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1.
Ethiop. j. health dev. (Online) ; 36(2): 1-9, 2022. tables, figures
Article in English | AIM | ID: biblio-1380275

ABSTRACT

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]


Subject(s)
Humans , Male , Female , Child , Diabetic Ketoacidosis , Therapeutics , Precipitating Factors , Treatment Outcome , Diabetes Mellitus , Hospitals
2.
Ethiop. j. health dev. (Online) ; VOL. 36 NO. 2 (2022)(2): 1-9, 2022-06-07. Tables
Article in English | AIM | ID: biblio-1380447

ABSTRACT

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors


Subject(s)
Diabetic Ketoacidosis , Child Mortality , Diabetes Mellitus, Type 1 , Pediatric Obesity , Signs and Symptoms , Precipitating Factors , Morbidity
3.
Iatreia ; 34(1): 7-14, ene.-mar. 2021. tab
Article in Spanish | LILACS | ID: biblio-1154353

ABSTRACT

RESUMEN Introducción: la cetoacidosis diabética es una de las complicaciones agudas más graves de la diabetes. Pocos estudios en Latinoamérica describen el perfil clínico y los desenlaces de la población adulta con esta condición. El objetivo de este estudio es determinar las características demográficas y clínicas de los pacientes adultos con esta enfermedad. Para esto se hizo énfasis en los factores precipitantes y en la determinación del porcentaje de letalidad intrahospitalaria por cualquier causa. Métodos: estudio de cohorte retrospectivo de pacientes mayores de 18 años admitidos por cetoacidosis diabética en el Hospital Universitario San Vicente Fundación de Medellín-Colombia, entre enero de 2012 y diciembre de 2015. Resultados: se incluyeron 159 pacientes con diagnóstico de cetoacidosis diabética. La mediana de la edad fue de 46 años. 40 individuos (25,2 %) tenían diabetes tipo 1, 107 (67,3 %) diabetes tipo 2 y, 12 (7,6 %), otro tipo de diabetes. El factor precipitante de cetoacidosis diabética más común fue la suspensión del tratamiento hipoglucemiante (36 %), seguida de infección (32 %) y diabetes de novo (28 %). La mediana de la estancia hospitalaria fue de 8 días. 12 pacientes fallecieron. Conclusión: la evaluación de los casos de cetoacidosis diabética en este estudio demostró diferencias importantes en la presentación clínica de aquellos con diabetes tipo 1 y tipo 2. La suspensión del tratamiento fue el factor precipitante más frecuente, seguido por la infección. La letalidad en este estudio fue de 7,5 %, superior a la tasa de 1 % que tienen los países desarrollados, evidenciando la necesidad de mejorar la atención de estos pacientes.


SUMMARY Importance: Ketoacidosis is one of the most serious complications of diabetes. Few studies in Latin Ameri-ca describe the clinical profile and outcomes of adults with diabetic ketoacidosis. We proposed to determine demographic and clinical features, precipitating fac-tors and mortality in adults with diabetic ketoacidosis at a university hospital. Methods: A retrospective cohort study of patients older than 18 years of age admitted to the Hospital Universitario San Vicente Fundación (Medellín, Colombia) were reviewed from 2012 to 2015. Results: 159 adult patients with diabetic ketoacidosis were included. The median age was 46 years. Forty patients (25,2 %) had type 1 diabetes, 107 (67,3%) type 2 diabetes and 12 (7,6%) other types of diabetes. The most common diabetic ketoacidosis precipitating factor was suspension of medical treatment (36%), followed by infection (32%) and new diagnosis of diabetes (28%). The median hospital stay was 8 days. Twelve patients died. Conclusion: The evaluation of patients with diabetic ketoacidosis in this study showed important differences in the clinical presentation of those with type 1 and type 2 diabetes. Suspension of treatment was the most frequent precipitating factor, followed by infection. Mortality in this cohort was 7,5% compared to 1% in developed countries, showing the need to urgently improve the care of these patients.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Diabetic Ketoacidosis
4.
Säo Paulo med. j ; 139(1): 10-17, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156965

ABSTRACT

ABSTRACT BACKGROUND: Diabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design. OBJECTIVE: To describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years. DESIGN AND SETTING: Prospective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil. METHODS: All patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate. RESULTS: The incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission. CONCLUSIONS: Diabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.


