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Diabetic Ketoacidosis Management in Adults

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1. GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

is recommended discuss with patients the risk factors for and signs and symptoms of diabetic ketoacidosis (see below) and advise them to seek immediate medical advice if these develop report suspected adverse drug reactions on a Background Exenatide ( , ), liraglutide ( , ▼, ▼[combination product with insulin]), and dulaglutide ( ▼) are glucagon-like peptide-1 (GLP-1) receptor agonists (also known as GLP-1 mimetic therapies) and are authorised for use in adults with type 2 diabetes to improve glycaemic (...) control, except for Saxenda, which is indicated for weight management. GLP-1 receptor agonists act by stimulating insulin secretion from the pancreas in a glucose-dependent manner, as well as slowing gastric emptying and suppressing glucagon secretion. GLP-1 receptor agonists are not substitutes for insulin. Review of cases of diabetic ketoacidosis Serious and life-threatening cases of diabetic ketoacidosis have been reported in association with exenatide, liraglutide, and dulaglutide, particularly

2019 MHRA Drug Safety Update

2. Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols (PubMed)

Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs).To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management (...) protocols and impact of DKA resolution rates on outcomes.Ovid Medline searches were conducted with limits "all adult" and published between "1973 to current" applied. National consensus statements were also reviewed. Eligibility was determined by two reviewers' assessment of title, abstract, and availability.A total of 85 eligible articles published between 1973 and 2016 were reviewed. The salient findings were (i) Crystalloids are favoured over colloids though evidence is lacking. The preferred

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2017 Frontiers in endocrinology

3. Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols (PubMed)

Corrigendum: Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols [This corrects the article on p. 106 in vol. 8, PMID: 28659865.].

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2017 Frontiers in endocrinology

4. Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: a national survey comparison of management in paediatric and adult settings. (PubMed)

Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: a national survey comparison of management in paediatric and adult settings. To assess the management of diabetic ketoacidosis in young people, which differs in the UK between paediatric and adult services, and to evaluate outcomes and extent to which national guidelines are used.A standardized questionnaire was sent to all paediatric and adult diabetes services in England, requesting details of all diabetic (...) ketoacidosis admissions in young people aged > 14 years in paediatric services ('paediatric' patients), and in young adults up to the age of 22 years in adult services ('adult' patients).A total of 64 adult patients aged ≤ 22 years (mean age 19.2 years) were reported, of whom seven were aged between 10 and 16 years. A total of 71 paediatric patients were reported [mean (range) age 14.9 (11-18) years]. We found that 85% of paediatric and 69% of adult patients were treated according to national guidelines

2016 Diabetic Medicine

5. Tiny Tips – Approach to Diabetic Ketoacidosis

. 2003;168(7):859-866. [ ] 2. Cheng AYY. Introduction. Canadian Journal of Diabetes . 2013;37:S1-S3. doi: 3. Whitney W. DKA, “Answers.” DKA, “Answers.” . Published August 23, 2014. 4. Blouin D. Too much of a good thing: management of diabetic ketoacidosis in adults. Can Fam Physician . 2012;58(1):55-57. [ ] Staff Review: Comments on DKA This “DKA” pneumonic and algorithm are a great, simple way to keep the three key parts of diabetic ketoacidosis management straight. Remember that this is one of the most (...) Tiny Tips – Approach to Diabetic Ketoacidosis Tiny Tips - Approach to Diabetic Ketoacidosis - CanadiEM Tiny Tips – Approach to Diabetic Ketoacidosis In , by Larissa Hattin February 24, 2017 Don’t Know Anything about Diabetic Ketoacidosis (DKA)? In Canada, 5 000 – 10 000 patients are admitted to the hospital with diabetic ketoacidosis (DKA) each year. 1 Most of these patients will initially present to the Emergency Department. The initial assessment and management of these patients in the ED

2017 CandiEM

6. Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study (PubMed)

