Title: Mastering the Challenge of Crafting a Diabetic Ketoacidosis Literature Review

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The authors suggested that DKA may be under-reported in clinical records and, therefore, chose to
use patient self-reported data for further analyses. 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. On admission, the child
presented in hypovolemic shock with an altered state of consciousness (GCS 12) without evident
focal neurological signs, pale skin and Kussmaul respiration. 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. If the ketone
level is moderate or high, seek medical help immediately. Therefore, seek emergency care if your
blood sugar level and ketones level are high. 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. The results of the quality assessment using the JBI tool
can be found in online supplementary appendix 3. ISPAD Clinical Practice Consensus Guidelines
2018: Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State. If you are using mobile
phone, you could also use menu drawer from browser. Small-Intestinal Necrosis Due to non-
Occlusive Mesenteric Ischemia With Diabetic Ketoacidosis After Quetiapine Treatment. Acosta S,
Ogren M, Sternby N-H, Bergqvist D, Bjorck M. Several other factors, such as lower socioeconomic
status, poor glycaemic control, female sex and depression or psychiatric symptoms, were associated
with increased risk of DKA. In this investigation, the cumulative incidence of DKA was calculated
to be 55.6 per 1000 people for CSII users. This is an open-access article distributed under the terms
of the Creative Commons Attribution License (CC BY). Most studies included in this SLR were
assessed as being of moderate quality. When insulin production decreases due to diabetes, blood
sugar levels increase. If the mean age was reported and the calculated age for minus three SDs was
Data extraction and analysis Data extraction was conducted by a single review author (EW or BAM)
using a Microsoft Excel file with standardised definitions for each data element that was extracted
from each study (see online supplementary appendix 1 ). If this is the first time you use this feature,
you will be asked to authorise Cambridge Core to connect with your account. Conclusions To our
knowledge, this is the first SLR on the epidemiology of DKA in T1D adults. Therefore, the
treatment of a diabetic ketoacidosis patient should be performed carefully. Worly JM, Fortenberry
JD, Hansen I, Chambliss CR, Stockwell J. This review, like any SLR, is subject to limitations that
should be considered when interpreting the results. By using this service, you agree that you will only
keep content for personal use, and will not openly distribute them via Dropbox, Google Drive or
other file sharing services. Publisher’s Note All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated organizations, or those of the
publisher, the editors and the reviewers. Despite an increasing prevalence of T1D in recent years,
DKA in adults has been poorly characterised. Created with BioRender.com. NOMI as Complication
of DKA It tends to occur mostly in elderly patients who have low-cardiac output and other risk
factors, but several pediatric cases have been previously described. Groger A, Bozkurt A, Franke E,
Hornchen H, Steinau G, Piatkowski A, et al. The following symptoms indicate that you might be
suffering from diabetic ketoacidosis. A single reviewer completed the study screening and selection
process and a second reviewer performed an additional screening of approximately 20% of the
publications; two reviewers independently conducted the quality assessment; the results were
narratively synthesised.
An appraisal of recent literature regarding epidemiology and physiopathology of DKA-associated
NOMI in children and adolescents will also be provided. Cengiz E, Xing D, Wong JC, Wolfsdorf JI,
Haymond MW, Rewers A, et al. Factors Associated With the Presence of Diabetic Ketoacidosis at
Diagnosis of Diabetes in Children and Young Adults: A Systematic Review. While there was
considerable variation in study design and data sources among the studies included in the SLR, the
majority of investigations presented recently obtained data (within the previous 10 years), and patient
baseline characteristics were broadly similar. Patient subgroup data were very limited, but a general
trend was observed for decreasing prevalence of DKA with increasing patient age. Article types
Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office.