Subject(s)
Humans , Child , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Prognosis , Brazil/epidemiology , Incidence , Prospective Studies , Retrospective Studies , Cohort Studies , Emergency Service, Hospital
5.
Rev. neuropsiquiatr ; 84(1): 51-57, ene-mar 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1251976

ABSTRACT

RESUMEN Los trastornos de ansiedad tienen gran importancia en la psiquiatría de urgencias, tanto por la frecuencia con la que se presentan, como por la relevancia de las enfermedades somáticas que pueden subyacer a un cuadro ansioso. Resulta imperativo determinar desde el abordaje diagnóstico inicial si los signos y síntomas de la ansiedad constituyen una plena respuesta a situaciones de estrés, son manifestaciones de una patología somática subyacente, o se pueden explicar como síntomas de un trastorno psiquiátrico primario específico. En el momento actual, la pandemia de COVID-19 -en la que el Perú ha llegado a tener la mayor tasa de mortalidad mundial-- desborda los servicios de salud con abigarrados cuadros en los que se combinan tanto los síntomas de la infección viral por sí misma, como los de reacciones ansiosas y respuestas al estrés. A propósito de un caso ilustrativo, en el que el proceso de tamizaje médico fue deficitario y se etiquetó al paciente como un caso primario de "ansiedad", con un desenlace lamentablemente ominoso, se revisa brevemente la literatura acerca del proceso de medical clearance (o descarte de condiciones médicas) y se reafirma concluyentemente la importancia de una consideración diagnóstica inicial abarcadora, no sesgada, y basada en criterios clínicos sólidamente elaborados y sustentados. Es evidente, por otro lado, que el psiquiatra requiere estar permanentemente actualizado sobre las formas de presentación psicopatológica asociadas a la sintomatología de COVID-19.


SUMMARY Anxiety disorders are of great importance in emergency psychiatry, both because of the frequency with which they occur, and because of the relevance of somatic diseases that can underlie an anxious condition. It is imperative to determine, from the initial diagnostic approach, whether the signs and symptoms of anxiety constitute either a response to stress, are manifestations of an underlying somatic pathology, or are explained as symptoms of a specific, primary psychiatric disorder. Currently, the COVID-19 pandemic --in which Peru has had the highest mortality rate in the world-is overwhelming the health services with complex and confusing pictures in which both the symptoms of the viral infection itself, as well as the of anxious reactions and stress responses are combined. On the basis of an illustrative case, in which the medical screening process was deficient and the patient was labeled as a primary case of "anxiety", with a regrettably ominous outcome, the literature about medical clearance is briefly reviewed, to categorically highlight the importance of a comprehensive and unbiased diagnostic consideration, based on well-developed and substantiated clinical criteria. On the other hand, the psychiatrist nowadays needs to be updated on the forms of psychopathological presentations associated with the symptoms of COVID-19.

6.
Article in Portuguese | LILACS | ID: biblio-1359773

ABSTRACT

RESUMO: Objetivos: Apresentar um caso raro de cetoacidose diabética (CAD) e pancreatite secundários ao uso de PEG-asparaginase em paciente pediátrico em tratamento para leucemia linfoblástica aguda (LLA) e alertar quanto aos sinais que remetem a esses diagnósticos. Descrição do caso: Adolescente do sexo feminino, 10 anos e 11 meses, em tratamento para LLA e uso prévio de PEG-asparaginase há seis dias da internação, admitida com choque hipotensivo grave e encaminhada à Unidade de Terapia Intensiva. Inicialmente o quadro foi interpretado como choque séptico. Em seguida a anamnese detalhada e os exames laboratoriais direcionaram para os diagnósticos de CAD e pancreatite, iniciando-se as intervenções específicas. Recebe alta hospitalar após 30 dias, sem necessidade de insulinoterapia, mas com reposição de enzimas pancreáticas. Comentários: Geralmente, às crianças com LLA gravemente enfermos e leucopênicos, atribui-se apenas o diagnóstico de sepse, que é um diagnóstico prioritário. Entretanto, no grupo em uso de PEG-asparaginase, o pediatra emergencista deve estar alerta ao raciocínio diferencial envolvendo CAD e pancreatite, o que pode ser bem difícil inicialmente. O alerta dos diagnósticos diferenciais do choque séptico, mesmo que raros, na assistência a pacientes oncológicos pediátricos, além da correta e pronta identificação do quadro e seu manejo apropriado, correlacionam-se diretamente ao sucesso terapêutico e, em algumas situações, à sobrevivência do paciente. (AU)


