Diabetic ketoacidosis physical examination: Difference between revisions
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=== Appearance of the Patient === | === Appearance of the Patient === | ||
Patient may look thin, cachectic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis. | Patient may look thin, cachectic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis.<ref name="urlHyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK279052/ |title=Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf |format= |work= |accessdate=}}</ref> | ||
=== Vital Signs === | === Vital Signs === | ||
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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.[1]
Vital Signs
- Hypothermia[2]
- Hypotension[3]
- Tachycardia[3]
- Tachypnea[4]
- Kussmaul breathing may be present in severe DKA[5]
- Weak pulse due to dehydration
Skin
- Cutaneous infection (non-healing ulcer)[6]
- Xerosis[6]
- Hair loss[6]
- Acanthosis nigricans in type 2 diabetics[7]
- Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics[8]
- Eruptive xanthomas in type 2 diabetics[9][6]
- Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)[6]
- Vitiligo[6]
- Diabetic bullae[10][6]
HEENT
- Cranial nerve mononeuropathies of third, fourth, sixth, and seventh cranial nerves affecting ocular movements[11]
- Necrotizing (malignant) otitis externa (black escar)[12]
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)[13]
Heart
- S1 normal
- S2 normal
- Prolonged QT interval[14]
- U wave (hypokalemia)[15]
- Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia[16]
Abdomen
- Nausea
- Vomiting
- Abdominal pain[17]
Back
- Not significant
Genitourinary
- Polyuria[3]
Extremities
Neuromuscular
References
- ↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ 3.0 3.1 3.2 3.3 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.
- ↑ Rosenbloom AL (2010). "The management of diabetic ketoacidosis in children". Diabetes Ther. 1 (2): 103–20. doi:10.1007/s13300-010-0008-2. PMC 3138479. PMID 22127748.
- ↑ "Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text".
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 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.
- ↑ Umpierrez G, Freire AX (2002). "Abdominal pain in patients with hyperglycemic crises". J Crit Care. 17 (1): 63–7. PMID 12040551.
- ↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
- ↑ Guisado R, Arieff AI (1975). "Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain". Metab. Clin. Exp. 24 (5): 665–79. PMID 805337.
- ↑ Yun C, Xuefeng W (2013). "Association between seizures and diabetes mellitus: a comprehensive review of literature". Curr Diabetes Rev. 9 (4): 350–4. PMID 23590576.