Diabetic ketoacidosis history and symptoms: Difference between revisions
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=== Past Medical History === | === Past Medical History === | ||
* DKA is associated with a past medical history of type 1 diabetes. | * DKA is associated with a past medical history of type 1 diabetes.<ref name="pmid15451769">{{cite journal |vauthors=Newton CA, Raskin P |title=Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences |journal=Arch. Intern. Med. |volume=164 |issue=17 |pages=1925–31 |year=2004 |pmid=15451769 |doi=10.1001/archinte.164.17.1925 |url=}}</ref> | ||
* Type 2 diabetics may rarely develop DKA at a late stage of the disease due to | * Type 2 diabetics may rarely develop DKA at a late stage of the disease due to failure of beta pancreatic cells.<ref name="pmid20119682">{{cite journal |vauthors=Lin MV, Bishop G, Benito-Herrero M |title=Diabetic ketoacidosis in type 2 diabetics: a novel presentation of pancreatic adenocarcinoma |journal=J Gen Intern Med |volume=25 |issue=4 |pages=369–73 |year=2010 |pmid=20119682 |pmc=2842543 |doi=10.1007/s11606-009-1237-9 |url=}}</ref> | ||
* History of infections (for example, urinary tract infections, pneumonia in an individual suffering from type 1 diabetes. <ref name=" | * History of infections (for example, urinary tract infections, pneumonia in an individual suffering from type 1 diabetes.<ref name="pmid22701840">{{cite journal |vauthors=Casqueiro J, Casqueiro J, Alves C |title=Infections in patients with diabetes mellitus: A review of pathogenesis |journal=Indian J Endocrinol Metab |volume=16 Suppl 1 |issue= |pages=S27–36 |year=2012 |pmid=22701840 |pmc=3354930 |doi=10.4103/2230-8210.94253 |url=}}</ref> | ||
=== Social History === | === Social History === | ||
* Patients may have a history of use of illicit drugs, for example, alcohol and cocaine. | * Patients may have a history of use of illicit drugs, for example, alcohol and cocaine.<ref name="pmid9738609">{{cite journal |vauthors=Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE |title=Diabetic ketoacidosis associated with cocaine use |journal=Arch. Intern. Med. |volume=158 |issue=16 |pages=1799–802 |year=1998 |pmid=9738609 |doi= |url=}}</ref> | ||
* Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics. | * Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics.<ref name="pmid24117508">{{cite journal |vauthors=Lewis KR, Clark C, Velarde MC |title=Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia |journal=Clin. Endocrinol. (Oxf) |volume=81 |issue=2 |pages=218–21 |year=2014 |pmid=24117508 |doi=10.1111/cen.12350 |url=}}</ref> | ||
==Symptoms== | ==Symptoms== | ||
===Early Symptoms=== | ===Early Symptoms=== | ||
The following are the early symptoms of DKA:<ref name="pmid23547550">{{cite journal |vauthors=Westerberg DP |title=Diabetic ketoacidosis: evaluation and treatment |journal=Am Fam Physician |volume=87 |issue=5 |pages=337–46 |year=2013 |pmid=23547550 |doi= |url=}}</ref><ref name="pmid15963033">{{cite journal |vauthors=Roche EF, Menon A, Gill D, Hoey H |title=Clinical presentation of type 1 diabetes |journal=Pediatr Diabetes |volume=6 |issue=2 |pages=75–8 |year=2005 |pmid=15963033 |doi=10.1111/j.1399-543X.2005.00110.x |url=}}</ref> | |||
* [[Sluggish]], [[extreme tiredness]] | * [[Sluggish]], [[extreme tiredness]] | ||
* [[Fruity smell to breath]]/compare to nail polish remover | * [[Fruity smell to breath]]/compare to nail polish remover | ||
* Extreme [[thirst]], despite large fluid intake | * Extreme [[thirst]], despite large fluid intake | ||
* [[Constant urination]] | * [[Constant urination]] | ||
| Line 39: | Line 40: | ||
===Late Symptoms=== | ===Late Symptoms=== | ||
At this point, DKA is life-threatening and medical attention should be sought immediately. | At this point, DKA is life-threatening and medical attention should be sought immediately. The following are late symptoms of DKA:<ref name="pmid26266145">{{cite journal |vauthors=Seth P, Kaur H, Kaur M |title=Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital |journal=J Clin Diagn Res |volume=9 |issue=6 |pages=OC01–4 |year=2015 |pmid=26266145 |pmc=4525534 |doi=10.7860/JCDR/2015/8586.5995 |url=}}</ref><ref name="pmid6419481">{{cite journal |vauthors=Barrett EJ, Sherwin RS |title=Gastrointestinal manifestations of diabetic ketoacidosis |journal=Yale J Biol Med |volume=56 |issue=3 |pages=175–8 |year=1983 |pmid=6419481 |pmc=2589676 |doi= |url=}}</ref><ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref> | ||
* Emesis ([[vomiting]]), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia. | * Emesis ([[vomiting]]), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia. | ||
* [[Confusion]] | * [[Confusion]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History
Age of onset
- Young children (age less than equal to 2 years) tend to present more likely with DKA as the first presentation of type 1 diabetes than older children.[1][2]
- Peripubertal and adolescent girls are affected more than other age groups.