ABSTRACT: Objectives: We present a rare case of diabetic ketoacidosis (DKA) and pancreatitis secondary to the use of PEG-asparaginase in a pediatric patient being treated for acute lymphoblastic leukemia (ALL) and draw attention to the signs that refer to these diagnoses. Case description: A female adolescent, aged 10 years and 11 months, undergoing treatment for ALL, used PEG-asparaginase for 6 days prior to admission. She was hospitalized due to severe hypotensive shock and was then referred to the intensive care unit. Initially, the clinical condition was interpreted as septic shock. However, detailed anamnesis and results of laboratory tests led to the diagnoses of DKA and pancreatitis; hence, appropriate interventions were initiated. She was discharged after 30 days without the need for insulin therapy but received pancreatic enzyme replacement therapy. Comments: Generally, diagnosing severely ill and leukopenic children with ALL is only attributed to sepsis, which is a priority diagnosis. However, in the group treated with PEG-asparaginase, the pediatric emergency specialist should consider differential reasoning in patients with DKA and pancreatitis, which can be quite difficult to assess initially. Alertness towards the differential diagnoses of septic shock, although rare, in the care of pediatric oncology patients, in addition to the correct and prompt identification of the condition and provision of appropriate management, directly correlates with treatment success and, in some situations, the improvement in patient's survival. (AU)


Subject(s)
Humans , Female , Child , Pancreatitis , Asparaginase , Diabetic Ketoacidosis , Sepsis , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Enzyme Replacement Therapy
7.
Journal of Preventive Medicine ; (12): 579-582, 2021.
Article in Chinese | WPRIM | ID: wpr-877286

ABSTRACT

Abstract@#Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children. A small number of children with DKA can be complicated by cerebral edema, leading to acute brain dysfunction, which is the main cause of death in children with diabetes. Because of unclear pathogenesis and non-specific clinical manifestations, DKA complicated with brain edema is easy to be missed or misdiagnosed. The identification and management of risk factors of DKA complicated with brain edema and early identification of brain edema are of great importance for improving the prognosis. This article reviewed the literature about the pathogenesis, clinical manifestations, risk factors, treatment and prevention of DKA complicated with brain edema, so as to provide reference for its early clinical identification and intervention.

8.
Arch. argent. pediatr ; 118(5): 332-336, oct 2020. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1122029

ABSTRACT

Introducción. El edema cerebral (EC) es la complicación más grave de la cetoacidosis diabética (CAD) en niños. La patogénesis del EC no se conoce con exactitud y su aparición ha sido relacionada con la terapia de rehidratación endovenosa en el tratamiento inicial.Objetivos. Estimar la prevalencia de EC en pacientes con CAD tratados en el Hospital General de Niños Pedro de Elizalde mediante rehidratación endovenosa y analizar potenciales factores de riesgo para el desarrollo de EC.Materiales y método. Estudio de diseño transversal para prevalencia y un análisis exploratorio para comparar las características clínicas y de laboratorio entre los pacientes con y sin EC. Se incluyeron pacientes de 1 a 18 años hospitalizados con diagnóstico de CAD desde el 1 de enero de 2005 hasta el 31 de diciembre de 2014.Resultados. Se analizaron 693 episodios de CAD en 561 historias clínicas. En 10 pacientes, se evidenció EC (el 1,44 %; intervalo de confianza del 95 %: 0,8-2,6). Los pacientes con EC presentaron mayor uremia (p < 0,001), menor presión de dióxido de carbono (p < 0,001) y menor natremia (p < 0,001) que aquellos pacientes sin EC.Conclusión. La prevalencia de EC en pacientes con CAD fue del 1,44 %, menor que la reportada en nuestro país (del 1,8 %). Los factores de riesgo al ingresar asociados a su desarrollo fueron la presencia de uremia elevada, hiponatremia e hipocapnia.


Introduction. Cerebral edema (CE) is the most severe complication of diabetic ketoacidosis (DKA) in children. There is no accurate knowledge of CE pathogenesis and its onset has been related to intravenous rehydration therapy during the initial treatment.Objectives. To estimate the prevalence of CE among DKA patients treated at Hospital General de Niños Pedro de Elizalde with intravenous rehydration and analyze potential risk factors for the development of CE.Materials and methods. Cross-sectional prevalence study and exploratory analysis to compare clinical and laboratory characteristics between patients with and without CE. Patients aged 1-18 years hospitalized with the diagnosis of DKA between January 1st, 2005 and December 31st, 2014 were included.Results. A total of 693 DKA events from 561 medical records were analyzed. Ten patients had evidence of CE (1.44 %; 95 % confidence interval: 0.8-2.6). Patients with CE had higher serum urea levels (p < 0.001), lower carbon dioxide pressure (p < 0.001), and lower serum sodium levels (p < 0.001) than those without CE.Conclusion. The prevalence of CE among DKA patients was 1.44 %, smaller than that reported in our country (1.8 %). The risk factors at admission associated with CE development were high serum urea levels, hyponatremia, and hypocapnia.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Brain Edema , Diabetic Ketoacidosis/complications , Prevalence , Cross-Sectional Studies , Risk Factors , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/therapy
9.
Article | IMSEAR | ID: sea-212572

