Title: Mastering the Art of Writing a Literature Review on Diabetic Ketoacidosis

Crafting a literature review on diabetic ketoacidosis (DKA) can be an arduous task, requiring
meticulous research, analysis, and synthesis of existing scholarly works. DKA, a serious complication
of diabetes, demands thorough exploration to understand its complexities, treatment modalities, and
advancements in medical science. However, navigating through the vast array of literature while
ensuring coherence and relevance poses significant challenges for researchers and students alike.

One of the primary hurdles in writing a literature review on DKA lies in the sheer volume and
diversity of available sources. From peer-reviewed journals and academic publications to conference
proceedings and clinical trials, the breadth of literature can be overwhelming. Identifying the most
pertinent studies, extracting relevant information, and discerning their significance demand both time
and expertise.

Furthermore, synthesizing the findings from disparate sources into a cohesive narrative presents
another layer of difficulty. Researchers must critically analyze each study's methodology, results, and
conclusions to draw meaningful connections and identify gaps in existing knowledge. Crafting a
narrative that effectively communicates these insights while maintaining clarity and coherence
requires precision and attention to detail.

Moreover, the evolving nature of medical research necessitates staying abreast of the latest
developments and breakthroughs in the field of DKA management. Integrating current evidence-
based practices and emerging trends adds complexity to the literature review process, requiring
researchers to continuously update their knowledge and refine their arguments.

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Understand the action of insulin on the metabolism of carbohydrates, protein, and fat Understand the
pathophysiology of IDDM and DKA Understand the management approach to the patient with
DKA. This restriction was deemed reasonable given the epidemiological outcomes of interest
(prevalence and incidence rate), as deriving these values from a very small patient population would
lead to a high degree of uncertainty in the estimates. Non-Occlusive Mesenteric Ischemia: Etiology,
Diagnosis, and Interventional Therapy. Report this Document Download now Save Save Diabetic
Ketoacidosis Case Presentation For Later 100% (2) 100% found this document useful (2 votes) 1K
views 37 pages Diabetic Ketoacidosis Case Presentation Uploaded by Nathan Vince Cruz Second
year nursing student presentation. Supervised by: Dr. Rasha Bondok Assistant professor of
anesthesia and intensive care Presented by: Lamya Elsayed Resident of anesthesia and intensive care.
On day 2 since DKA resolution, Clostridium difficile toxin tested positive and oral vancomycin
treatment was started. All of these studies relied on patient self-report to determine occurrence of
DKA events, and the recall period varied from three to 12 months. For two publications, cumulative
incidence was calculated (number of new DKA events out of total patients at risk) because data on
incidence rates were not directly reported in the publications. Subgroup analyses were performed
using data from no more than two studies per subgroup. Nieuwdorp M, van Haeften TW,
Gouverneur MC, Mooij HL, van Lieshout MH, Levi M, et al. While most studies were rated as
having moderate study quality based on the JBI prevalence studies quality assessment checklist (see
online supplementary appendix 4 ), a few outliers were identified with both high and low quality. A
brain CT excluded cerebral edema. ( 2 ) On arrival the patient’s pump controller showed that the
patch pump had expired. Conclusions This SLR is, to our knowledge, the first review to describe the
epidemiology of DKA among adult patients with T1D. Expand 1,719 PDF 1 Excerpt Save Excess
thyroid hormone and carbohydrate metabolism. M. Potenza Michael A. Via Robert T. Yanagisawa
Medicine Endocrine Practice 2009 TLDR Thyrotoxicosis can alter carbohydrate metabolism in a type
2 diabetic patient to such an extent that diabetic ketoacidosis develops if untreated, and all diabetic
patients should be screened for thyroid dysfunction because correcting hyperthyroidism can
profoundly affect glucose homeostasis. Data of interest were incidence rate of DKA (number of new
DKA events out of accumulated patient time under study, in person-years (PYs)) and prevalence of
DKA (number of DKA events among the total number of patients at risk). Article types Author
guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. The
diagnosis of DKA-associated NOMI must be suspected in pediatric patients with DKA, persistent
abdominal pain, and severe dehydration. A lack of resolution within the first 24 hours of treatment
should prompt investigation for other causes. ( 3 ) We therefore present a rare case of non-occlusive
mesenteric ischemia (NOMI) that presented as mild persistent abdominal pain in the context of
progressively resolved severe DKA. Upload Read for free FAQ and support Language (EN) Sign in
Skip carousel Carousel Previous Carousel Next What is Scribd. The targeted population was men and
women aged at least 18 years with T1D. The clinical evolution of the adolescent male described by
Chan Chua et al. Massive Ischemic Intestinal Necrosis at the Onset of Diabetes Mellitus With
Ketoacidosis in a Three-Year-Old Girl. Despite an increasing prevalence of T1D in recent years,
DKA in adults has been poorly characterised. To our knowledge, this is the first SLR on the
epidemiology of DKA in adults with T1D. For Later 0 ratings 0% found this document useful (0
votes) 77 views 4 pages Management of Diabetic Ketoacidosis in Adults PDF Uploaded by Neneng
Humairoh AI-enhanced title Full description Save Save 050314-Management-of-diabetic-
ketoacidosis-in-adul. The quality of included studies was assessed using a standardised tool (the
Joanna Briggs Institute prevalence studies quality assessment tool). Rare Presentation of Shock and
Acute Mesenteric Ischaemia Secondary to Acute Adrenal Insufficiency in an 11-Year-Old Male. This
review, like any SLR, is subject to limitations that should be considered when interpreting the results.
