2-position-statement.pdf |title=www.aace.com |format= |work= |accessdate=}}</ref> | ||
* '''Recognition of early signs:''' | * '''Recognition of early signs:''' | ||
** Vomiting | ** [[Vomiting]] | ||
** Hyperglycemia | ** [[Hyperglycemia]] | ||
** Large ketonuria | ** Large [[ketonuria]] | ||
** Weakness | ** [[Weakness]] | ||
** Heavy breathing or shortness of breath | ** Heavy breathing or [[shortness of breath]] | ||
* '''Early recognition of inciting event of DKA:''' | * '''Early recognition of inciting event of DKA:''' | ||
** Missed insulin dose or error in dosing | ** Missed [[insulin]] dose or error in dosing | ||
** Intercurrent illness, especially infection | ** Intercurrent illness, especially [[infection]] | ||
** Psychologic stress | ** [[Psychologic stress]] | ||
** Surgery or trauma | ** [[Surgery]] or [[trauma]] | ||
* '''Early intervention:''' | * '''Early intervention:''' | ||
** Enhanced and more frequent monitoring of blood glucose and urine ketones | ** Enhanced and more frequent monitoring of [[blood glucose]] and [[urine]] [[ketones]] | ||
** Increased fluid intake | ** Increased [[fluid]] intake | ||
** Seek advice from health care team | ** Seek advice from health care team | ||
* '''Aggressive intervention in patients with recurrent episodes of DKA:''' | * '''Aggressive intervention in patients with recurrent episodes of DKA:''' | ||
** Psychiatric evaluation | ** [[Psychiatric]] evaluation | ||
** Individual and family evaluation/intervention | ** Individual and family evaluation/intervention | ||
** Continuous subcutaneous insulin infusion helpful in some patients | ** Continuous [[subcutaneous]] [[insulin]] [[infusion]] helpful in some patients | ||
** Possible out-of-home placement | ** Possible out-of-home placement | ||
* '''Adjustment of anti-diabetic agents in diabetic patients:''' | |||
** Patients with [[diabetes]] undergoing emergency surgery or a under sudden external severe stress event, the following drugs should be stopped immediately: | |||
*** [[Canagliflozin]] | |||
*** [[Dapagliflozin]] | |||
*** [[Empagliflozin]] | |||
** Patients taking [[SGLT2|SGLT-2 inhibitors]] should avoid excess [[alcohol]] intake and very-low-[[carbohydrate]]/[[Ketogenic diet|ketogenic diets]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 16:44, 6 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Effective measures for the primary prevention of diabetic ketoacidosis (DKA) include recognition of early signs of DKA, implementation of early and aggressive interventions (especially in patients with recurrent episodes of DKA) and administration of optimum anti-diabetic medications in diabetic patients.
Primary Prevention
Primary prevention of diabetic ketoacidosis (DKA) includes the following measures:[1][2][3][4]
- Recognition of early signs:
- Vomiting
- Hyperglycemia
- Large ketonuria
- Weakness
- Heavy breathing or shortness of breath
- Early recognition of inciting event of DKA:
- Missed insulin dose or error in dosing
- Intercurrent illness, especially infection
- Psychologic stress
- Surgery or trauma
- Early intervention:
- Enhanced and more frequent monitoring of blood glucose and urine ketones
- Increased fluid intake
- Seek advice from health care team
- Aggressive intervention in patients with recurrent episodes of DKA:
- Psychiatric evaluation
- Individual and family evaluation/intervention
- Continuous subcutaneous insulin infusion helpful in some patients
- Possible out-of-home placement
- Adjustment of anti-diabetic agents in diabetic patients:
- Patients with diabetes undergoing emergency surgery or a under sudden external severe stress event, the following drugs should be stopped immediately:
- Patients taking SGLT-2 inhibitors should avoid excess alcohol intake and very-low-carbohydrate/ketogenic diets.
References
- ↑ Vanelli M, Scarabello C, Fainardi V (2008). "Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. "The Parma campaign"". Acta Biomed. 79 (1): 73–8. PMID 18551826.
- ↑ "Management of Diabetic Ketoacidosis - American Family Physician".
- ↑ Zhou HC (1985). "[Preliminary studies of cardiac function in pre-eclamptic patients with echocardiography and systolic time intervals]". Zhonghua Fu Chan Ke Za Zhi (in Chinese). 20 (5): 266–9, 317. PMID 4085289.
- ↑ "www.aace.com" (PDF).