ABSTRACT

Background: The acute metabolic complications of diabetes consist of diabetic ketoacidosis (DKA), hyperosmolar non-ketotic coma (HNC), lactic acidosis (LA), and hypoglycemia. All of these are associated with significant morbidity and mortality. These can easily be prevented by early recognition and prompt management. Therefore, this study was conducted to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II.Methods: This observational, analytical study was conducted on 100 patients aged more than 18 years admitted in the ICU with acute complication of Diabetes mellitus Type II. Medical history was recorded. Physical examination and investigations were done and recorded.Results: The mean age of the study population was 55.26±13.13 years. Hypoglycemia was more common (63%) than DKA (37%). Fever and sweating had the overall highest incidence (and were more in patients with hypoglycemia) while stupor, nausea and abdominal pain had the lowest incidence (and were more in patients with DKA). On examination, only one patient of DKA was drowsy. Mean temperature, pulse and respiratory rate were higher in the patients having DKA while blood pressure was higher in patients having hypoglycemia.Conclusions: It can be effectively concluded from the present study that DKA and hypoglycaemia have a broad spectrum of clinicopathological features. But the incidences vary widely. This may help in early recognition of the impending complication and thereby enabling prompt management of the same, reducing the associated morbidity and mortality.

10.
Rev. mex. ing. bioméd ; 41(2): 8-21, may.-ago. 2020. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1139334

ABSTRACT

Resumen El presente trabajo describe el desarrollo y simulación de un algoritmo para el control automático de la infusión de insulina en el manejo glucémico de pacientes con cetoacidosis diabética (CAD) y estado hiperosmolar hiperglucémico (EHH). Se programó un algoritmo que calcula la insulina necesaria para lograr un descenso glucémico de 50 mg/dL/h hasta llegar a glucemias de 250 mg/dL, para posteriormente mantenerlas en 220 mg/dL hasta la remisión de la patología. La simulación del software se realizó haciendo uso de registros glucémicos de 10 pacientes con CAD manejados en el Hospital Juárez de México. Los resultados de la simulación mostraron una incidencia 6 veces menor de hipoglucemias, así como un 33.7% menos de insulina necesaria dentro del tratamiento, sin diferencias entre los descensos medios de glucosa por hora de las mediciones reales y simuladas. Este software propone un uso innovador de los llamados páncreas artificiales al aplicarlos en urgencias hiperglucémicas, implementando además el uso de la sensibilidad a la insulina como variable para el funcionamiento de los mismos. Los resultados demuestran que el algoritmo podría ser capaz de lograr un manejo glucémico apegado a las guías de tratamiento, generando un menor gasto de insulina y evitando hipoglucemias durante la terapéutica, con una posible aplicación en dispositivos biomédicos autónomos.


Abstract This paper describes the development and simulation of an algorithm for the automatic control of insulin infusion, in the glycemic management of patients with diabetic ketoacidosis (CAD) and hyperglycemic hyperosmolar state (EHH). An algorithm was programmed to calculate the requirement insulin for a glycemic decrease of 50 mg/dL/h until reach 250 mg/dL in blood glucose levels, and thus maintaining it at 220 mg/dL until the pathology remission. The software simulation was performed using glycemic records of 10 patients with CAD managed in the Hospital Juárez de México. The results of the simulation showed a lower incidence of hypoglycemia, as well as a lower insulin requirement within the treatment, without differences in the average glucose decreases per hour between real and simulated measurements. This software proposes an innovative use of the artificial pancreas in hyperglycemic emergencies, and also implementing the use of insulin sensitivity as a variable for their function. The results show that the algorithm could be able to achieve glycemic management attached to the treatment guidelines, generating lower insulin expenditure and avoiding hypoglycemia during therapy, with a possible application in autonomous biomedical devices.

11.
Med. crít. (Col. Mex. Med. Crít.) ; 34(4): 245-248, Jul.-Aug. 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375833

ABSTRACT

Resumen: La cetoacidosis diabética es una complicación aguda de la diabetes mellitus, caracterizada por acidosis metabólica con un aumento de la brecha aniónica y evidencia de cuerpos cetónicos en sangre u orina. En la mayor parte de los casos se presenta con hiperglucemia. La cetoacidosis diabética euglucémica se define por la tríada de glucosa con valores menores de 200 mg/dL, acidosis metabólica con anión gap elevado y cetonemia. Los factores asociados con esta entidad son embarazo, tratamiento con SGLT2, disminución da la ingesta calórica, enfermedades hepáticas, ingesta crónica de alcohol, uso de insulina previo a la hospitalización, sepsis, pancreatitis, aumento de las hormonas contrarreguladoras y estados perioperatorios. La base del tratamiento consiste en la corrección rápida de la deshidratación con fluidos intravenosos así como el uso de goteo de insulina junto con una solución que contiene dextrosa hasta que la brecha aniónica y los niveles de bicarbonato se normalicen. En este artículo se reporta el caso de una paciente que ingresa a UCI en el periodo perioperatorio inmediato.


