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Reviews on Recent Clinical Trials

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ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

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Review Article

An Approach to Diabetic Ketoacidosis in an Emergency Setting

Author(s): Dario Pitocco*, Mauro Di Leo, Linda Tartaglione, Emanuele Gaetano Rizzo, Salvatore Caputo, Alessandro Rizzi and Alfredo Pontecorvi

Volume 15, Issue 4, 2020

Page: [278 - 288] Pages: 11

DOI: 10.2174/1574887115666200709172402

Price: $65

Abstract

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon.

Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter-regulatory hormones.

Results: Goals of therapy are to correct dehydration, acidosis, and to reverse ketosis, gradually restoring blood glucose concentration to near normal.

Conclusion: It is essential to monitor potential complications of DKA and, if necessary, to treat them and any precipitating events.

Keywords: Type 1 diabetes mellitus, diabetic ketoacidosis, mortality, medicine, glycemic control, insulin pump therapy, complications, children.

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Graphical Abstract

[1]
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016; 12(4): 222-32.
[http://dx.doi.org/10.1038/nrendo.2016.15] [PMID: 26893262]
[2]
Westerberg DP. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician 2013; 87(5): 337-46.
[PMID: 23547550]
[3]
Fralick M, Schneeweiss S, Patorno E. Risk of diabetic ketoacidosis after initiation of an SGLT2 inhibi-tor. N Engl J Med 2017; 376(23): 2300-2.
[http://dx.doi.org/10.1056/NEJMc1701990] [PMID: 28591538]
[4]
Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: A systematic review. Diabetologia 2012; 55(11): 2878-94.
[http://dx.doi.org/10.1007/s00125-012-2690-2] [PMID: 22933123]
[5]
Fazeli Farsani S, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): A systematic literature review. BMJ Open 2017; 7(7): e016587.
[http://dx.doi.org/10.1136/bmjopen-2017-016587] [PMID: 28765134]
[6]
Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism 2016; 65(4): 507-21.
[http://dx.doi.org/10.1016/j.metabol.2015.12.007] [PMID: 26975543]
[7]
Van Zyl DG, Rheeder P, Delport E. Fluid management in diabetic-acidosis--Ringer’s lactate versus normal saline: A randomized controlled trial. QJM 2012; 105(4): 337-43.
[http://dx.doi.org/10.1093/qjmed/hcr226] [PMID: 22109683]
[8]
Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; 2(2): CD000567.
[http://dx.doi.org/10.1002/14651858.CD000567.pub6] [PMID: 23450531]
[9]
Tran TTT, Pease A, Wood AJ, et al. Review of Evidence for adult diabetic ketoacidosis management protocols. Front Endocrinol (Lausanne) 2017; 8: 106.
[http://dx.doi.org/10.3389/fendo.2017.00106] [PMID: 28659865]
[10]
Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Gonzalez-Padilla DA. Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis. Cochrane Database Syst Rev 2016; 1(1): CD011281.
[http://dx.doi.org/10.1002/14651858.CD011281.pub2] [PMID: 26798030]
[11]
Umpierrez GE, Latif K, Stoever J, et al. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J Med 2004; 117(5): 291-6.
[http://dx.doi.org/10.1016/j.amjmed.2004.05.010] [PMID: 15336577]
[12]
Ersöz HO, Ukinc K, Köse M, et al. Subcutaneous lispro and intravenous regular insulin treatments are equally effective and safe for the treatment of mild and moderate diabetic ketoacidosis in adult patients. Int J Clin Pract 2006; 60(4): 429-33.
[http://dx.doi.org/10.1111/j.1368-5031.2006.00786.x] [PMID: 16620355]
[13]
Islam T, Sherani K, Surani S, Vakil A. Guidelines and controversies in the management of diabetic ketoacidosis - A mini-review. World J Diabetes 2018; 9(12): 226-9.
[http://dx.doi.org/10.4239/wjd.v9.i12.226] [PMID: 30588284]
[14]
