Diabetic ketoacidosis physical examination: Difference between revisions
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* Hypothermia<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> | * Hypothermia<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> | ||
* Hypotension<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> | * Hypotension<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> | ||
* Tachycardia<ref name="pmid17308209"> | * Tachycardia<ref name="pmid17308209"></ref> | ||
* Tachypnea | * Tachypnea | ||
* Kussmaul breathing may be present in severe DKA<ref name="urlAlternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text">{{cite web |url=https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-2-41 |title=Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text |format= |work= |accessdate=}}</ref> | * Kussmaul breathing may be present in severe DKA<ref name="urlAlternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text">{{cite web |url=https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-2-41 |title=Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text |format= |work= |accessdate=}}</ref> | ||
| Line 21: | Line 21: | ||
=== Skin === | === Skin === | ||
* Cutaneous infection (non-healing ulcer) | * Cutaneous infection (non-healing ulcer)<ref name="pmid25653473">{{cite journal |vauthors=Duff M, Demidova O, Blackburn S, Shubrook J |title=Cutaneous manifestations of diabetes mellitus |journal=Clin Diabetes |volume=33 |issue=1 |pages=40–8 |year=2015 |pmid=25653473 |pmc=4299750 |doi=10.2337/diaclin.33.1.40 |url=}}</ref> | ||
* Xerosis | * Xerosis<ref name="pmid25653473"></ref> | ||
* Hair loss | * Hair loss<ref name="pmid25653473"></ref> | ||
* Acanthosis nigricans in type 2 diabetics | * Acanthosis nigricans in type 2 diabetics<ref name="urlChapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392§ionid=41138874 |title=Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical |format= |work= |accessdate=}}</ref> | ||
* Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics | * Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics<ref name="urlChapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392§ionid=41138766 |title=Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical |format= |work= |accessdate=}}</ref> | ||
* Eruptive xanthomas in type 2 diabetics | * Eruptive xanthomas in type 2 diabetics<ref name="pmid10815049">{{cite journal |vauthors=Paron NG, Lambert PW |title=Cutaneous manifestations of diabetes mellitus |journal=Prim. Care |volume=27 |issue=2 |pages=371–83 |year=2000 |pmid=10815049 |doi= |url=}}</ref><ref name="pmid25653473"></ref> | ||
* Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery) | * Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)<ref name="pmid25653473"></ref> | ||
* Vitiligo | * Vitiligo<ref name="pmid25653473"></ref> | ||
* Diabetic bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref> | * Diabetic bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref><ref name="pmid25653473"></ref> | ||
=== HEENT === | === HEENT === | ||
*Cranial nerve mononeuropathies of third, fourth, sixth, and seventh cranial nerves affecting ocular movements<ref name="pmid21760834">{{cite journal |vauthors=Skarbez K, Priestley Y, Hoepf M, Koevary SB |title=Comprehensive Review of the Effects of Diabetes on Ocular Health |journal=Expert Rev Ophthalmol |volume=5 |issue=4 |pages=557–577 |year=2010 |pmid=21760834 |pmc=3134329 |doi=10.1586/eop.10.44 |url=}}</ref> | |||
*Necrotizing (malignant) otitis externa (black escar)<ref name="pmid17185850">{{cite journal |vauthors=Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S |title=Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis |journal=Indian J Med Microbiol |volume=24 |issue=4 |pages=289–91 |year=2006 |pmid=17185850 |doi= |url=}}</ref> | |||
=== Neck === | === Neck === | ||
* Not significant | |||
=== Lungs === | === Lungs === | ||
*Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)<ref name="pmid26240698">{{cite journal |vauthors=Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH |title=Respiratory failure in diabetic ketoacidosis |journal=World J Diabetes |volume=6 |issue=8 |pages=1009–23 |year=2015 |pmid=26240698 |pmc=4515441 |doi=10.4239/wjd.v6.i8.1009 |url=}}</ref> | *Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)<ref name="pmid26240698">{{cite journal |vauthors=Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH |title=Respiratory failure in diabetic ketoacidosis |journal=World J Diabetes |volume=6 |issue=8 |pages=1009–23 |year=2015 |pmid=26240698 |pmc=4515441 |doi=10.4239/wjd.v6.i8.1009 |url=}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Physical Examination
Appearance of the Patient
Patient may look thin, cachectic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis.
Vital Signs
- Hypothermia[1]
- Hypotension[2]
- Tachycardia[2]
- Tachypnea
- Kussmaul breathing may be present in severe DKA[3]
- Weak pulse due to dehydration
Skin
- Cutaneous infection (non-healing ulcer)[4]
- Xerosis[4]
- Hair loss[4]
- Acanthosis nigricans in type 2 diabetics[5]
- Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics[6]
- Eruptive xanthomas in type 2 diabetics[7][4]
- Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)[4]
- Vitiligo[4]
- Diabetic bullae[8][4]
HEENT
- Cranial nerve mononeuropathies of third, fourth, sixth, and seventh cranial nerves affecting ocular movements[9]
- Necrotizing (malignant) otitis externa (black escar)[10]
Neck
- Not significant
Lungs
- Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)[11]
Heart
- S1 normal
- S2 normal
- Prolonged QT interval[12]
- U wave (hypokalemia)[13]
- Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia[14]
Abdomen
- Nausea
- Vomiting
- Abdominal pain
Back
- Not significant
Genitourinary
- Polyuria
Extremities
- Muscle atrophy
- Cold extremities
Neuromuscular
- Hemianopia
- Hemiparesis
- Seizures
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ 2.0 2.1 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.
- ↑ "Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text".
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Duff M, Demidova O, Blackburn S, Shubrook J (2015). "Cutaneous manifestations of diabetes mellitus". Clin Diabetes. 33 (1): 40–8. doi:10.2337/diaclin.33.1.40. PMC 4299750. PMID 25653473.
- ↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
- ↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
- ↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
- ↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
- ↑ Skarbez K, Priestley Y, Hoepf M, Koevary SB (2010). "Comprehensive Review of the Effects of Diabetes on Ocular Health". Expert Rev Ophthalmol. 5 (4): 557–577. doi:10.1586/eop.10.44. PMC 3134329. PMID 21760834.
- ↑ Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S (2006). "Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis". Indian J Med Microbiol. 24 (4): 289–91. PMID 17185850.
- ↑ Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH (2015). "Respiratory failure in diabetic ketoacidosis". World J Diabetes. 6 (8): 1009–23. doi:10.4239/wjd.v6.i8.1009. PMC 4515441. PMID 26240698.
- ↑ Kuppermann N, Park J, Glatter K, Marcin JP, Glaser NS (2008). "Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children". Arch Pediatr Adolesc Med. 162 (6): 544–9. doi:10.1001/archpedi.162.6.544. PMID 18524745.
- ↑ Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
- ↑ Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG (2016). "Role of diabetes in heart rhythm disorders". World J Diabetes. 7 (3): 45–9. doi:10.4239/wjd.v7.i3.45. PMC 4733448. PMID 26862372.