Dec 22, 2012 diabetic ketoacidosis dka remains a significant complication of diabetes in both the united states and around the world. It can also occur in patients with other types of diabetes. Nurse practitioners are well positioned to promote patient education, selfmanagement, and individualized patient care. Food and drug administration fda issued a drug safety communication that warns of an increased risk of diabetic ketoacidosis.
Descriptionetiology lesson quick diabetic ketoacidosis in. Aug 06, 2015 diabeteic ketoacidosis dka is a medical emergency and has a high mortality rate if not promptly managed. The incidence and economic burden of diabetic ketoacidosis have continued to rise but its mortality has decreased to less than 1% in good centers. Diabetic ketoacidosis in children descriptionetiology diabetic ketoacidosis dka is a lifethreatening medical emergency brought on by severe insulin deficiency, which usually results in hyperglycemia i. Sodiumglucose cotransporter2 sglt2 inhibitors are now widely used as an adjunctive treatment in managing type 2 diabetes. Hospital admission for diabetic ketoacidosis or severe. Diabetic ketoacidosis dka is not a rare presentation to hospital, despite being an entirely preventable condition. Misdiagnosis and diabetic ketoacidosis at diagnosis of type 1.
Diabetic ketoacidosis dka society of hospital medicine. Diagnosis requires these clinical signs plus confirmation of high blood or urine ketone concentrations and metabolic acidosis, in conjunction with persistent. Diabetic ketoacidosis dka is the most common acute hyperglycaemic emergency in people with diabetes mellitus. This protocol is to be used for the management of diabetic ketoacidosis dka in adults over the age of 16. Isfm consensus guidelines on the practical management of. Management of diabetic ketoacidosis in adults queensland health. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Halperin reports holding a patent on the use of sodiumlinked glucose transporter 2 inhibitors to increase the excretion of water in patients with hyponatremia us 8,518,895,b2 and a pending. The frequency of diabetic ketoacidosis has increased during the past decade, with more than 160 000 hospital admissions in 2017 in the us.
The 2009 american diabetes association ada position statement on hyperglycaemic emergencies in adult patients with diabetes details the management of diabetic ketoacidosis dka and hyperosmolar hyperglycaemia state. This causes harmful substances called ketones to build up in the body, which can be lifethreatening if not spotted and treated quickly. Diabetic ketoacidosis an overview sciencedirect topics. May 14, 2020 diabetic ketoacidosis dka is the most common acute hyperglycaemic emergency in people with diabetes mellitus. Historically,bothdka and hhs were initially described as one entity but subsequently recognized as separate conditions. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. While it can occur in all types of diabetes mellitus, it is seen most often in patients with type 1 diabetes. Diabetic ketoacidosis dka in patients with type 1 diabetes is a medical emergency that may present with neurologic signs and symptoms. Guideline title management of diabetic ketoacidosis. Diabetic ketoacidosis dka is the most common hyperglycemic emergency in patients with type 1 and type 2 diabetes mellitus. May 17, 2015 hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach. Pdf diabetic ketoacidosis dka is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof35%.
Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Diabeteic ketoacidosis dka is a medical emergency and has a high mortality rate if not promptly managed. A recent analysis found that hospital admissions for diabetic ketoacidosis had increased in the uk for patients with both type 1 and type 2 diabetes. The state of queensland queensland health 2015 licensed under. Guidelines are still evolving concerning the perioperative management of patients on sglt2i. Diabetic ketoacidosis guidelines bmj best practice. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute. Our retrospective online survey found that 25% of all participants were misdiagnosed and. Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in colorado youth, 19982012. Diabetic ketoacidosis and hyperglycemic hyperosmolar state table 1.
Acidbase problems in diabetic ketoacidosis new england journal. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counterregulatory hormones ie, glucagon, cortisol, growth hormone, epinephrine. May 19, 2015 rewers a, dong f, slover rh, klingensmith gj, rewers m. In may 2015, the us food and drug administration added a warning about the risk of dka with use of these drugs. Dec 04, 2018 diabetic ketoacidosis is a serious complication of type 1 diabetes, though its sometimes seen in people with type 2 diabetes. Diabetic ketoacidosis dka is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. Diabetic ketoacidosis dka is a serious condition that can lead to diabetic coma passing out for a long time or even death.
Serious adverse events of dka and related events were reported in 12 patients. Since approval of the firstinclass drug in 20, data have emerged suggesting that these drugs increase the risk of diabetic ketoacidosis. Diabetic ketoacidosis dka accounts for % 2, 3 to 19% of diseaserelated mortality and occurs at a rate of 110100 patientyears in children and adolescents with established diabetes remaining largely constant within the last decade 1, 5, 6, 7. Identification of factors that precipitated dka or hhs during the index hospitalization. Sglt2 inhibitors may predispose to ketoacidosis the journal.
