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Severe Diabetic Ketoacidosis (severe + diabetic_ketoacidosis)
Selected AbstractsEvaluation of a bedside blood ketone sensor: the effects of acidosis, hyperglycaemia and acetoacetate on sensor performanceDIABETIC MEDICINE, Issue 7 2004A. S. A. Khan Abstract Aims To assess the performance of a handheld bedside ketone sensor in the face of likely metabolic disturbances in diabetic ketoacidosis, namely: pH, glucose and acetoacetate. Methods The effects of pH (7.44,6.83), glucose (5,50 mmol/l) and acetoacetate (0,5 mmol/l) were examined in venous blood to investigate the accuracy of betahydroxybutyrate measurement (0,5 mmol/l) by a handheld ketone sensor. Sensor results were compared with a reference method. Linear regression models were fitted to the difference between the methods with the concentration of metabolite as the explanatory factor. Results Decreasing pH and increasing glucose had no effect on the accuracy of the handheld ketone sensor; the gradients of the fitted lines were ,0.14 and ,0.003, respectively. The 95% confidence intervals were ,0.7,0.4 and ,0.01,0.004, respectively (P = 0.59 and 0.4, respectively). In the acetoacetate study, a positive relationship between the sensor and reference method results was found, the gradient was 0.09. The 95% confidence interval was 0.05,0.14 (P , 0.001), indicating that high concentrations of acetoacetate interfere with the sensor performance. Conclusions Acidosis and hyperglycaemia have minimal effects on the sensor performance. However, high concentrations of acetoacetate result in some overestimation of betahydroxybutyrate. This bedside ketone sensor provides useful data over a broad range of conditions likely to be encountered during moderate to severe diabetic ketoacidosis. [source] Oesophageal rupture secondary to gastric stasis, complicating severe diabetic ketoacidosisPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 9 2006BSc(Hons) Specialist Registrar Specialist Registrar, General Medicine, N Martin MRCP, Respiratory Abstract Gastric stasis is a common, and easily treated, complication of diabetic ketoacidosis (DKA). Here we report a case of oesophageal rupture in DKA that highlights the need for early nasogastric tube placement in patients with gastric stasis and protracted vomiting. Copyright © 2006 John Wiley & Sons. [source] Reversible blindness associated with severe diabetic ketoacidosisANAESTHESIA, Issue 1 2010M. A. Ali No abstract is available for this article. [source] Bedside Detection of Urine ,-Hydroxybutyrate in Diagnosing Metabolic AcidosisACADEMIC EMERGENCY MEDICINE, Issue 8 2008Silas W. Smith MD Abstract Objectives:, While critically important, the rapid identification of the etiology of metabolic acidosis (MA) may be labor-intensive and time-consuming. Alcoholic, starvation, and severe diabetic ketoacidosis (AKA, SKA, and DKA, respectively) may produce ,-hydroxybutyrate (BOHB) in marked excess of acetone (ACET) and acetoacetate (AcAc). Unfortunately, current urine dipstick technology poorly detects ACET and cannot measure BOHB. The inability to detect BOHB might delay therapy for ketoacidoses or provoke unnecessary evaluation or empiric treatment of other causes of MA, such as toxic alcohol poisoning. The authors tested the previous assertion that commonly available hydrogen peroxide (H2O2) would improve BOHB detection. The effectiveness of alkalinization and use of a silver nitrate (AgNO3) catalyst was also assessed. Methods:, Control and urine test specimens containing from 0.5 to 800 mmol/L ACET, AcAc, and BOHB were prepared. Urine specimens were oxidized with H2O2 (3%) 1:9 (H2O2:urine), alkalinized with potassium hydroxide (KOH; 10%), exposed to AgNO3 sticks, or altered with a combination of these methods in a random fashion. Three emergency physicians (EPs) blinded to the preparation technique evaluated urine dipsticks (Multistix, Bayer Corp.) placed in the specimens for "ketones." Results:, Multistix detected AcAc appropriately; ACET was detected only at high concentrations of ,600 mmol/L. Multistix failed to measure BOHB at all concentrations tested. H2O2 improved urinary BOHB detection, although not to clinically relevant levels (40 mmol/L). Alkalinization and AgNO3 sticks did not improve BOHB detection beyond this threshold. Conclusions:, Addition of H2O2 (3%), alkalinization, or AgNO3 sticks did not improve clinically meaningful urine BOHB detection. Clinicians should use direct methods to detect BOHB when suspected. [source] | ||||||||||