Diabetes research and clinical practice
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Diabetes Res. Clin. Pract. · Dec 2011
ReviewEvidence-based management of hyperglycemic emergencies in diabetes mellitus.
The hyperglycemic emergencies, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially fatal complications of uncontrolled diabetes mellitus. The incidence of DKA and the economic burden of its treatment continue to rise, but its associated mortality rate which was uniformly high has diminished remarkably over the years. This Improvement in outcome is largely due to better understanding of the pathogenesis of hyperglycemic emergencies and the application of evidence-based guidelines in the treatment of patients. ⋯ A succinct discussion of the pathophysiology and important etiological factors in DKA and HHS are provided as a prerequisite for understanding the rationale for the effective therapeutic maneuvers employed in these acute severe metabolic conditions. The evidence for the role of preventive measures in DKA and HHS is also discussed. The unanswered questions and future research needs are also highlighted.
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Diabetes Res. Clin. Pract. · Dec 2011
Point-of-care beta-hydroxybutyrate testing for assessing diabetic ketoacidosis severity prior to treatment in the emergency department.
We prospectively evaluated the correlation between point-of-care β-OHB values and DKA severity at time of initial diagnosis in 54 patients. The correlation coefficients between β-OHB and pH, bicarbonate and anion gap were 0.33, 0.25 and 0.16, respectively. We conclude that point-of-care β-OHB absolute values cannot reliably assess DKA severity.