Crafting a literature review can be a daunting task, requiring extensive research, critical analysis, and

effective synthesis of existing literature. For those delving into the intricate realm of Diabetic
Ketoacidosis (DKA), the process becomes even more challenging due to the complex nature of the
subject matter.

DKA literature reviews demand a comprehensive understanding of various medical concepts,

including the pathophysiology, diagnostic criteria, treatment modalities, and long-term management
of this condition. Additionally, researchers must sift through a plethora of scholarly articles, medical
journals, and clinical trials to gather relevant information and insights.

Furthermore, synthesizing this information into a coherent narrative that contributes meaningfully to
the existing body of knowledge poses a significant hurdle. It requires not only meticulous attention
to detail but also the ability to critically evaluate the reliability and validity of each source.

Given the intricacies involved, many individuals find themselves overwhelmed by the daunting task
of composing a DKA literature review. However, there's a solution at hand - ⇒ StudyHub.vip ⇔.

⇒ StudyHub.vip ⇔ offers professional assistance tailored to your specific needs. With a team of
experienced writers well-versed in medical literature, they can alleviate the burden of crafting a
literature review from scratch. By entrusting your project to ⇒ StudyHub.vip ⇔, you can rest
assured that your literature review will be meticulously researched, expertly written, and delivered on
time.