Data sources Medline (via PubMed) and Embase (1 January 2000 to 23 June 2016). Therefore, an
urgent ileal resection (44 cm) was performed, and NOMI was diagnosed intraoperatively. All authors
approved the final version and take full responsibility for the integrity of the data and the accuracy of
the data summarisation and interpretation. 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. Author
Contributions GF and RT share first authorship due to equal contribution. 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. Provenance and peer review Not
commissioned; externally peer reviewed. Close this message to accept cookies or find out how to
manage your cookie settings. The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications
for Research and Clinical Practice. Case Report A 13-year-old female with previously diagnosed
T1D, was admitted to the emergency department presenting incoercible vomiting since the previous
day, oligo-anuria and deteriorating state of consciousness. Since admission she referred modest
abdominal pain that had persisted throughout DKA treatment. 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. The following symptoms indicate that you might be suffering from diabetic
ketoacidosis. Rectifier of Aberrant mRNA Splicing Recovers tRNA Modification in Familial
Dysautonomia. The liver burns the body fats for generating the energy needed for the body’s
metabolism. Therefore, the treatment of a diabetic ketoacidosis patient should be performed
carefully. Regulation and Function of Endothelial Glycocalyx Layer in Vascular Diseases.
Intraoperative Acute Mesenteric Ischemia: A Hard Nut to Crack. If the mean age was reported and
the calculated age for minus three SDs was Data extraction and analysis Data extraction was
conducted by a single review author (EW or BAM) using a Microsoft Excel file with standardised
definitions for each data element that was extracted from each study (see online supplementary
appendix 1 ). The investigators attribute this discrepancy, at least in part, to differences in national
healthcare systems, which may limit access to routine healthcare for some patients with T1D in
China, as well as infrequent self-monitoring of blood glucose by patients and inappropriate treatment
or errors in diabetes management. Frequency and Associated Risk Factors of Recurrent Diabetic
Ketoacidosis Among Saudi Adolescents With Type 1 Diabetes Mellitus. BSN-II Full description
Save Save Diabetic Ketoacidosis Case Presentation For Later 100% 100% 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 37 Search inside
document. Takiguchi T, Arai M, Kim S, Ishii H, Ogasawara T, Shigeta K, et al. Given the design of
the registry, all five studies relied on patient self-report of past DKA events; three publications 11 22
33 examined the prior 12-month period and two 36 38 queried patients about the previous 3?months.
Data sharing statement Additional data are available in the appendices. If you are using mobile
phone, you could also use menu drawer from browser. This review, like any SLR, is subject to
limitations that should be considered when interpreting the results. 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). But your consciousness and quick response can save you from unhappy outcomes. Increased
insulin resistance due to puberty or obesity may also play a role in greater risk of DKA, as higher
insulin dose was a predictor of DKA at all ages. Data on risk factors and clinical parameters
associated with DKA events were also extracted when reported in the included publications. Patient
subgroup data were very limited, but a general trend was observed for decreasing prevalence of DKA
with increasing patient age. The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for
Research and Clinical Practice. When distinctive signs of ischemia were revealed during imaging
assessment, both children underwent laparotomy and subsequent intestinal resection. Secondary
diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1 diabetes mellitus
in China: a multicentre registration study. Overall incidence and prevalence of DKA in North
America Eleven studies conducted in North America (USA and Canada) reported incidence rate (2)
or prevalence (9) for DKA events in adults with T1D (see online supplementary appendix 2 ).
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. The
use, distribution or reproduction in other forums is permitted, provided the original author(s) and the
copyright owner(s) are credited and that the original publication in this journal is cited, in accordance
with accepted academic practice. BSN-II Full description Save Save Diabetic Ketoacidosis Case
Presentation For Later 100% 100% 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 37 Search inside document. Given the design of the registry,
all five studies relied on patient self-report of past DKA events; three publications 11 22 33
examined the prior 12-month period and two 36 38 queried patients about the previous 3?months.