Incidence and long-term outcomes of adult patients with diabetic ketoacidosis admitted to intensive care: A retrospective cohort study Diabetic ketoacidosis is a life-threatening but avoidable complication of diabetes mellitus often managed in intensive care units. The risk of emergency hospital readmission in patients surviving an intensive care unit episode of diabetic ketoacidosis is unknown. We aimed to report the cumulative incidence of emergency hospital readmission and costs in all (...) patients surviving an intensive care unit episode of diabetic ketoacidosis in Scotland.We used a national six-year cohort of survivors of first diabetic ketoacidosis admissions to Scottish intensive care units (1 January 2005-31 December 2010) identified in the Scottish Intensive Care Society Audit Group registry linked to acute hospital and death records (follow-up censored 31 December 2010). Diabetic ketoacidosis-related emergency readmissions were identified using International Classification

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2016 Journal of the Intensive Care Society

7. Diabetic Ketoacidosis Management in Adults

Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Diabetic Ketoacidosis Management in Adults Diabetic Ketoacidosis Management in Adults Aka: Diabetic Ketoacidosis Management in Adults , DKA Management From Related Chapters II. Management: Phase 1 - Fluids in Adults (Emergent) Stabilize shock and states first! Disconnect Removes the risk of uncalculated additional admininistered from pump (risk of ) Clearly, pump is not working properly if the patient is presenting in Remove needle from insertion site and observe for needle or tubing problem

2018 FP Notebook

8. Management of Diabetic Ketoacidosis with Dengue Hemorrhagic Fever (PubMed)

, and hemorrhage varies from none to life-threatening. Infection is the predominant precipitating factor for diabetic ketoacidosis. In addition to insulin administration, successful management of diabetic ketoacidosis requires fluid resuscitation. We herein report an adult patient with diabetic ketoacidosis complicated with dengue hemorrhagic fever who developed leakage syndrome. Early recognition of leakage and appropriate fluid management was critical in the diabetic ketoacidosis management of this case. (...) Management of Diabetic Ketoacidosis with Dengue Hemorrhagic Fever Viral hemorrhagic fever is one of the most important emerging infectious diseases. Some viral hemorrhagic fevers include dengue, hantavirus, Ebola infection, and yellow fever. Dengue virus infection results in a wide spectrum of clinical diseases, including dengue hemorrhagic fever, characterized by the transient period of plasma leakage and hemorrhagic tendency. Vascular instability ranges from mild to fatal shock

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2018 Cureus

9. The Two-Bag Method for Treatment of Diabetic Ketoacidosis in Adults. (PubMed)

The Two-Bag Method for Treatment of Diabetic Ketoacidosis in Adults. The "two-bag method" of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant.We aimed to evaluate the feasibility and potential benefits of this strategy in adult emergency department (ED) patients with DKA.This is a before-and-after comparison (...) of a protocol using the two-bag method operationalized in our adult ED in 2015. A retrospective electronic medical record search identified adult ED patients presenting with DKA from January 1, 2013 to June 30, 2016. Clinical and laboratory data, timing of medical therapies, and safety outcomes were collected and analyzed.Sixty-eight patients managed with the two-bag method (2B) and 107 patients managed with the one-bag method (1B) were identified. The 2B and 1B groups were similar in demographics

2018 Journal of Emergency Medicine

10. ABCD position statement on standards of care for management of adults with type 1 diabetes

and monitoring 4.1 Treatment 4.2 Targets 4.3 Monitoring 4.4 Unexplained or unpredictable blood glucose results 5. Long term complications: screening and management 5.1 Screening and treatment for microvascular complications 5.1.1 Retinopathy 5.1.2 Nephropathy 5.1.3 Neuropathy 5.2 Screening and risk factor modification for macrovascular disease 3 6. Acute complications 6.1 Hypoglycaemia 6.2 Diabetic ketoacidosis 7. Special circumstances 7.1 Children and young adults 7.2 Older people and care homes 7.3 (...) guideline for the management of Diabetic Ketoacidosis in Adults. https://www.diabetes.org.uk/.../The-Management-of-Diabetic- Ketoacidosis-in -Adults/ 24 Children and young people under the age of 18 years should be treated according to the British Society of Paediatric Endocrinology and Diabetes (BSPED). http://www.bsped.org.uk/clinical/docs/DKAguideline.pdf_ Follow up after resolution of DKA All people with DKA should be reviewed by the diabetes specialist team (an audit criterion) for: ? Education