Abstract: Diabetic ketoacidosis is an acute complication of diabetes, characterized by metabolic acidosis with an increase in the values of anion gap and evidence of ketone bodies in blood or urine. In most cases, it is present with hyperglycemia. Euglycemic diabetic ketoacidosis is defined by the triad of glucose with values < than 200 mg/dL, metabolic acidosis with high anion gap and ketonemia. The factors associated with this entity are pregnancy, treatment with SGLT2, decrease in caloric intake, liver disease, chronic alcohol intake, use of insulin prior to hospitalization, sepsis, pancreatitis, increase in counter-regulatory hormones and perioperative states. The basis of the treatment is the rapid correction of dehydration with intravenous fluids, as well as the use of insulin drip along with a solution containing dextrose until the anion gap, and bicarbonate levels normalize. In this article, a case of a patient admitted to the ICU in the immediate perioperative period is reported.


Resumo: A cetoacidose diabética é uma complicação aguda do diabetes mellitus, caracterizada por acidose metabólica com aumento do gap aniônico e evidência de corpos cetônicos no sangue ou na urina. Na maioria dos casos está presente com hiperglicemia. A cetoacidose diabética euglicêmica é definida pela tríade glicêmica com valores inferiores a 200 mg/dL, acidose metabólica com amplo ânion Gap e cetonemia. Os fatores associados a essa entidade são gravidez, tratamento com SGLT2, diminuição da ingestão calórica, doença hepática, ingestão crônica de álcool, uso de insulina antes da hospitalização, sepse, pancreatite, aumento de hormônios contra-regulatórios e estados perioperatórios. A base do tratamento consiste na correção rápida da desidratação com fluidos intravenosos, bem como no uso de infusāo de insulina, juntamente com uma solução contendo dextrose até o hiato aniônico e os níveis de bicarbonato voltarem ao normal. Neste artigo, é relatado o caso de um paciente admitido na UTI no período perioperatório imediato.

12.
Rev. méd. hered ; 31(3): 155-163, jul-sep 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1150059

ABSTRACT

Resumen Objetivo: Describir las alteraciones del equilibrio ácido base y electrolíticas en pacientes con crisis hiperglicémica atendidos en la emergencia de un hospital general de Chiclayo. Material y métodos: Serie de casos, prospectivo y de corte transversal; se seleccionaron pacientes diabéticos con crisis hiperglicémica que fueron vigilados por 3 horas. Se registraron los datos clínicos, demográficos, gases arteriales, glicemia y electrolitos. Resultados: Se evaluaron 52 pacientes con una edad promedio 55,1 ± 16,9 y 29 (55,8%) de sexo femenino. El tiempo promedio de diagnóstico fue 4,3 ± 5,4 meses; 13 (25,0%) eran episodios debut, 4 (7,7%) fallecieron. El síntoma más frecuente fue confusión mental en 14 (26,9%), 30 (57,7%) tuvieron falla renal aguda. Las alteraciones electrolíticas más frecuentes fueron hiponatremia en 26 (50,0%) e hipokalemia en 18 (34,6%). La acidosis metabólica fue más frecuente en cetoacidosis que en coma hiperosmolar (85,0 vs 15,0%; p= 0,000). La falla renal aguda ocurrió en 76,7% en cetoacidosis diabética y en 23,3% en el coma hiperosmolar (p= 0,74). Conclusiones: La frecuencia y las complicaciones de la cetoacidosis diabética y del coma hiperosmolar, así como de las alteraciones electrolíticas, muestran grandes diferencias con los datos reportados en la literatura.


Summary Objective: To describe electrolyte and acid-base imbalances in patients with hyperglycemic crisis attended at emergency in a general hospital in Chiclayo. Methods: A case series of diabetic patients with hyperglycemic crisis that were followed for 3 hours. Clinical, demographic, blood gases, serum glucose and electrolytes were gathered from patient´s charts. Results: 52 patients were evaluated; mean age was 55.1 ± 16.9 years and 29 (55.8%) were females. Mean time to diagnosis was 4.3 ± 5.4 months; 13 (25.0%) occurred at onset of diabetes and 4 (7.7%) died. The most common symptom was mental confusion in 14 (26,9%) of patients, 30 (57,7%) had acute renal failure. Hyponatremia in 26 (50.0%) patients and hypokalemia in 18 (34.6%) were the most common electrolyte abnormalities found. Metabolic acidosis was more frequently found in patients with ketoacidosis than in hyperosmolar coma (85.0 vs 15.0%; p<0.0001). Acute renal failure occurred in 76.7% among patients with ketoacidosis and in 23.3% of patients with hyperosmolar coma (p=0.74). Conclusions: the frequency and complications of diabetic ketoacidosis and of hyperosmolar coma as well as the electrolyte abnormalities differed from those reported in the literature.