Family History
- Families harboring HLA-associated high-risk genotypes are associated with a high chance of presenting DKA at diabetes onset.[3]
- Patients who have a family history of type 1 diabetes have less chance of developing DKA, possibly due to increased awareness of the disorder.[4]
Initial Presentation
- Patients may present with a history of poor compliance with insulin therapy or missed insulin injections due to vomiting or psychological reasons.
Past Medical History
- DKA is associated with a past medical history of type 1 diabetes.[5]
- Type 2 diabetics may rarely develop DKA at a late stage of the disease due to failure of beta pancreatic cells.[6]
- History of infections (for example, urinary tract infections, pneumonia in an individual suffering from type 1 diabetes.[7]
Social History
- Patients may have a history of use of illicit drugs, for example, alcohol and cocaine.[8]
- Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics.[9]
Symptoms
Early Symptoms
The following are the early symptoms of DKA:[10][11]
- Sluggish, extreme tiredness
- Fruity smell to breath/compare to nail polish remover
- Extreme thirst, despite large fluid intake
- Constant urination
- Extreme weight-loss
- Oral Thrush may be present, or/ yeast infections that fail to go away, this is because the normal fungal/flora present in oral cavity/cervix in women, the balance is upset and bacterial began to feast on the high sugar from urine output/ dry mouth from extreme thirst.
- Muscle wasting
- Agitation / Irritation / Aggression / Confusion
Late Symptoms
At this point, DKA is life-threatening and medical attention should be sought immediately. The following are late symptoms of DKA:[12][13][14]
- Emesis (vomiting), although this is not always a sign of late-stage ketoacidosis, and can occur both in early-stage ketoacidosis and in non-ketoacidic hyperglycaemia.
- Confusion
- Abdominal pain
- Loss of appetite
- Flu-like symptoms
- Lethargy and apathy
- Extreme weakness
- Kussmaul breathing ("air hunger"). Patients breathe more deeply and/or rapidly.
- Unconsciousness (diabetic coma) after prolonged DKA. At this stage, speedy medical attention is imperative.
References
- ↑ de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M (2013). "Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents". Diabet. Med. 30 (11): 1360–6. doi:10.1111/dme.12252. PMID 23758313.
- ↑ "Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait | Scientific Reports".
- ↑ Marigliano M, Morandi A, Maschio M, Costantini S, Contreas G, D'Annunzio G, Calcaterra V, Maffeis C (2013). "Diabetic ketoacidosis at diagnosis: role of family history and class II HLA genotypes". Eur. J. Endocrinol. 168 (1): 107–11. doi:10.1530/EJE-12-0541. PMID 23065995.
- ↑ Hekkala A, Ilonen J, Knip M, Veijola R (2011). "Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis". Eur. J. Endocrinol. 165 (5): 813–7. doi:10.1530/EJE-11-0376. PMID 21890652.
- ↑ Newton CA, Raskin P (2004). "Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences". Arch. Intern. Med. 164 (17): 1925–31. doi:10.1001/archinte.164.17.1925. PMID 15451769.
- ↑ Lin MV, Bishop G, Benito-Herrero M (2010). "Diabetic ketoacidosis in type 2 diabetics: a novel presentation of pancreatic adenocarcinoma". J Gen Intern Med. 25 (4): 369–73. doi:10.1007/s11606-009-1237-9. PMC 2842543. PMID 20119682.
- ↑ Casqueiro J, Casqueiro J, Alves C (2012). "Infections in patients with diabetes mellitus: A review of pathogenesis". Indian J Endocrinol Metab. 16 Suppl 1: S27–36. doi:10.4103/2230-8210.94253. PMC 3354930. PMID 22701840.
- ↑ Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE (1998). "Diabetic ketoacidosis associated with cocaine use". Arch. Intern. Med. 158 (16): 1799–802. PMID 9738609.
- ↑ Lewis KR, Clark C, Velarde MC (2014). "Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia". Clin. Endocrinol. (Oxf). 81 (2): 218–21. doi:10.1111/cen.12350. PMID 24117508.
- ↑ Westerberg DP (2013). "Diabetic ketoacidosis: evaluation and treatment". Am Fam Physician. 87 (5): 337–46. PMID 23547550.
- ↑ Roche EF, Menon A, Gill D, Hoey H (2005). "Clinical presentation of type 1 diabetes". Pediatr Diabetes. 6 (2): 75–8. doi:10.1111/j.1399-543X.2005.00110.x. PMID 15963033.
- ↑ Seth P, Kaur H, Kaur M (2015). "Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital". J Clin Diagn Res. 9 (6): OC01–4. doi:10.7860/JCDR/2015/8586.5995. PMC 4525534. PMID 26266145.
- ↑ Barrett EJ, Sherwin RS (1983). "Gastrointestinal manifestations of diabetic ketoacidosis". Yale J Biol Med. 56 (3): 175–8. PMC 2589676. PMID 6419481.
- ↑ Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.