2017 Association of British Clinical Diabetologists

11. Type 2 diabetes in adults: management

Type 2 diabetes in adults: management T T ype 2 diabetes in adults: management ype 2 diabetes in adults: management NICE guideline Published: 2 December 2015 nice.org.uk/guidance/ng28 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When (...) with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Type 2 diabetes in adults: management (NG28) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 44Contents Contents Overview 5 Who is it for? 5 Introduction 6 Reasons

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. Type 1 diabetes in adults: diagnosis and management

21 1.6 Blood glucose management 22 1.7 Insulin therapy 26 1.8 Insulin delivery 28 1.9 Referral for islet or pancreas transplantation 29 1.10 Awareness and management of hypoglycaemia 29 1.11 Ketone monitoring and management of diabetic ketoacidosis (DKA) 32 1.12 Associated illness 34 1.13 Control of cardiovascular risk 34 Type 1 diabetes in adults: diagnosis and management (NG17) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice (...) , quantifying and managing impaired awareness of hypoglycaemia monitoring for thyroid disease use of blood ketone measurement in preventing and monitoring diabetic ketoacidosis carbohydrate counting and glycaemic index diets referral criteria for transplantation therapies. This guideline describes methods for achieving optimal outcomes for adults with type 1 diabetes and to inform service design and delivery. Its intended audience includes healthcare professionals Type 1 diabetes in adults: diagnosis

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

13. ABCD position statement on the risk of diabetic ketoacidosis with the use of sodium-glucose cotransporter-2 inhibitors

Care. 2015;38:1687-1693. 36. Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343. 37. Savage MW, Dhatariya KK, Kilvert A et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabetic Medicine. 2011;28:508-15. 38. Dhatariya K. The use of point-of-care blood ketone monitors in the management of diabetic ketoacidosis in adults. Ann Clin Biochem 2014;51:525-7. 39. Medicines (...) systematic detection or reporting of DKA and hence may be an underestimate. High risk groups The majority of cases of SGLT-2 inhibitor associated DKA have occurred in people with type 1 diabetes including latent autoimmune diabetes in adults (in general people with insulin deficiency). Some cases are thought to have occurred in patients with a prolonged history of type 2 diabetes and reduced beta cell reserve. 18 In the canagliflozin clinical trials 6 of the 12 patients that developed ketoacidosis had

2016 Association of British Clinical Diabetologists

14. Basal insulin for the management of diabetic ketoacidosis. (PubMed)

Basal insulin for the management of diabetic ketoacidosis. Due to its pharmacokinetic properties, it has been suggested that long-acting insulin analogues may have a role in facilitating the transition from continuous intravenous insulin infusion to subcutaneous maintenance therapy in patients with DKA for prevention of rebound hyperglycemia, particularly if there are high insulin requirements. Concomitant administration of basal insulin analogues with regular insulin infusion accelerates (...) ketoacidosis resolution and prevents rebound hyperglycemia. Several studies have investigated the use of basal insulin in the management of DKA. Studies have been instituted on pediatric patients and adult patients. These studies reveal that co-administration of basal insulin in combination with an insulin infusion in the acute management of DKA is feasible. Basal insulin co-administration with regular insulin infusion was well tolerated, associated with faster resolution of acidosis without any adverse

2017 European journal of internal medicine

15. Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis (PubMed)

Comparison of a ‘two-bag system’ versus conventional treatment protocol (‘one-bag system’) in the management of diabetic ketoacidosis We compared the conventional 'one-bag protocol' of management of diabetic ketoacidosis (DKA) with the 'two-bag protocol' which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the other containing the same solution with the addition of 10% dextrose.A retrospective chart review and analysis was done on adult patients (...) admitted for DKA to the Riverside University Health System Medical Center from 2008 to 2015. There were 249 cases of DKA managed by the one-bag system and 134 cases managed by the two-bag system.The baseline patient characteristics were similar in both groups. The anion gap closed in 13.56 hours in the one-bag group versus 10.94 hours in the two-bag group (p value <0.0002). None of the individual factors significantly influenced the anion gap closure time; only the two-bag system favored earlier

