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{{Diabetic ketoacidosis}} | {{Diabetic ketoacidosis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{HK}} | ||
==Overview== | |||
If left untreated, patients with diabetic ketoacidosis (DKA) may progress to develop [[Multiorgan failure|multi-organ failure]] and death. Common complications of diabetic ketoacidosis (DKA) include [[hypokalemia]], [[cerebral edema]], [[hyperglycemia]], [[ketoacidemia]], [[renal tubular necrosis]] and [[pulmonary edema]]. | |||
==Natural History== | ==Natural History== | ||
* If left untreated, diabetic ketoacidosis may progress to [[Multiorgan failure|multi-organ failure]] and death | |||
* Early in the course of the ketoacidotic process, [[hyperventilation]] results in a decrease in [[pCO2]]. The [[metabolic acidosis]] is compensated, and [[pH]] may be normal or only slightly reduced (e.g., in mild or moderate DKA) | |||
* As DKA progresses into the severe stage, more significant [[acidosis]] occurs and [[pH]] falls | |||
* If compensatory [[hyperventilation]] does not occur for the [[acidosis]], such as, in pulmonary disease ([[pneumonia]], [[asthma]], or [[adult respiratory distress syndrome]]) or [[CNS depression]] (e.g., [[cerebral edema]]), the [[acidosis]] becomes more severe and results in a poor [[prognosis]] | |||
* Although [[acidosis]] impairs [[myocardial]] [[contractility]], [[heart failure]] and [[cardiogenic shock]] are rare in children with DKA | |||
* [[Hypotension]] or [[shock]] during DKA is nearly always the result of [[hypovolemia]] or [[cerebral edema]] in children | |||
* [[Heart failure]], [[myocardial infarction]], and [[arrhythmias]] during DKA are seen commonly in untreated diabetic ketoacidosis | |||
==Complications== | ==Complications== | ||
People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment: | People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:<ref name="pmid9083292">{{cite journal |vauthors=Silver SM, Clark EC, Schroeder BM, Sterns RH |title=Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis |journal=Kidney Int. |volume=51 |issue=4 |pages=1237–44 |year=1997 |pmid=9083292 |doi= |url=}}</ref><ref name="pmid15220225">{{cite journal |vauthors=Muir AB, Quisling RG, Yang MC, Rosenbloom AL |title=Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification |journal=Diabetes Care |volume=27 |issue=7 |pages=1541–6 |year=2004 |pmid=15220225 |doi= |url=}}</ref><ref name="mayo">{{cite web | By Mayo Clinic Staff | title = Diabetic ketoacidosis | publisher=Mayo Foundation for Medical Education and Research | work = Diabetic ketoacidosis | url=http://www.mayoclinic.com/health/diabetic-ketoacidosis/DS00674/DSECTION=7 | year = 2006 | accessdate=2007-06-15}}</ref><ref name="AMN">{{cite web | Umesh Masharani, MB, BS, MRCP | title = Diabetic Coma > Diabetic ketoacidosis | publisher=Armenian Medical Network | work = Diabetic ketoacidosis | url=http://www.health.am/db/diabetic-ketoacidosis/ | year = 2006 | accessdate=2007-06-15}}</ref><ref name="monitor">{{cite web | title = Diabetic ketoacidosis complications| publisher=The Diabetes Monitor | work = Diabetic ketoacidosis | url=http://www.diabetesmonitor.com/dmemerh/sld033.htm | year = 2007 | accessdate=2007-06-15}}</ref> | ||
* [[Hypokalemia]] and often, [[potassium depletion]] | * [[Hypokalemia]] and often, [[potassium depletion]] | ||
* [[Cerebral edema]] | * [[Cerebral edema]] | ||
* [[Hyperglycemia]] | * [[Hyperglycemia]] | ||
* [[Ketoacidemia]] | * [[Ketoacidemia]] | ||
* Fluid and electrolyte depletion | * Fluid and electrolyte depletion | ||
* [[Aspiration]] | * [[Aspiration]] | ||
* Unrecognized [[renal tubular necrosis]] | * Unrecognized [[renal tubular necrosis]] | ||
* [[Pulmonary edema]] | * [[Pulmonary edema]] | ||
==Prognosis== | ==Prognosis== | ||
=== Signs of poor prognosis === | |||
* The following are the signs of poor [[prognosis]] in diabetic ketoacidosis at the time of diagnosis:<ref name="pmid26825908">{{cite journal |vauthors=Liu WY, Lin SG, Wang LR, Fang CC, Lin YQ, Braddock M, Zhu GQ, Zhang Z, Zheng MH, Shen FX |title=Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis |journal=Medicine (Baltimore) |volume=95 |issue=4 |pages=e2596 |year=2016 |pmid=26825908 |pmc=5291578 |doi=10.1097/MD.0000000000002596 |url=}}</ref><ref name="pmid102402">{{cite journal |vauthors=Gale EA, Tattersall RB |title=Hypothermia: a complication of diabetic ketoacidosis |journal=Br Med J |volume=2 |issue=6149 |pages=1387–9 |year=1978 |pmid=102402 |pmc=1608617 |doi= |url=}}</ref><ref name="pmid19736483">{{cite journal |vauthors=Al-Matrafi J, Vethamuthu J, Feber J |title=Severe acute renal failure in a patient with diabetic ketoacidosis |journal=Saudi J Kidney Dis Transpl |volume=20 |issue=5 |pages=831–4 |year=2009 |pmid=19736483 |doi= |url=}}</ref> | |||
