First line management of adult diabetic ketoacidosis patients

BackgroundiDiabetic Ketoacidosis [DKA] is a hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. It is a medical emergency with a significant morbidity and mortality. It is however a potentially reversible condition in case an emergency and immediate medical attention, prompt recognition, diagnosis and treatment were provided

Aim of the Study: was to leverage the current research data in order to construct a treatment guideline for diabetic ketoacidosis in the emergency department

Methods:A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL,Embase and the Cochrane Library. Databases using [diabetic ketoacidosis] as a MeSH heading and as textword. High yield journals were also hand searched

Findings: The initial treatment phase aims to restore circulating volume, reduce blood glucose levels, to correct any electrolyte imbalances and to reduce ketone levels which in turn corrects the acidosis. Evidence also showed that there is no need for insulin bolus prior to starting an insulin drip in the treatment of diabetic ketoacidosis. Also, using beta-hydroxybutyrate at presentation can expedite diagnosis and therefore treatment. Implementing treatment guidelines into the emergency department may help expedite diagnosis and treatment

Conclusion: Prompt first line management of DKA is the most critical stage to profoundly reduce morbidity and mortality rates of this potentially fatal crisis. It's therefore crucial to follow the evidence-based guidelines and DKA protocol in the emergency department to expedite diagnosis, guide treatment, and improve continuity of care between the emergency department and the ICU as well as improving the clinical outcomes of patients with DKA. Initially, this will improve outcomes by decreasing the delay until treatment is initiated andprovide a continuum of treatment between the emergency department and the intensive care unit

Furthermore, the healthcare providersmust ensure that they have the ability to provide support and education to people at risk of developing DKA and those that have had an episode of DKA by spreading awareness and education to help reduce both the initial occurrence and recurrence of this often preventable life-threatening condition

Carotid endarterectomy versus medical therapy in stroke prevention

Stroke is one of the leading causes of deaths in different parts of the world affecting individuals of different ages, it is mostly dominant among people having risk factors such drug abuse, having a background of a mild stroke, and overweight. Various approaches including carotid endarterectomy [CEA] and medical therapy have been used as mechanisms for preventing stroke particularly ipsilateral ischemia. However, there are several studies suggesting that even though CEA has the potential of reducing the risks of stroke, incidences of a high residual risk of stroke after carotid endarterectomy since Various cases of increased short-term myocardial infarction after CEA are recorded. Based on the results drawn from randomized trials comparing the effectiveness of CEA and medical therapy ,CEA provides better protection from ipsilateral strokes than the latter. The efficacy of CEA is more pronounced in patients presenting symptomatic and asymptomatic carotid artery disease. The aim of this study was to explore the comparative merits and demerits of using carotid endarterectomy and medical therapy to determine the most appropriate of the two approaches to be used in specific cases

This research concludes that even through both therapeutic methods and carotid endarterectomy have the ability to reduce the predisposition of patients to different events of stroke, each of them have inherent limitations that must be addressed effectively to contribute to overall positive medical outcomes