Diabetic ketoacidosis primary prevention: Difference between revisions
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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> | 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:''' | * '''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 with [[diabetes]] undergoing emergency surgery or a under sudden external severe stress event, the following drugs should be stopped immediately: | ||
*** Canagliflozin | *** [[Canagliflozin]] | ||
*** Dapagliflozin | *** [[Dapagliflozin]] | ||
*** Empagliflozin | *** [[Empagliflozin]] | ||
** Patients taking SGLT-2 inhibitors should avoid excess alcohol intake and very-low-carbohydrate/ketogenic diets. | ** 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}} | ||
Revision as of 16:39, 6 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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).