In terms of baseline characteristics, patient selection and descriptions of outcomes, there were some
broad similarities across studies included in this review. No other signs or symptoms were present
apart from slightly loose stools which were collected for microbiological testing.
Al-Diery H, Phillips A, Evennett N, Pandanaboyana S, Gilham M, Windsor JA. When sufficient data
were available in the published literature to allow computation of these outcomes if not specifically
reported by the authors (for example, the number or proportion of patients who experienced a DKA
event over a defined time period), the appropriate calculations were performed and are noted as
such. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (CC BY). ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic Ketoacidosis and
the Hyperglycemic Hyperosmolar State. This review, like any SLR, is subject to limitations that
should be considered when interpreting the results. Severe Hypoglycemia and Diabetic Ketoacidosis
Among Youth With Type 1 Diabetes in the T1D Exchange Clinic Registry. Upload Read for free
FAQ and support Language (EN) Sign in Skip carousel Carousel Previous Carousel Next What is
Scribd. Expand 1 Save Recurrent Concurrent Diabetic Ketoacidosis and Thyroid Storm D. F. Crudo
Elizabeth T. Walsh J. Hunter Medicine Cureus 2021 TLDR The case of an adolescent patient with
type 1 diabetes and autoimmune hypothyroidism who developed recurrent concurrent DKA and
thyroid storm twice in an eight-month period is presented. Ischaemic Necrosis of Small and Large
Intestine in a 2-Year-Old Child With 20% Partial Thickness Burns: A Case Report. This SLR was
originally intended to include only population-based studies but was expanded to include clinic-
based and (potentially unrepresentative) registry studies since there were so few population-based
studies found. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and
predicted new cases 2005-20: a multicentre prospective registration study. Article types Author
guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office Frontiers in
Endocrinology. Several publications reported DKA outcome data stratified by age. 11 22 33 36 38 In
contrast, subgroup data for patients categorised based on other baseline characteristics, such as sex,
11 ethnicity 11 or insulin delivery method 11 36 were scarce. Ideally, future studies would focus
specifically on DKA outcomes and employ population-based methods to identify patients with T1D
and would therefore be more representative of a broad, unselected patient population. Most (16 of
19) studies had approximately a 1:1 male-to-female ratio of patients. Furthermore, many publications
did not describe whether (or how) the included patient cohort differed from the broader population
of adults with T1D, which makes an evaluation of potential selection bias, and generalisability, more
difficult. Introduction. DKA is a serious acute complications of Diabetes Mellitus. Standardised
measurements of DKA events were not frequently used, as many studies (seven of 19) relied on
patient self-report of DKA episodes or hospitalisation records (four of 19). If this is the first time
you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Subgroup analyses were performed using data from no more than two studies per subgroup.
References 1. Ghetti S, Lee JK, Sims CE, DeMaster DM, Glaser NS. Ethics Statement Ethical
review and approval was not required for the study on human participants in accordance with the
local legislation and institutional requirements. Depression in adults in the T1D Exchange Clinic
Registry. Non-Occlusive Mesenteric Ischemia: Etiology, Diagnosis, and Interventional Therapy.
Secondary diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1
diabetes mellitus in China: a multicentre registration study. The results of the quality assessment using
the JBI tool can be found in online supplementary appendix 3. This restriction may limit the available
data from certain geographical regions in which English is not the primary language of publication
and limits the overall scope of the review. Non-Occlusive Intestinal Ischemia in the Ascending Colon
and Rectum: A Pediatric Case Occurring During Encephalitis Treatment. While most studies were
rated as having moderate study quality based on the JBI prevalence studies quality assessment
checklist (see online supplementary appendix 4 ), a few outliers were identified with both high and
low quality. Expand 5 PDF Save Concurrent presentation of thyroid storm and diabetic ketoacidosis:
a systematic review of previously reported cases D. Rathish S. Karalliyadda Medicine BMC
Endocrine Disorders 2019 TLDR Concurrent presentation of thyroid storm and diabetic ketoacidosis
is rare but life-threatening and efforts should be made to maximise patient compliance to anti-thyroid
and anti-diabetic agents in treating such patients.