Goyal N, Miller JB, Sankey SS, Mossallam U. Utility of initial bolus insulin in the treatment of diabetic ketoacidosis. J Emerg Med 2010; 38(4): 422-7.
[http://dx.doi.org/10.1016/j.jemermed.2007.11.033] [PMID: 18514472]
[15]
Munir A, Fargo I, Garrison R, et al. Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis BMJ Open Diabetes Res Care 2017; 5: e000395.
[16]
Wolfsdorf J, Glaser N, Sperling MA. American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care 2006; 29(5): 1150-9.
[http://dx.doi.org/10.2337/dc06-9909] [PMID: 16644656]
[17]
Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic diabetic ketoacidosis: A po-tential complication of treatment with sodium-glucose cotransporter 2 inhibition. Diabetes Care 2015; 38(9): 1687-93.
[http://dx.doi.org/10.2337/dc15-0843] [PMID: 26078479]
[18]
Dabelea D, Rewers A, Stafford JM, et al. SEARCH for Diabetes in Youth Study Group. Trends in the prevalence of ketoacidosis at diabetes diagnosis: The SEARCH for diabetes in youth study. Pediatrics 2014; 133(4): e938-45.
[http://dx.doi.org/10.1542/peds.2013-2795] [PMID: 24685959]
[19]
Gerich JE, Martin MM, Recant L. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabetes 1971; 20(4): 228-38.
[http://dx.doi.org/10.2337/diab.20.4.228] [PMID: 4994561]
[20]
Lipscombe LL, Austin PC, Alessi-Severini S, et al. Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Atypical antipsychotics and hyperglycemic emergencies: multicentre, retrospective cohort study of administrative data. Schizophr Res 2014; 154(1-3): 54-60.
[http://dx.doi.org/10.1016/j.schres.2014.01.043] [PMID: 24581419]
[21]
Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis: Risk factors and management strategies. Treat Endocrinol 2003; 2(2): 95-108.
[http://dx.doi.org/10.2165/00024677-200302020-00003] [PMID: 15871546]
[22]
Mecklenburg RS, Benson EA, Benson JW Jr, et al. Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patients. JAMA 1984; 252(23): 3265-9.
[http://dx.doi.org/10.1001/jama.1984.03350230025026] [PMID: 6439896]
[23]
Modi A, Agrawal A, Morgan F. Euglycemic diabetic ketoacidosis: A review. Curr Diabetes Rev 2017; 13(3): 315-21.
[http://dx.doi.org/10.2174/1573399812666160421121307] [PMID: 27097605]
[24]
Bonora BM, Avogaro A, Fadini GP. Sodium-glucose co-transporter-2 inhibitors and diabetic ketoacidosis: An updated review of the literature. Diabetes Obes Metab 2018; 20(1): 25-33.
[http://dx.doi.org/10.1111/dom.13012] [PMID: 28517913]
[25]
Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis N Engl J Med 2001; 344: 264-9.
[26]
Glaser NS. Frequency of subclinical cerebral edema in children with diabetic ketoacidosis Pediatr Diabetes 2006; 7: 75-80.
[27]
Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007; 50(4): 938-48.
[http://dx.doi.org/10.1097/GRF.0b013e31815a5494] [PMID: 17982337]
[28]
Morrison FJR, Movassaghian M, Seely EW, et al. Fetal outcomes after diabetic ketoacidosis during preg-nancy. Diabetes Care 2017; 40(7): e77-9.
[http://dx.doi.org/10.2337/dc17-0186] [PMID: 28606900]
[29]
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371(9606): 75-84.
[http://dx.doi.org/10.1016/S0140-6736(08)60074-4] [PMID: 18177778]
[30]
Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G. Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol 2000; 20(4): 319-23.
[http://dx.doi.org/10.1159/000013607] [PMID: 10970986]
[31]
Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med 2003; 10(8): 836-41.
[http://dx.doi.org/10.1197/aemj.10.8.836] [PMID: 12896883]
[32]
Misra S, Oliver NS. Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. Diabet Med 2015; 32(1): 14-23.
[http://dx.doi.org/10.1111/dme.12604] [PMID: 25307274]
[33]
Dunger DB, Sperling MA, Acerini CL, et al. ESPE; LWPES. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 2004; 89(2): 188-94.
