Diabetic ketoacidosis in adults

@article{Misra2015DiabeticKI,
  title={Diabetic ketoacidosis in adults},
  author={Shivani Misra and Nick S. Oliver},
  journal={BMJ : British Medical Journal},
  year={2015},
  volume={351}
}
#### What you should know Diabetic ketoacidosis (DKA) is an extreme metabolic state caused by insulin deficiency. The breakdown of fatty acids (lipolysis) produces ketone bodies (ketogenesis), which are acidic. Acidosis occurs when ketone levels exceed the body’s buffering capacity (figure⇓).1 2 Diabetic ketoacidosis may follow absolute insulin deficiency or relative insulin deficiency. Relative insulin deficiency may occur in the presence of increased levels of counter-regulatory hormones… 
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There are currently no guidelines from endocrinology or internal medicine societies regarding the management of euglycemic DKA, but careful monitoring of all potential side effects as well as the contraindications are prudent to successful management of complex disease states.
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TLDR
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TLDR
Key points from the revised Joint British Diabetes Societies (JBDS) guidelines on the management of diabetic ketoacidosis, which have been endorsed by the Intensive Care Society, are highlighted.
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TLDR
The various ways of approaching patients who suffer from type-one diabetes during ketoacidosis and keto-acidotic coma are evaluated, to understand the triggers and pathophysiology behind this condition, and explore ways to prevent them.
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TLDR
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Reversible Microvascular Hyporeactivity to Acetylcholine During Diabetic Ketoacidosis
TLDR
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Awareness of Risk Factors of DKA among Diabetic Adults in KSA
TLDR
A compelling need to bridge the disparity in awareness of DKA among Saudi adults with both types is revealed, which will lead to improved quality of life particularity for DM patients and their caregivers.
Metabolic encephalopathy secondary to diabetic ketoacidosis: a case report
TLDR
The dramatic cognitive decline of a young man due to metabolic encephalopathy complicating DKA is highlighted and the current research in diabetic related brain injury in diabetes mellitus is explored.
Diagnostic and Management Approach of Diabetic ketoacidosis in Emergency Department, Review Article
TLDR
The objective was to look into the literature concerning diabetic ketoacidosis and particularly the diagnosis process and management and found that diagnosing DKA has been easier due to easier access to lab tests and the guidelines of diagnosis.
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References

SHOWING 1-10 OF 37 REFERENCES
Hyperglycemic Crises in Adult Patients With Diabetes
TLDR
This consensus statement will outline precipitating factors and recommendations for the diagnosis, treatment, and prevention of DKA and HHS in adult subjects and is based on a previous technical review and more recently published peer-reviewed articles since 2001.
When should determination of ketonemia be recommended?
TLDR
It is recommended that diabetic children and adolescents measure beta-OHB when symptoms like nausea or vomiting occur to differentiate ketoacidosis from gastroenteritis, and during infections, during periods with high blood glucose (> 15 mmol/L), and if they notice ketonuria.
Can serum beta-hydroxybutyrate be used to diagnose diabetic ketoacidosis?
TLDR
Serum beta-hydroxybutyrate levels in the presence of uncontrolled diabetes can be used to diagnose DKA and may be superior to the serum HCO(3) level for that purpose.
Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis.
TLDR
The data support that alkali therapy in DKA has nonsaltuary effects in the metabolism and plasma levels of ketones and unravels an effect of bicarbonate infusion that promotes a selective build up of AcAc in body fluids.
Hyperglycaemic crises and lactic acidosis in diabetes mellitus
TLDR
Understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed and what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.
Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes.
TLDR
The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (Patients with preceding severe hypglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.
Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis
  • S. Misra, N. Oliver
  • Medicine
    Diabetic medicine : a journal of the British Diabetic Association
  • 2015
TLDR
The various existing methods of ketone measurement are reviewed, the precision of capillary blood ketone as compared with other measures, its diagnostic accuracy in predicting ketoacidosis and other clinical applications including prevention, assessment of severity and resolution of keto acidosis are reviewed.
Blood β‐hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review
TLDR
The aim of this study was to review the effectiveness of capillary or serum β‐hydroxybutyrate compared with urine acetoacetate testing in prevention and management of diabetic ketoacidosis.
Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?
TLDR
Adherence to the JBDS DKA guideline was good in the immediate stage of treatment, but inadequate metabolic monitoring, fluid management and iatrogenic hypoglycaemia remain areas of concern.
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