4/30/2024 0 Comments Bun normal range nclexIn urban Black patients, poor compliance with insulin was the leading precipitating cause of DKA. The prognosis substantially worsens at the extremes of age in the presence of coma, hypotension, and severe comorbidities. Death in these conditions is rarely because of the metabolic complications of hyperglycemia or ketoacidosis alone. Mortality rate greater than 5% has been reported in the elderly and patients with concomitant life-threatening illnesses. Increased mortality was associated with nursing home residence among patients with DKA. In the United States, one study reported nursing home residents accounted for 0.7% of DKA. The highest incidence rate was found in Sweden and Finland, with 41.0 and 37.4 per 100,000. The lowest incidence was found in Nigeria (2.9 cases per 100,000). Rates of DKA among children varies widely from country to country. Incidence is higher among patients using injectable insulin compared to the subcutaneous insulin infusion pumps. DKA has a higher prevalence rate among women and non-Whites. ĭiabetic ketoacidosis incidence ranges from 0 to person-years, shown in different studies from different geographic areas. Socioeconomic and educational factors play a significant role in poor adhesion to medications, including insulin. A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence. One of the major causes of recurrent DKA in the inner-city population in the United States is non-compliance with insulin. SGLT-2 inhibitors may precipitate euglycemic DKA. While hyperglycemia is typically the hallmark of DKA, a small subset of patients may experience euglycemic DKA. Euglycemic DKA results in a high anion gap metabolic acidosis with positive serum and urine ketones when serum glycemic levels are less than 250 mg/dL. SGLT2 inhibitors promote glucagon secretion and may decrease urinary excretion of ketone bodies, leading to an increase in plasma ketone body levels as well as hyperglycemia and DKA. SGLT2 is also expressed in pancreatic α-cells. A lower dose of insulin may not be sufficient to suppress lipolysis and ketogenesis. When SGLT2 inhibitors are used together with insulin, insulin doses are often decreased to avoid hypoglycemia. SGLT2 inhibitors can predispose to diabetic ketoacidosis via multiple mechanisms. Conventional, as well as atypical antipsychotic drugs, may also cause hyperglycemia and rarely DKA. Other conditions like alcohol abuse, trauma, pulmonary embolism, and myocardial infarction can also precipitate DKA. Drugs that affect carbohydrate metabolisms, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, may precipitate DKA. The most common types of infections are pneumonia and urinary tract infections. Common precipitating factors for DKA are non-compliance, new-onset diabetes, and other acute medical illness. In both populations, catabolic stress of acute illness or injuries such as trauma, surgery, or infections may be a trigger. Patients with type 2 diabetes are also at risk. Diabetic ketoacidosis more commonly occurs in patients with type 1 diabetes, though it can also occur in patients with type 2 diabetes.
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