[http://dx.doi.org/10.1136/adc.2003.044875] [PMID: 14736641]
[34]
Kuppermann N, Ghetti S, Schunk JE, et al. PECARN DKA FLUID Study Group. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med 2018; 378(24): 2275-87.
[http://dx.doi.org/10.1056/NEJMoa1716816] [PMID: 29897851]
[35]
Puttha R, Cooke D, Subbarayan A, et al. North West England Paediatric Diabetes Network. Low dose (0.05 units/kg/h) is comparable with standard dose (0.1 units/kg/h) intravenous insulin infusion for the initial treatment of diabetic ketoacidosis in children with type 1 diabetes-an observational study. Pediatr Diabetes 2010; 11(1): 12-7.
[http://dx.doi.org/10.1111/j.1399-5448.2009.00536.x] [PMID: 19602154]
[36]
Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990; 13(1): 22-33.
[http://dx.doi.org/10.2337/diacare.13.1.22] [PMID: 2105195]
[37]
Hillman K. Fluid resuscitation in diabetic emergencies-a reappraisal. Intensive Care Med 1987; 13(1): 4-8.
[http://dx.doi.org/10.1007/BF00263548] [PMID: 3104431]
[38]
Glaser N. Cerebral injury and cerebral edema in children with diabetic ketoacidosis: Could cerebral ischemia and reperfusion injury be involved? Pediatr Diabetes 2009; 10(8): 534-41.
[http://dx.doi.org/10.1111/j.1399-5448.2009.00511.x] [PMID: 19821944]
[39]
Yuen N, Anderson SE, Glaser N, Tancredi DJ, O’Donnell ME. Cerebral blood flow and cerebral edema in rats with diabetic ketoacidosis. Diabetes 2008; 57(10): 2588-94.
[http://dx.doi.org/10.2337/db07-1410] [PMID: 18633109]
[40]
Roberts MD, Slover RH, Chase HP. Diabetic ketoacidosis with intracerebral complications. Pediatr Diabetes 2001; 2(3): 109-14.
[http://dx.doi.org/10.1034/j.1399-5448.2001.002003109.x] [PMID: 15016193]
[41]
Regmi A, Konstantinov NK, Agaba EI, Rohrscheib M, Dorin RI, Tzamaloukas AH. Respiratory failure in the course of treatment of diabetic ketoacidosis. Clin Diabetes 2014; 32(1): 28-31.
[http://dx.doi.org/10.2337/diaclin.32.1.28] [PMID: 26246676]
[42]
Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care 2009; 32(7): 1164-9.
[http://dx.doi.org/10.2337/dc09-0169] [PMID: 19366972]
[43]
Savage MW, Dhatariya KK, Kilvert A, et al. Joint British Diabetes Societies. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011; 28(5): 508-15.
[http://dx.doi.org/10.1111/j.1464-5491.2011.03246.x] [PMID: 21255074]
[44]
Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality-United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2018; 67(12): 362-5.
[http://dx.doi.org/10.15585/mmwr.mm6712a3] [PMID: 29596400]
[45]
Goldenberg RM, Gilbert JD, Hramiak IM, Woo VC, Zinman B. Sodium-glucose co-transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol. Diabetes Obes Metab 2019; 21(10): 2192-202.
[http://dx.doi.org/10.1111/dom.13811] [PMID: 31183975]
[46]
Handelsman Y, Henry RR, Bloomgarden ZT, et al. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the association of SGLT-2 inhibitors and diabetic ketoacidosis. Endocr Pract 2016; 753-62.
[47]
Laffel LM, Limbert C, Phelan H, Virmani A, Wood J, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19(Suppl. 27): 193-204.
[http://dx.doi.org/10.1111/pedi.12741] [PMID: 30079506]
[48]
Seattle Children’s Hospital. Insulin Sick Day Management for Diabetes (Non-DKA) Pathway. Ness K, Hrachovec JB, Klee K, Leu MG, Magin J, Eds. Seattle, WA: Seattle Children’s Hospital 2013.
[49]
Garg SK, Henry RR, Banks P, et al. Effects of sotagliflozin added to insulin in patients with Type 1 Diabetes. N Engl J Med 2017; 377(24): 2337-48.
[http://dx.doi.org/10.1056/NEJMoa1708337] [PMID: 28899222]
[50]
Musso G, Gambino R, Cassader M, Paschetta E. Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type 1 diabetes: Meta-analysis of randomised controlled trials. BMJ 2019; 365: l1328.
[http://dx.doi.org/10.1136/bmj.l1328] [PMID: 30967375]

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