13.
Article | IMSEAR | ID: sea-209482

ABSTRACT

Introduction: The prevalence of diabetes mellitus has been dramatically increasing worldwide, making it an extremely costlychronic disease, both in terms of patient morbidity and health-care expenditure. As many non-communicable diseases havesimilar pathophysiologic mechanisms, so the clinicopathological spectrum and incidences of complications may be expectedto be different from that observed in the general population. However, not many studies are available in this regard. Therefore,this study was conducted to assess the clinicopathological spectrum of the acute complications of diabetes mellitus in relationto hypertension.Materials and Methods: This cross-sectional, analytical study was conducted on patients admitted in the ICU with the acutecomplication of diabetes mellitus. One hundred patients aged more than 18 years were included in the study. Relevant medicalhistory and investigations were recorded.Results: The mean diastolic BP was significantly lower in hypertensive patients. More proportion of hypertensive patients hadderanged creatinine.Conclusion: From the present study, it can be effectively concluded that the epidemiological and clinic-pathological profile ofthe patients having acute complications of diabetes mellitus is significantly different in hypertensive patients than in the nonhypertensives. Further studies need to be done in this regard.

14.
Article | IMSEAR | ID: sea-204592

ABSTRACT

Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.

15.
Arch. argent. pediatr ; 118(2): 135-138, abr. 2020. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1100249

ABSTRACT

El daño renal agudo es causa de morbilidad en niños diabéticos en países en vías de desarrollo, especialmente, en pacientes con cetoacidosis diabética. El objetivo de esta investigación fue identificar factores de riesgo para daño renal agudo en pacientes con cetoacidosis diabética. Se realizó un estudio de cohorte retrospectiva. Se incluyeron 50 pacientes diabéticos con cetoacidosis; el 54 % desarrollaron daño renal; en ellos, los niveles de glucosa y ácido úrico fueron mayores (541 mg/dl contra 407 mg/dl, p = 0,014, y 8,13 mg/dl contra 5,72 mg/dl, p = 0,015, respectivamente). El ácido úrico mayor de 6,5 mg/dl demostró un odds ratio de 6,910 (p = 0,027) para daño renal. En conclusión, la hiperuricemia fue un factor de riesgo para el desarrollo de daño renal agudo en estos pacientes. Son necesarios estudios prospectivos para determinar el papel del ácido úrico en la patogénesis del daño renal agudo en pacientes diabéticos.


Acute kidney injury is a cause of morbidity in children with diabetes in developing countries, especially in patients with diabetic ketoacidosis. The objective of this study was to identify the risk factors for acute kidney injury in patients with diabetic ketoacidosis. This was a retrospective cohort study. A total of 50 patients with diabetic ketoacidosis were included; 54 % developed kidney injury. These had higher glucose and uric acid levels (541 mg/dL vs. 407 mg/dL, p = 0.014 and 8.13 mg/dL vs. 5.72 mg/dL, p = 0.015, respectively). Uric acid levels above 6.5 mg/dL showed an odds ratio of 6.910 (p= 0.027) for kidney injury. To conclude, hyperuricemia was a risk factor for acute kidney injury in these patients. Prospective studies are required to determine the role of uric acid in the pathogenesis of acute kidney injury in patients with diabetes.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/diagnosis , Acute Kidney Injury , Uric Acid , Data Interpretation, Statistical , Retrospective Studies , Risk Factors , Hyperuricemia
16.
Arch. méd. Camaguey ; 24(2): e6594, mar.-abr. 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1124169

ABSTRACT

RESUMEN Fundamento: la mayoría de los casos de cetoacidosis diabética se presentan con hiperglucemia, en ocasiones puede ser diagnostica con valores normales de la misma, por lo general en la mujer embarazada. Objetivo: presentar el caso de dos gestantes sin diagnóstico previo de diabetes gestacional que desarrollan durante el embarazo una cetoacidosis diabética normoglucémica. Presentación de casos: se trata de dos gestantes sin diagnóstico previo de diabetes gestacional que en el segundo y tercer trimestre del embarazo reciben tratamiento con glucocorticoides endovenosos por diferentes cuestiones (inducción de la madurez pulmonar fetal y crisis materna de asma bronquial) lo cual desencadena cuadros clínicos y bioquímicos compatibles con cetoacidosis diabética normoglucémica. Conclusiones: la cetoacidosis diabética durante el embarazo ocurre con mayor frecuencia en mujeres con diabetes pregestacional sin diagnóstico previo del trastorno, solo en raros casos ocurre en gestantes con diabetes gestacional, las cuales en un pequeño porcentaje se presenta como una cetoacidosis diabética normoglucémica después de la presentación de factores de riesgo gatillantes.