A lack of resolution within the first 24 hours of treatment should prompt investigation for other
causes. ( 3 ) We therefore present a rare case of non-occlusive mesenteric ischemia (NOMI) that
presented as mild persistent abdominal pain in the context of progressively resolved severe DKA.
This review, like any SLR, is subject to publication bias, as an SLR inherently relies upon data
available in the published literature. One of the main issues affecting the quality determination for
many of the included studies is the fact that the epidemiology of DKA events was not a primary (or,
in many cases, even a secondary) objective of the study; rather, DKA data were reported only as part
of overall rates of acute diabetic complications (along with other parameters such as severe
hypoglycaemic events). Medline (via PubMed) and Embase databases were searched for articles
published between 1 January 2000 and 23 June 2016 (date of search execution) by a single review
author (EW). DKA commonly presents with a short history of symptoms developing over a few
weeks. Author Contributions GF and RT share first authorship due to equal contribution. In addition,
many included studies did not provide sufficient information to make a clear determination of
quality for some aspects of study design; this lack of detail was particularly notable for ascertainment
of cases of T1D. Cell damage induced by prolonged ischemia-reperfusion injury may lead to
apoptosis, autophagy, necrosis, and necroptosis. ( 20 ) The integrity of the membrane is lost, with
further cell necrosis. Abdelaziz Elamin Professor of Pediatric Endocrinology University of
Khartoum, Sudan. Data sharing statement Additional data are available in the appendices. In most
studies, specific definitions or diagnostic criteria for T1D were not described, and some studies did
not fully report patient baseline demographic information such as patient ethnicity or insulin delivery
method. Rewers and colleagues 48 indicated that the increased risk of DKA among adolescent girls
(relative to younger children) may be related to body image issues that lead adolescent girls to skip
insulin injections to promote weight loss. Hirabayashi K, Takatsuki M, Motobayashi M, Kurata T,
Saito S, Shigemura T, et al. An Unusual Case of Mesenteric Ischemia in a Patient With New-Onset
Diabetes Mellitus. Upload Read for free FAQ and support Language (EN) Sign in Skip carousel
Carousel Previous Carousel Next What is Scribd. Data of interest were incidence rate of DKA
(number of new DKA events out of accumulated patient time under study, in person-years (PYs))
and prevalence of DKA (number of DKA events among the total number of patients at risk).
Abdominal pain and ileus can result from potassium depletion, acidosis, and poor splanchnic
perfusion. ( 13 ) These symptoms and signs have been described in 40-75% of the cases of DKA and
typically resolve during the first 24 hours of treatment, after administration of fluids and insulin. ( 2 )
In the initial phase of DKA abdominal pain may be severe enough to mimic an acute abdomen.
Gesuita R, Maffeis C, Bonfanti R, Cardella F, Citriniti F, D'Annunzio G, et al. Only five publications
described the epidemiology of DKA in adult patient populations in Europe; two reported on patients
from the Diabetes-Patienten-Verlaufsdokumentation (DPV) database, which includes patients in
Germany and Austria 27 40 and three evaluated small single-centre patient cohorts. 28 39 41 In all
cases, DKA events were ascertained based on patient medical records. Pathophysiology of DKA
Biochemical criteria for DKA Treatment of DKA Prevention of DKA Hyperosmolar Nonketoic
Syndrome. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the
Allen Institute for AI. Eating disorders, frequent among children with diabetes, also may affect risk
of DKA but may be challenging to identify in this population. 48 In one study using the Diabetes
Audit and Research in Tayside Scotland database, it was suggested that poor adherence to insulin
treatment in young adults with insulin-dependent diabetes mellitus is the major factor that contributes
to long-term poor glycaemic control and diabetic ketoacidosis. 49. Results summarises the literature
review process, including the number of records identified, the screening and eligibility results and
the final list of included references. Deep Venous Thrombosis in Children With Diabetic
Ketoacidosis and Femoral Central Venous Catheters. In other cases, data were aggregated as
cumulative sums of DKA events during the study period 27 or reported as events per patient per
year, 43 and some studies 23 34 42 43 did not provide details regarding the method of calculation of
incidence rates. Expand 5 PDF Save Concurrent presentation of thyroid storm and diabetic
ketoacidosis: a systematic review of previously reported cases D. Rathish S. Karalliyadda Medicine
BMC Endocrine Disorders 2019 TLDR Concurrent presentation of thyroid storm and diabetic
ketoacidosis is rare but life-threatening and efforts should be made to maximise patient compliance to
anti-thyroid and anti-diabetic agents in treating such patients. There was no information on incidence
rate stratified by patient age reported in any studies identified by this SLR. The findings from the
Chinese study highlight the difficulties encountered in comparing the epidemiological data across the
included studies, in which the methods of calculating incidence rate or prevalence often were not
explicitly described. Diagnosis is based on standard biochemical (hyperglycemia and metabolic
acidosis) and clinical (dehydration, nausea, vomiting) signs.