Don't let the complexities of writing a DKA literature review impede your progress. Order from ⇒
StudyHub.vip ⇔ today and embark on your academic journey with confidence.
Occasionally, DKA is the presentation of a serious underlying problem, especially sepsis. Although
her cancer status showed nearly complete remission, she stopped the pembrolizumab due to poor
general condition. Massive Ischemic Intestinal Necrosis at the Onset of Diabetes Mellitus With
Ketoacidosis in a Three-Year-Old Girl. This may be treated with IV bicarbonate as described below.
The results of the quality assessment using the JBI tool can be found in online supplementary
appendix 3. All of the publications describing prevalence of DKA in the USA were based on data
from the T1D Exchange Clinic Registry, although each investigation evaluated a slightly different
patient population. Most studies included in this SLR were assessed as being of moderate quality.
Regardless of the continuation of ICIs, all patients continue to receive insulin therapy for their
glycemic control. Is fear of DKA a barrier to optimal self management of type 1 diabetes?
Supornsilchai Published in Case Reports in Endocrinology 20 January 2016 Medicine TLDR In
patients with DKA and hypertriglyceridemia, clinicians should be mindful of the possibility of
associated acute pancreatitis and cerebral edema. We did not observe other endocrine dysfunctions
affecting the thyroid and adrenal glands at with DKA, however, one patient developed adrenal
insufficiency 2 months after DKA. For comparison, here is an example DKA management protocol
from another local hospital. The initial fluid of choice in most guidance is 0.9% saline. It happens
predominantly in type 1 diabetes mellitus, but it can also occur in type 2 diabetes mellitus under
certain circumstances. Thyroid dysfunction or adrenal insufficiency was not observed. Introduction
to Personality Type TYPEFOCUS TM CAREERS. Al-Hayek AA, Robert AA, Braham RB, Turki
AS, Al-Sabaan FS. Therefore, our overall goal is to titrate insulin as needed to treat the ketoacidosis
(figure above). Retrospective written informed consent was obtained from the participants for the
publication of this case report. There is a clear need for future studies to better describe the
epidemiology of DKA among adult patients with T1D. The serum anion gap in the evaluation of
acid-base disorders: what are its limitations and can its effectiveness be improved. In the past year,
glipizide (Glucotrol), metformin (Glucophage), and ultralente insulin were added because of poor
glycemic control. Internationally there is little consensus on how ketones should. Recently, I was
asked to give a lecture to both my residents and nurses at the University of Texas Health Science
Center at San Antonio (UTHSCSA) on some common DKA myths. 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. 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 mean age of the patients was 71.5 years, and the mean time for diagnosing the onset of
DKA after starting ICIs was 15.8 weeks. Glutamic acid decarboxylase antibodies were positive in
one patient (25%) who already had been treated with type 2 diabetes. Insulin reduces glucose levels
and suppresses ketogenesis. This. The quality of included studies was assessed using a standardised
tool (the Joanna Briggs Institute prevalence studies quality assessment tool). Intensive rehabilitation
therapy and low-molecular-weight heparin (enoxaparin, 30 mg subcutaneously every 12 hours) were
started after.
However, an insulin bolus may be helpful in the following situations. Hyperglycemic crises in adult
patients with diabetes. 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. The Joint British Diabetes Societies recommend
high levels of. A table describing these factors for each included study can be found in this report (
table 1 ). Note that the patient's sodium level will often initially increase during resuscitation, as
glucose and water enter the cells. Massive Ischemic Intestinal Necrosis at the Onset of Diabetes
Mellitus With Ketoacidosis in a Three-Year-Old Girl. 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. This can help
sort out the precise etiology of the elevated anion gap, for example. Type 2: Overview. Type 2 is the
most common form of diabetes (DM). Since admission she referred modest abdominal pain that had
persisted throughout DKA treatment. A laboratory finding in addition to elevated blood glucose
could be elevated serum causes potassium to accumulate in the blood leading to hyperkalemia.
Carbohydrate intake (along with meal-associated and sliding-scale insulin) is important at this point,
to prevent recurrent DKA. In Browsegrades, a student can earn by offering help to other student.
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. In acute arterial occlusion these processes occur
sequentially; in non-occlusive ischemia different stages can occur simultaneously, intermittently, or
even repeatedly. Our findings may provide additional evidence of improving antitumor responses in
patients who developed autoimmune diabetes after ICI therapy. Fasting C-peptide was measured by
immunoradiometric assay (SST; Becton, Dickinson and Company, Franklin Lakes, NJ, USA).
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).
Antibiotic treatment with piperacillin-tazobactam and gentamicin was administered for 7 days, and
treatment with metronidazole and vancomycin was continued for 10 days. Funding This study was
sponsored by Boehringer Ingelheim International GmbH. He continues atezolizumab having a stable
disease status under insulin injection therapy. However, it is unclear whether the GAD antibodies
preceded the start of pembrolizumab or developed after receiving therapy. This is especially true of
patients with type-II DM, who don't generally require exogenous insulin but may develop DKA in
the context of physiologic stress. The advantage of giving the components separately is that it
provides you greater control with regards to adjusting the amount of sodium you are giving versus
the amount of dextrose. SR is a 59-year-old man who comes to the clinic because his wife complains
“my snoring is. While the anion gap is still open, use the predicted final bicarbonate to get a rough
concept of the bicarbonate deficit. Swamp thang by ruthless ejuice is one of the best ejuices you
should consider investing your money in. 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. Management of Hyperglycemic Crises:
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Among patients who initially presented with DKA, a reduction of the beta-hydroxybutyrate level
below resolution of the DKA. ( 32409703 ). References 1. Ghetti S, Lee JK, Sims CE, DeMaster
