Diabetic ketoacidosis natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
| Line 17: | Line 17: | ||
==Complications== | ==Complications== | ||
People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment: | People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:<ref name="pmid15220225">{{cite journal |vauthors=Muir AB, Quisling RG, Yang MC, Rosenbloom AL |title=Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification |journal=Diabetes Care |volume=27 |issue=7 |pages=1541–6 |year=2004 |pmid=15220225 |doi= |url=}}</ref><ref name="mayo">{{cite web | By Mayo Clinic Staff | title = Diabetic ketoacidosis | publisher=Mayo Foundation for Medical Education and Research | work = Diabetic ketoacidosis | url=http://www.mayoclinic.com/health/diabetic-ketoacidosis/DS00674/DSECTION=7 | year = 2006 | accessdate=2007-06-15}}</ref><ref name="AMN">{{cite web | Umesh Masharani, MB, BS, MRCP | title = Diabetic Coma > Diabetic ketoacidosis | publisher=Armenian Medical Network | work = Diabetic ketoacidosis | url=http://www.health.am/db/diabetic-ketoacidosis/ | year = 2006 | accessdate=2007-06-15}}</ref><ref name="monitor">{{cite web | title = Diabetic ketoacidosis complications| publisher=The Diabetes Monitor | work = Diabetic ketoacidosis | url=http://www.diabetesmonitor.com/dmemerh/sld033.htm | year = 2007 | accessdate=2007-06-15}}</ref> | ||
* [[Hypokalemia]] and often, [[potassium depletion]] | * [[Hypokalemia]] and often, [[potassium depletion]] | ||
* [[Cerebral edema]] | * [[Cerebral edema]] | ||
* [[Hyperglycemia]] | * [[Hyperglycemia]] | ||
* [[Ketoacidemia]] | * [[Ketoacidemia]] | ||
* Fluid and electrolyte depletion | * Fluid and electrolyte depletion | ||
* [[Aspiration]] | * [[Aspiration]] | ||
* Unrecognized [[renal tubular necrosis]] | * Unrecognized [[renal tubular necrosis]] | ||
* [[Pulmonary edema]] | * [[Pulmonary edema]] | ||
==Prognosis== | ==Prognosis== | ||
Revision as of 20:12, 10 August 2017
|
Diabetic ketoacidosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Diabetic ketoacidosis natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Diabetic ketoacidosis natural history, complications and prognosis |
|
FDA on Diabetic ketoacidosis natural history, complications and prognosis |
|
CDC on Diabetic ketoacidosis natural history, complications and prognosis |
|
Diabetic ketoacidosis natural history, complications and prognosis in the news |
|
Blogs on Diabetic ketoacidosis natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.
Overview
Natural History
- If left untreated, diabetic ketoacidosis may progress to multi-organ failure and death.
- Early in the course of the ketoacidotic process, hyperventilation results in a decrease in pCO2. The metabolic acidosis is compensated, and pH may be normal or only slightly reduced (e.g., in mild or moderate DKA).
- As DKA progresses into the severe stage, more significant acidosis occurs and pH falls.
- If compensatory hyperventilation does not occur for the acidosis, such as, in pulmonary disease (pneumonia, asthma, or adult respiratory distress syndrome) or CNS depression (e.g., cerebral edema), the acidosis becomes more severe and results in a poor prognosis.
- Although acidosis impairs myocardial contractility, heart failure and cardiogenic shock are rare in children with DKA.
- Hypotension or shock during DKA is nearly always the result of hypovolemia or cerebral edema in children
- Heart failure, myocardial infarction, and arrhythmias during DKA are seen commonly in untreated diabetic ketoacidosis. In children,
Complications
People with diabetic ketoacidosis need close and frequent monitoring for complications. Surprisingly, the most common complications of DKA are related to the treatment:[1][2][3][4]
- Hypokalemia and often, potassium depletion
- Cerebral edema
- Hyperglycemia
- Ketoacidemia
- Fluid and electrolyte depletion
- Aspiration
- Unrecognized renal tubular necrosis
- Pulmonary edema
Prognosis
Signs of poor prognosis
- The following are the signs of poor prognosis in diabetic ketoacidosis at the time of diagnosis:[5][6][7]
- Hypothermia
- Coma
- Oliguria
- Extremes of age (young and elderly)
- Intercurrent comorbidity, for example, myocardial infaction, sepsis
- Positive tropinins without evident acute coronary syndrome
- High platelet to lymphocyte ratio
- Over the last 3 decades, mortality rates from DKA have significantly decreased in developed countries, from 7960 per 100,00 indivuals to 670 per 100,00 individuals in
References
- ↑ Muir AB, Quisling RG, Yang MC, Rosenbloom AL (2004). "Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification". Diabetes Care. 27 (7): 1541–6. PMID 15220225.
- ↑ "Diabetic ketoacidosis". Diabetic ketoacidosis. Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-06-15. Text " By Mayo Clinic Staff " ignored (help)
- ↑ "Diabetic Coma > Diabetic ketoacidosis". Diabetic ketoacidosis. Armenian Medical Network. 2006. Retrieved 2007-06-15. Text " Umesh Masharani, MB, BS, MRCP " ignored (help)
- ↑ "Diabetic ketoacidosis complications". Diabetic ketoacidosis. The Diabetes Monitor. 2007. Retrieved 2007-06-15.
- ↑ Liu WY, Lin SG, Wang LR, Fang CC, Lin YQ, Braddock M, Zhu GQ, Zhang Z, Zheng MH, Shen FX (2016). "Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis". Medicine (Baltimore). 95 (4): e2596. doi:10.1097/MD.0000000000002596. PMC 5291578. PMID 26825908.
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ Al-Matrafi J, Vethamuthu J, Feber J (2009). "Severe acute renal failure in a patient with diabetic ketoacidosis". Saudi J Kidney Dis Transpl. 20 (5): 831–4. PMID 19736483.