Mildly progressive abdominal pain persisted after DKA correction and after repeated ultrasound
evaluations ultimately suspect for intestinal perforation, an intraoperative diagnosis of NOMI was
made. Heidi Chamberlain Shea, MD Endocrine Associates of Dallas. Further inquiries can be
directed to the corresponding author. Severe Hypoglycemia and Diabetic Ketoacidosis Among Youth
With Type 1 Diabetes in the T1D Exchange Clinic Registry. All authors contributed to the article and
approved the submitted version. An investigation of patients with T1D in Scotland 47 found that the
cumulative incidence of DKA events was 154 events per 1000 people for the overall population, with
considerable variation based on patients’ economic status. The wide range of incidence rates and
prevalence of DKA in adults with T1D 23 27 28 34 35 39 42 43 is similar to the published literature
for children. There was no information on incidence rate stratified by patient age reported in any
studies identified by this SLR. DKA prevalence by other patient subgroups of interest Subgroup data
for patients categorised according to clinical or demographic characteristics other than age, such as
sex, ethnicity, insulin delivery method, glycaemic control and depression comorbidity were very
limited, with data available from only one or two studies. Non-Occlusive Mesenteric Ischaemia: A
Common Disorder in Gastroenterology and Intensive Care. For Later 0% 0% found this document
useful, Mark this document as useful 0% 0% found this document not useful, Mark this document as
not useful Embed Share Print Download now Jump to Page You are on page 1 of 4 Search inside
document. An Evaluation of Recurrent Diabetic Ketoacidosis, Fragmentation of Care, and Mortality
Across Chicago, Illinois. Only two studies 33 42 included any description of criteria for the
diagnosis of T1D. Treatment with metronidazole was started and the patient was transferred to the
city’s center of reference for pediatric surgery. Standardised measurements of DKA events were not
frequently used, as many studies (seven of 19) relied on patient self-report of DKA episodes or
hospitalisation records (four of 19). Abdominal magnetic resonance imaging revealed a large, fluid-
filled pelvic abscess with air bubbles suspect for bowel perforation, with parietal contrast
enhancement ( Figure 1 ). Predictors of Intensive Care Unit and Hospital Length of Stay in Diabetic
Ketoacidosis. Abdelaziz Elamin Professor of Pediatric Endocrinology University of Khartoum,
Sudan. Cherubini V, Pintaudi B, Rossi MC, Lucisano G, Pellegrini F, Chiumello G, et al. Prevalence
of DKA was reported in two European studies. 40 41 One single-centre longitudinal study of 104
patients performed in Sweden 41 found a numerical (but not statistically significant) reduction in
DKA cases with increasing year of age from 18 to 24 years (prevalence ranged from 0 to 60 cases
per 1000 people over this period and was calculated for each 1?year of age separately by the
authors). Social Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes. Yoshida
M, Kataoka N, Miyauchi K, Ohe K, Iida K, Yoshida S, et al. Since admission she referred modest
abdominal pain that had persisted throughout DKA treatment. We present a rare case of non-
occlusive mesenteric ischemia (NOMI) with overt manifestation after DKA resolution and a
discussion of recent literature addressing DKA-associated NOMI epidemiology and pathogenesis in
children and adolescents. The authors stated that in this study, more than a third (34.4%) of DKA
events represented recurrent (two or more) episodes of DKA for 3.8% of patients, suggesting that a
small population of very high-risk patients contributed substantially to the overall incidence rate.
Medline (via PubMed) and Embase databases were searched for articles published between 1
January 2000 and 23 June 2016 (date of search execution) by a single review author (EW). This SLR
was originally intended to include only population-based studies but was expanded to include clinic-
based and (potentially unrepresentative) registry studies since there were so few population-based
studies found. While most studies were rated as having moderate study quality based on the JBI
prevalence studies quality assessment checklist (see online supplementary appendix 4 ), a few
outliers were identified with both high and low quality. Rewers and colleagues 48 indicated that the
increased risk of DKA among adolescent girls (relative to younger children) may be related to body
image issues that lead adolescent girls to skip insulin injections to promote weight loss. Data sources
Medline (via PubMed) and Embase (1 January 2000 to 23 June 2016).