DM, Glaser NS. Data on risk factors and clinical parameters associated with DKA events were also
extracted when reported in the included publications. On day 2 since DKA resolution, Clostridium
difficile toxin tested positive and oral vancomycin treatment was started. Note that DKA does not
require the presence of acid emia (low pH). A table describing these factors for each included study
can be found in this report ( table 1 ). There was a strong smell of ketones in the exam room. It is a
potentially life-threatening complication in patients with diabetes mellitus. Expand 2 PDF 3 Excerpts
Save A 4 year-old Girl with Diabetic Ketoacidosis and Lipemic Blood. C. Novak Sarah Johnson
Graeme Rinholm J. Critical illness causes insulin resistance, so patients may have a tendency to
require more insulin (not less). If the predicted final bicarbonate is falling over time to well under 20
mM, this suggests NAGMA. 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. Three patients were treated with PD-1 inhibitor, pembrolizumab, and one patient was
treated with PD-L1 inhibitor, atezolizumab. Al-Hayek AA, Robert AA, Braham RB, Turki AS, Al-
Sabaan FS. 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. This is generally not a major problem, but it
can be for the sickest patients who present with severe acidosis. This causes hyperglycemia,
hyperosmolality, increased lipolysis, and ketogenesis. ( 13 ) Glucose-induced osmotic diuresis leads
to vascular volume depletion, severe dehydration and low cardiac output; moreover, the high
catecholaminergic expression may induce hypoperfusion. Quality assessment of each included study
using the JBI Checklist for Prevalence Studies was undertaken independently by two reviewers (EW
and BAM), with any discrepancies resolved by a third reviewer (Xcenda employee, member of
evidence synthesis team). Define sources of data Develop quality measures Data reporting Implement
changes. 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). 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. However, hemodialysis often isn't required (e.g., insulin
alone may be adequate to improve hyperkalemia and acidosis). Regardless of the continuation of
ICIs, all patients continue to receive insulin therapy for their glycemic control. 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. Valabhji, M. Watson, J. Cox, C. Poulter, C. Elwig,R. S. Elkeles.
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. Glargine has a delayed onset compared to
some older forms of insulin (e.g., NPH), so the traditional two-hour overlap may not work well with
glargine. ( 28372715 ) Early initiation of long-acting insulin facilitates transitioning off the insulin
infusion, reduces the incidence of hyperglycemia, and might decrease hospital length of stay. (
28183452 ). Hyperglycemic Crises in Adult Patients With Diabetes. Of note, although the authors
acknowledge the availability of nationwide population-based databases with high ascertainment rates
in the Nordic countries, which could be used to evaluate epidemiological queries in T1D,
publications on DKA rates among adults in this region were very limited; only one such study 41
met the inclusion criteria for this SLR. An Unusual Case of Mesenteric Ischemia in a Patient With
New-Onset Diabetes Mellitus.
In patients with diabetes and alcoholism, it may be nearly impossible to sort out diabetic
ketoacidosis versus alcoholic ketoacidosis (in this situation, the safest approach is often to treat the
patient as if they have DKA). 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. In addition, because of the pre-existing fever, cough, localized
rales on auscultation and high white blood cell count, a respiratory tract infection should be
considered. Results from data extraction, including incidence rate, prevalence and risk factors for
DKA can be found in online supplementary appendix 2 and supplementary appendix 3. 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. Note that DKA does not require the presence of acid emia (low pH). Author
Contributions GF and RT share first authorship due to equal contribution. Nonocclusive Mesenteric
Ischemia After Chemotherapy in an Adolescent Patient With a History of Three Allogeneic
Hematopoietic Stem Cell Transplantations for Acute Lymphoblastic Leukemia. The evidence in
favour of a specific DKA diagnostic threshold. Small-Intestinal Necrosis Due to non-Occlusive
Mesenteric Ischemia With Diabetic Ketoacidosis After Quetiapine Treatment. The advantage of
giving the components separately is that it provides you greater control with regards to adjusting the
amount of sodium you are giving versus the amount of dextrose. Isotonic solution Hypertonic
solution Hypotonic solution. Expand 19 Highly Influential 3 Excerpts Save. 1 2 3. Related Papers
Showing 1 through 3 of 0 Related Papers Figures and Tables Ask This Paper 16 Citations 22
References Related Papers Table 1: Literature review of pediatric DKA patients with
hypertriglyceridemia. Out of 1082 articles identified through the initial search, 19 peer-reviewed
observational study publications met the inclusion and exclusion criteria; no SLRs or meta-analyses
were identified that met the inclusion and exclusion criteria. 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. For
instance, people might broke one of their teeth in an accident or injury. DKA usually develops
quickly, within 24 hours. Typically. For personal use only: See rights and reprints Subscribe. In the
present study, all patients showed a good response to their ICI therapy, from stable disease to even
complete remission. On day 2 since DKA resolution, Clostridium difficile toxin tested positive and
oral vancomycin treatment was started. Hyperglycemic Crises in Adult Patients With Diabetes. This
is an open-access article distributed under the terms of the Creative Commons Attribution License
(CC BY). Similarly, studies of fewer than 50 adult patients with T1D were excluded. 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. The mainstay of treatment is carefully monitored delivery of.
Although not explicitly described in the publication, it seems likely that this study reported the
incidence rate of all DKA events during the study period rather than only the first instance of DKA
for each patient. The Joint British Diabetes Societies recommend high levels of. 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). Lutfi
Jennifer T. Huang H. Wong Medicine Pediatrics 2012 TLDR This is the first report of a pediatric
patient presenting with the triad of severe hypertriglyceridemia, diabetic ketoacidosis, and
pancreatitis treated successfully with plasmapheresis, and it is known that diabetes is known to
contribute to an elevated triglyceride level. Abdominal pain in patients with hyperglycemic crises.