ABSTRACT Background: although the majority cases who suffer from diabetic ketoacidosis show with hyperglycemia, occasionally it can be diagnosed with normal values of glycemia especially on pregnant women. Objective: to show two pregnant women without diagnosis of gestational diabetes previously who developed a normoglyacemic diabetic ketoacidosis during pregnancy. Cases report: two pregnant women without diagnosis of gestational diabetes previously who are treated with glucocorticoids to induce fetal pulmonary develop and to resolve an acute crisis of asthma respectively and they later developed a normoglyacemic diabetic ketoacidosis. Conclusions: diabetic ketoacidosis during pregnancy happen more frequent on pregnant women without previously diagnosis of pre-gestational diabetes, on few cases it happen on pregnant women who suffer from gestational diabetes in which it shows as a normoglyacemic diabetic ketoacidosis in a low percent.

17.
Article in English | LILACS | ID: biblio-1057225

ABSTRACT

ABSTRACT Objective: To analyze the variables associated with the presence of diabetic ketoacidosis in type 1 diabetes mellitus (T1DM) diagnosis and its impact on the progression of the disease. Methods: We reviewed the records of 274 children and adolescents under 15 years, followed in a Pediatric Endocrinology clinic of a university hospital in Curitiba-PR. They had their first appointment between January 2005 and April 2015. Results: Most patients received their T1DM diagnosis during a diabetic ketoacidosis episode. The associated factors were: lower age and greater number of visits to a physician's office prior to diagnosis; diabetic ketoacidosis was less frequent in patients who had siblings with T1DM and those diagnosed at the first appointment. Nausea and vomiting, abdominal pain, tachydyspnea, and altered level of consciousness were more common in the diabetic ketoacidosis group. There was no association with socioeconomic status, duration of symptoms before diagnosis, and length of the honeymoon period. Conclusions: Prospective studies are necessary to better define the impact of these factors on diagnosis and disease control. Campaigns to raise awareness among health professionals and the general population are essential to promote early diagnosis and proper treatment of diabetes mellitus in children and adolescents.


RESUMO Objetivo: Avaliar as variáveis associadas ao diagnóstico de diabetes melito tipo 1 (DM1) na vigência de cetoacidose diabética e seu impacto na evolução da doença. Métodos: Foram avaliadas 274 crianças e adolescentes com idade até 15 anos acompanhados em um ambulatório de endocrinologia pediátrica de um hospital universitário de Curitiba, Paraná, cuja primeira consulta ocorreu entre janeiro de 2005 e abril de 2015. Resultados: A maioria dos pacientes teve diagnóstico de DM1 na vigência de cetoacidose diabética. Os fatores associados foram: menor idade e maior número de consultas prévias ao diagnóstico; a cetoacidose diabética foi menos frequente quando havia um irmão com DM1 e quando o diagnóstico foi feito na primeira consulta médica. Náuseas ou vômitos, dor abdominal, taquidispneia e alteração do nível de consciência foram mais frequentes no grupo com cetoacidose diabética ao diagnóstico. Não se observou associação com nível socioeconômico, tempo de sintomas antes do diagnóstico e duração do período de lua de mel. Conclusões: São necessários estudos prospectivos para definir melhor o impacto desses fatores no diagnóstico e no controle da doença. Campanhas de conscientização dos profissionais de saúde e da população são necessárias para que haja diagnóstico precoce e tratamento adequado do diabetes melito em crianças e adolescentes.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Diabetic Ketoacidosis/pathology , Diabetic Ketoacidosis/therapy , Disease Progression , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/therapy , Diagnosis, Differential , Ambulatory Care/statistics & numerical data , Insulin/therapeutic use
18.
Article in English | LILACS | ID: biblio-1092149