Diabetic ketoacidosis dka is an extreme metabolic state caused by insulin. The present article summarizes the recent guidance on. Management of dka has changed in the last decade, and national guidelines introduced, to help standardise care, spread best practice, and reduce mortality and morbidity. A diagnosis of dka is confirmed when all of the three criteria are present d. This article outlines updates in the clinical management of. Trends in diabetic ketoacidosis hospitalizations and in. Perioperative diabetic ketoacidosis associated with sodium. Euglycemic diabetic ketoacidosis induced by sglt2 inhibitors.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are hyperglycemic emergencies that continue to account for increased burden of hospitalizationsinboththeusa1anduk2. Updates in the management of diabetic ketoacidosis the. The condition develops when your body cant produce enough insulin. Insulin normally plays a key role in helping sugar glucose a major source of energy for your muscles and other tissues enter your. Sglt inhibition and euglycaemic diabetic ketoacidosis the. Our retrospective online survey found that 25% of all participants were misdiagnosed and that. Perioperative diabetic ketoacidosis dka with nearnormal blood glucose concentrations, termed euglycaemic ketoacidosis edka, is an adverse effect associated with sodiumglucose cotransporter2 inhibitors sglt2i. In may 2015, the food and drug administration issued a warning that sglt2 inhibitors may lead to ketoacidosis. Therefore, it becomes vital that the healthcare professional be able to manage the hyperglycemic crises. The biochemical criteria for the diagnosis of diabetic ketoacidosis dka are. Diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia.
Not a hyperosmolar state like hyperglycemic hyperosmolar state hhs. Rewers a, dong f, slover rh, klingensmith gj, rewers m. Diabetic ketoacidosis dka remains a significant complication of diabetes in both the united states and around the world. Hospitalization rates for diabetic ketoacidosis have been increasing in the united states since 2009 among all age groups. Mar 31, 2017 guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. Guidelines and position statements from medical organisations are widely used by clinicians to guide the care of their patients. Diabetic ketoacidosis symptoms and causes mayo clinic. May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetes is a common chronic condition and as of 2015, approximately 30 million persons in the united states had diabetes 23 million with diagnosed and 7. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes in blood ph and requires medical attention. Hyperglycaemic hyperosmolar state hhs is a medical emergency, which differs from diabetic ketoacidosis dka and requires a different approach.
Diabetic ketoacidosis typically develops in patients who lack significant endogenous insulin. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Diabetic ketoacidosis is a serious complication of type 1 diabetes, though its sometimes seen in people with type 2 diabetes. Ketones are chemicals that the body creates when it breaks down fat to use for energy. A predictable, detectable, and preventable safety concern with sglt2 inhibitors diabetes care 2015. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus.
Guidelines for management of diabetic ketoacidosis. Dec 11, 2019 diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. Management of hyperosmolar hyperglycaemic state in adults. A persons breath may develop a specific fruity smell. Management of children and young people under the age of 18 years with diabetic ketoacidosis external link opens in a new window. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. Dka onset and recurrence can largely be prevented through patient education. When your cells dont get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Diabetic ketoacidosis dka is a lifethreatening complication of diabetes mellitus. Food and drug administration fda issued a drug safety communication that warns of an increased risk of diabetic ketoacidosis dka with uncharacteristically mild to moderate glucose elevations euglycemic dka eudka associated with the use of all the approved sodiumglucose cotransporter 2 sglt2 inhibitors 1. Diabetic ketoacidosis remains a significant complication of diabetes in both the united states and worldwide with its associated high rates of hospital admissions. Treatment of diabetic ketoacidosis dkahyperglycemic. When blood sugar levels are too high and insulin levels are too low. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3.
Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management emergency medicine. The excess glucose in the bloodstream acts as an osmole i. Dka mainly affects people with type 1 diabetes, but can sometimes occur in. Diabetic ketoacidosis dka develops in a proportion of untreated diabetic cats, and should be suspected when cats are depressed, anorexic, vomiting, weak, collapsed or moribund. Patients admitted to icu with dka diabetic ketoacidosis will be monitored and managed appropriately. Free fulltext pdf articles from hundreds of disciplines, all in one place. In brief diabetic ketoacidosis dka is a lifethreatening complication that frequently occurs at diagnosis of type 1 diabetes, occurs more commonly when a patient is misdiagnosed, is the leading cause of death in children with type 1 diabetes, and is associated with worse longterm outcomes.
1424 499 585 1254 519 118 55 977 437 58 590 288 665 695 1377 16 850 985 1055 1224 788 710 328 1042 147 62 264 465 946 898 508 1376 566