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2017 BMJ open diabetes research & care

16. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

of the blood glucose level ? a person not known to have diabetes, presenting with osmotic symptoms, a raised blood glucose and ketones in either blood (3mmol/L or more) or urine (more than 2+) Treatment of DKA Adults with DKA should be treated according to local hospital guidelines or using the Joint British Diabetes Societies Inpatient Care Group guideline for the management of Diabetic Ketoacidosis in Adults. https://www.diabetes.org.uk/.../The-Management-of-Diabetic- Ketoacidosis-in -Adults/ Children (...) ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above The Association of British Clinical Diabetologists (ABCD) Standards of care for management of adults with type 1 diabetes Foreword This position statement is the first ABCD has produced on the subject of type 1 diabetes since 2012, when it ran its 'Lost Tribe' campaign. This arose from concerns that people with type 1 diabetes had inadvertently

2016 Association of British Clinical Diabetologists

17. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Hyperglycemic emergencies in adults

in higher PG levels (typically ≥34.0 mmol/L), plasma osmolality >320 mOsm/kg and greater ECFV contraction, but minimal acid-base disturbance . Pregnant women in DKA typically present with lower PG levels than nonpregnant women , and there are case reports of euglycemic DKA in pregnancy . Table 2 Priorities to be addressed in the management of adults presenting with hyperglycemic emergencies DKA , diabetic ketoacidosis; ECFV , extracellular fluid volume; HHS , hyperosmolar hyperglycemic state. Severity (...) for this condition even if BG is not elevated [Grade D, Consensus]. Abbreviations: BG , blood glucose; CBG, capillary blood glucose; DKA , diabetic ketoacidosis; ECFV , extracellular fluid volume; HHS , hyperosmolar hyperglycemic state; KPD , ketosis-prone diabetes, PG , plasma glucose. Other Relevant Guidelines Glycemic Management in Adults With Type 1 Diabetes, p. S80 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults, p. S88 Type 1 Diabetes in Children and Adolescents, p. S234 Relevant Appendix

2013 CPG Infobase

18. Moderate-Intensity Insulin Therapy Is Associated With Reduced Length of Stay in Critically Ill Patients With Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State. (PubMed)

Moderate-Intensity Insulin Therapy Is Associated With Reduced Length of Stay in Critically Ill Patients With Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State. Insulin infusion therapy is commonly used in the hospital setting to manage diabetic ketoacidosis and hyperosmolar hyperglycemic state. Clinical evidence suggests both hypoglycemia and glycemic variability negatively impact patient outcomes. The hypothesis of this study was that moderate-intensity insulin therapy decreases (...) hospital length of stay and prevalence of hypoglycemia in patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state.Pre-post study.Large academic medical center in the United States.Two-hundred one consecutive, nonpregnant, adult patients admitted for diabetic ketoacidosis and hyperosmolar hyperglycemic state between October 2010 and December 2014.High-intensity insulin therapy versus moderate-intensity insulin therapy. High-intensity insulin therapy was designed to rapidly normalize

2019 Critical Care Medicine

19. Insulin Degludec for the Management of Patient With Recurrent Diabetic Ketoacidosis

Insulin Degludec for the Management of Patient With Recurrent Diabetic Ketoacidosis Insulin Degludec for the Management of Patient With Recurrent Diabetic Ketoacidosis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before (...) adding more. Insulin Degludec for the Management of Patient With Recurrent Diabetic Ketoacidosis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03001323 Recruitment Status : Recruiting First Posted : December 23, 2016

2016 Clinical Trials

20. Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. (PubMed)

Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. The Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS) for Inpatient Care guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings are available in full at: www.diabetes.org.uk/joint-british-diabetes (...) with diabetes and severe mental illness. Acute trusts are asked to develop joint pathways with mental health providers and facilitate multidisciplinary working and to screen for mental ill health in those admitted with acute complications of diabetes whose aetiology is unclear or not medically explained. Mental health trusts should create a diabetes register, screen for diabetes, particularly in those prescribed second-generation antipsychotics and ensure that staff are trained in managing and avoiding

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2018 Diabetic Medicine

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