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. Conclusion: The
diagnosis of DKA-associated NOMI must be suspected in pediatric patients with DKA, persistent
abdominal pain, and severe dehydration even after DKA resolution. Provenance and peer review Not
commissioned; externally peer reviewed. Therefore, the first thing you can do to prevent DKA is
diabetes management. No other signs or symptoms were present apart from slightly loose stools
which were collected for microbiological testing. Find out more about the Kindle Personal Document
Service. Please use the Get access link above for information on how to access this content. The liver
burns the body fats for generating the energy needed for the body’s metabolism. In such a situation,
the patient may suffer from cardiac arrhythmia. A table describing these factors for each included
study can be found in this report ( table 1 ). Importantly, our case underlines how NOMI may exhibit
a very subtle onset with mildly progressive abdominal pain, and unremarkable ultrasound imaging
over days until overt symptoms and signs of complications (ie. Trompeter M, Brazda T, Remy CT,
Vestring T, Reimer P. Case Presentation: A 13-year-old female with previously diagnosed T1D, was
admitted at our emergency department with hypovolemic shock, DKA, hyperosmolar state and acute
kidney injury (AKI). Case Report A 13-year-old female with previously diagnosed T1D, was
admitted to the emergency department presenting incoercible vomiting since the previous day, oligo-
anuria and deteriorating state of consciousness.
References 1. Ghetti S, Lee JK, Sims CE, DeMaster DM, Glaser NS. Article types Author guidelines
Editor guidelines Publishing fees Submission checklist Contact editorial office. When DKA
resolved, the patient was transferred to the pediatrics department and her SAP was reinstated. 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. Of note, both young adults and elderly patients were included in this SLR, so
the results could be applicable across the whole spectrum of the adult population. Nonocclusive
Mesenteric Ischemia After Chemotherapy in an Adolescent Patient With a History of Three
Allogeneic Hematopoietic Stem Cell Transplantations for Acute Lymphoblastic Leukemia. When
insulin production decreases due to diabetes, blood sugar levels increase. On day 2 since DKA
resolution, Clostridium difficile toxin tested positive and oral vancomycin treatment was started.
Overall incidence and prevalence of DKA in North America Eleven studies conducted in North
America (USA and Canada) reported incidence rate (2) or prevalence (9) for DKA events in adults
with T1D (see online supplementary appendix 2 ). On admission, the child presented in hypovolemic
shock with an altered state of consciousness (GCS 12) without evident focal neurological signs, pale
skin and Kussmaul respiration. 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. If you are using mobile phone, you could also use menu drawer from
browser. Most studies included in this SLR were assessed as being of moderate quality.
Nonocclusive Mesenteric Ischemia Associated With a Hyperosmolar Hyperglycemic State: Hepatic
Portal Venous Gas as an Indicator of Mesenteric Ischemia. Note that only studies published in
English were included. As with patient stratification by age, only data on DKA prevalence were
available for the other categorical variables reviewed. 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. Excretion of electrolytes such as potassium, calcium, magnesium occurs due to the
loss of large amounts of fluids through urine and results in electrolyte disturbance. Article types
Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office
Submit your research Search Download article. Severe hypoglycemia and diabetic ketoacidosis
among youth with type 1 diabetes in the T1D Exchange clinic registry. 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. Find out more about the Kindle Personal Document Service. Only two studies 33 42 included
any description of criteria for the diagnosis of T1D. She is an eligible teacher for IDCCM and
Respiratory medicine. Several other factors, such as lower socioeconomic status, poor glycaemic
control, female sex and depression or psychiatric symptoms, were associated with increased risk of
DKA. All authors approved the final version and take full responsibility for the integrity of the data
and the accuracy of the data summarisation and interpretation. Submitted as image. Footnotes. Key
search terms: Type 1 diabetes; adult; diabetic ketoacidosis. While there was considerable variation in
study design and data sources among the studies included in the SLR, the majority of investigations
presented recently obtained data (within the previous 10 years), and patient baseline characteristics
were broadly similar. Most (16 of 19) studies had approximately a 1:1 male-to-female ratio of
patients. From the currently available body of evidence, which provides an overall prevalence of
DKA ranging from approximately 50 to 100 events per 1000 adult patients with T1D, it is clear that
there remains an unmet need to address the prevention of this serious complication.