** [[Hypothermia]] | |||
** [[Coma]] | |||
** [[Oliguria]] | |||
** Extremes of age (young and elderly) | |||
** Intercurrent [[comorbidity]], for example, [[myocardial infaction]], [[sepsis]] | |||
** Positive tropinins without evident [[Acute coronary syndromes|acute coronary syndrome]] | |||
** High [[platelet]] to [[lymphocyte]] ratio | |||
==References== | ==References== | ||
{{ | |||
{{Reflist|2}} | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Needs overview]] | |||
[[Category: | [[Category:Needs content]] | ||
[[Category:Pediatrics]] | |||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Emergency medicine]] | |||
Latest revision as of 07:00, 11 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
If left untreated, patients with diabetic ketoacidosis (DKA) may progress to develop multi-organ failure and death. Common complications of diabetic ketoacidosis (DKA) include hypokalemia, cerebral edema, hyperglycemia, ketoacidemia, renal tubular necrosis and pulmonary edema.
Natural History
- If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death
- Early in the course of the ketoacidotic process, hyperventilation results in a decrease in pCO2. The metabolic acidosis is compensated, and pH may be normal or only slightly reduced (e.g., in mild or moderate DKA)
- As DKA progresses into the severe stage, more significant acidosis occurs and pH falls
- If compensatory hyperventilation does not occur for the acidosis, such as, in pulmonary disease (pneumonia, asthma, or adult respiratory distress syndrome) or CNS depression (e.g., cerebral edema), the acidosis becomes more severe and results in a poor prognosis
- Although acidosis impairs myocardial contractility, heart failure and cardiogenic shock are rare in children with DKA
- Hypotension or shock during DKA is nearly always the result of hypovolemia or cerebral edema in children
- Heart failure, myocardial infarction, and arrhythmias during DKA are seen commonly in untreated diabetic ketoacidosis
Complications
People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:[1][2][3][4][5]
- Hypokalemia and often, potassium depletion
- Cerebral edema
- Hyperglycemia
- Ketoacidemia
- Fluid and electrolyte depletion
- Aspiration
- Unrecognized renal tubular necrosis
- Pulmonary edema
Prognosis
Signs of poor prognosis
- The following are the signs of poor prognosis in diabetic ketoacidosis at the time of diagnosis:[6][7][8]
- Hypothermia
- Coma
- Oliguria
- Extremes of age (young and elderly)
- Intercurrent comorbidity, for example, myocardial infaction, sepsis
- Positive tropinins without evident acute coronary syndrome
- High platelet to lymphocyte ratio
References
- ↑ Silver SM, Clark EC, Schroeder BM, Sterns RH (1997). "Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis". Kidney Int. 51 (4): 1237–44. PMID 9083292.
- ↑ Muir AB, Quisling RG, Yang MC, Rosenbloom AL (2004). "Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification". Diabetes Care. 27 (7): 1541–6. PMID 15220225.
- ↑ "Diabetic ketoacidosis". Diabetic ketoacidosis. Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-06-15. Text " By Mayo Clinic Staff " ignored (help)
- ↑ "Diabetic Coma > Diabetic ketoacidosis". Diabetic ketoacidosis. Armenian Medical Network. 2006. Retrieved 2007-06-15. Text " Umesh Masharani, MB, BS, MRCP " ignored (help)
- ↑ "Diabetic ketoacidosis complications". Diabetic ketoacidosis. The Diabetes Monitor. 2007. Retrieved 2007-06-15.
- ↑ Liu WY, Lin SG, Wang LR, Fang CC, Lin YQ, Braddock M, Zhu GQ, Zhang Z, Zheng MH, Shen FX (2016). "Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis". Medicine (Baltimore). 95 (4): e2596. doi:10.1097/MD.0000000000002596. PMC 5291578. PMID 26825908.
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ Al-Matrafi J, Vethamuthu J, Feber J (2009). "Severe acute renal failure in a patient with diabetic ketoacidosis". Saudi J Kidney Dis Transpl. 20 (5): 831–4. PMID 19736483.