ABSTRACT

ABSTRACT Objective: To analyze the variables associated with the presence of diabetic ketoacidosis in type 1 diabetes mellitus (T1DM) diagnosis and its impact on the progression of the disease. Methods: We reviewed the records of 274 children and adolescents under 15 years, followed in a Pediatric Endocrinology clinic of a university hospital in Curitiba-PR. They had their first appointment between January 2005 and April 2015. Results: Most patients received their T1DM diagnosis during a diabetic ketoacidosis episode. The associated factors were: lower age and greater number of visits to a physician's office prior to diagnosis; diabetic ketoacidosis was less frequent in patients who had siblings with T1DM and those diagnosed at the first appointment. Nausea and vomiting, abdominal pain, tachydyspnea, and altered level of consciousness were more common in the diabetic ketoacidosis group. There was no association with socioeconomic status, duration of symptoms before diagnosis, and length of the honeymoon period. Conclusions: Prospective studies are necessary to better define the impact of these factors on diagnosis and disease control. Campaigns to raise awareness among health professionals and the general population are essential to promote early diagnosis and proper treatment of diabetes mellitus in children and adolescents.


RESUMO Objetivo: Avaliar as variáveis associadas ao diagnóstico de diabetes melito tipo 1 (DM1) na vigência de cetoacidose diabética e seu impacto na evolução da doença. Métodos: Foram avaliadas 274 crianças e adolescentes com idade até 15 anos acompanhados em um ambulatório de endocrinologia pediátrica de um hospital universitário de Curitiba, Paraná, cuja primeira consulta ocorreu entre janeiro de 2005 e abril de 2015. Resultados: A maioria dos pacientes teve diagnóstico de DM1 na vigência de cetoacidose diabética. Os fatores associados foram: menor idade e maior número de consultas prévias ao diagnóstico; a cetoacidose diabética foi menos frequente quando havia um irmão com DM1 e quando o diagnóstico foi feito na primeira consulta médica. Náuseas ou vômitos, dor abdominal, taquidispneia e alteração do nível de consciência foram mais frequentes no grupo com cetoacidose diabética ao diagnóstico. Não se observou associação com nível socioeconômico, tempo de sintomas antes do diagnóstico e duração do período de lua de mel. Conclusões: São necessários estudos prospectivos para definir melhor o impacto desses fatores no diagnóstico e no controle da doença. Campanhas de conscientização dos profissionais de saúde e da população são necessárias para que haja diagnóstico precoce e tratamento adequado do diabetes melito em crianças e adolescentes.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Diabetic Ketoacidosis/pathology , Diabetic Ketoacidosis/therapy , Disease Progression , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/therapy , Diagnosis, Differential , Ambulatory Care/statistics & numerical data , Insulin/therapeutic use
19.
Article in English | WPRIM | ID: wpr-886416

ABSTRACT

@#BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes. METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described. RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered. CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.


Subject(s)
Diabetic Ketoacidosis , COVID-19 , Water-Electrolyte Imbalance , Acid-Base Imbalance , Coma
20.
Article in English | WPRIM | ID: wpr-880604

ABSTRACT

OBJECTIVES@#To compare the differences in clinical characteristics between Type 1 diabetes mellitus (T1DM) and fulminant Type 1 diabetes mellitus (FT1DM), and to reduce the missed diagnosis, misdiagnosis, and mistreatment of FT1DM by medical staff.@*METHODS@#A total of 101 hospitalized patients with T1DM (including 8 cases of FT1DM) were enrolled in this study from Changsha Central Hospital between June 2012 and December 2018. Clinical characteristics of the 8 FT1DM patients were collected and compared with all T1DM patients.@*RESULTS@#All FT1DM patients were adult with the average age of (30.25±5.28) years old, accompanied by severe diabetic ketoacidosis (DKA) occurred within 1 week after onset. Moreover, pancreatic beta cells in these patients were destroyed and the islet-related antibodies were negative, while the serum pancreatic enzyme levels were increased. Compared with classic T1DM patients, the plasma glucose levels in FT1DM patients were much higher [(41.89±12.54) mmol/L vs (22.57±9.74) mmol/L], but glycosylated hemoglobin (HbA1c) and fasting C peptide levels were significantly lower [(6.08±0.41)% vs (10.87±2.46%)%, @*CONCLUSIONS@#The onset time of FT1DM patients is very urgent via driving DKA. These patients have higher blood glucose concentration than classic T1DM patients, accompanied by electrolyte disturbances, impaired renal function, partially impaired liver function, as well as gastrointestinal symptoms and elevated trypsin. Most FTDM patients are adolescents and adults with no gender difference, especially pregnant women who are at high risk. Lifelong insulin dependence in FT1DM patients should be paid more attention in clinical treatment.


Subject(s)
Adolescent , Adult , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis , Female , Glycated Hemoglobin A/analysis , Humans , Insulin , Pregnancy , Sex Factors , Young Adult
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