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Research Article| Volume 7, ISSUE 1, P89-108, January 1991

Diabeic Ketoacidosis

  • William T. Cefalu
    Correspondence
    Address reprint requests to: William T. Cefalu, MD Director, Diabetes Comprehensive Care and Research Programs, Bowman Gray School of Medicine of, Wake Forest University, 300 South Hawthorne Rd. Winston-Salem, NC 27103
    Affiliations
    Director, Diabetes Comprehensive Care and Research Programs, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina
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      Diabetic ketoacidosis (DKA) remains a significant clinical problem because there is considerable morbidity and mortality associated with the condition. Although prevention of DKA remains a major focus in diabetic patients, it is apparent that critical care personnel will continue to be exposed to the acute complications. It is important that critical care personnel have training in the management of DKA so as to rapidly stabilize the patient, begin appropriate medical treatment, and initiate the work-up to identify precipitating factors. Only then will the mortality and morbidity associated with DKA be reduced.
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      References

        • Alberti K.G.M.M.
        • Christensen N.J.
        • Iverson J.
        • et al.
        Role of glucagon and other hormones in development of diabetic ketoacidosis.
        Lancet. 1975; 1: 1307-1311
        • Alberti K.G.M.M.
        • Emerson P.M.
        • Darley J.H.
        • et al.
        2,3-Diphosphoglycerate and tissue oxygenation in uncontrolled diabetes mellitus.
        Lancet. 1972; 2: 391-395
        • Alberti K.G.M.M.
        • Hockaday T.D.R.
        Diabetic coma—a reappraisal.
        Clin Endocrinol Metab. 1977; 6: 421-456
        • Barrett E.J.
        • DeFronzo R.A.
        • Bevilacqua S.
        • et al.
        Insulin resistance in diabetic ketoacidosis.
        Diabetes. 1982; 31: 923-928
        • Beigelman P.M.
        Severe diabetic ketoacidosis (diabetic “coma”): 482 episodes in 257 patients; experience of 3 years.
        Diabetes. 1971; 20: 490-500
        • Beigelman P.M.
        Potassium in severe diabetic ketoacidosis.
        Am J Med. 1973; 54: 419-420
        • Bergenstal R.M.
        Diabetic ketoacidosis: How to treat and, when possible, prevent.
        Postgrad Med. 1985; 77: 151-161
        • Cahill Jr, G.F.
        Starvation in man.
        N Engl J Med. 1970; 282: 668-675
        • Campbell I.W.
        • Duncan L.P.J.
        • Innes J.A.
        • et al.
        Abdominal pain in diabetic metabolic decompensation.
        JAMA. 1975; 233: 166-168
        • Chapman J.
        • Wright A.D.
        • Nattrass M.
        • et al.
        Recurrent diabetic ketoacidosis.
        Am J Med. 1985; 78: 54-60
        • Cohen A.S.
        • Vance V.K.
        • Runyan Jr, J.W.
        • et al.
        Diabetic acidosis: An evaluation of the cause, course, and therapy of 73 cases.
        Ann Intern Med. 1960; 52: 55-86
        • Dorin R.I.
        • Crapo L.M.
        Hypokalemic respiratory arrest in diabetic ketoacidosis.
        AMA. 1987; 257: 1517-1518
        • Drenick E.J.
        • Alvarez L.G.
        • Tamasi G.C.
        • et al.
        Resistance to symptomatic insulin reactions after fasting.
        J Clin Invest. 1972; 51: 2757-2762
        • Faich G.A.
        • Fishbein H.A.
        • Ellis S.E.
        The epidemiology of diabetic acidosis: A population-based study.
        Am J Epidemiol. 1983; 117: 551-558
        • Feig P.U.
        • McCurdy D.K.
        The hypertonic state.
        N Engl J Med. 1977; 297: 1444-1454
        • Fishbein H.A.
        Diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, and hypoglycemia.
        Diabetes in America (National Diabetes Data Group). Harris MI, Hamman RF. US Department of Health and Human Sciences, Washington, DC1985: XII-1-XII-16
        • Fisher J.N.
        • Kitabchi A.E.
        A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis.
        J Clin Endocrinol Metab. 1983; 57: 177-180
        • Fort P.
        • Waters S.M.
        • Lifshitz F.
        Low-dose insulin infusion in the treatment of diabetic ketoacidosis: Bolus versus no bolus.
        J Pediatr. 1980; 96: 36-40
        • Foster D.W.
        From glycogen to ketones and back.
        Diabetes. 1984; 33: 1188
        • Foster D.W.
        • McGarry J.D.
        Intermediary metabolism of carbohydrates, lipids, and proteins.
        in: Petersdorf R.G. Adams R.D. Braunwald E. Harrison’s Principles of Internal Medicine. ed 10. McGraw-Hill, New York1983: 490-495
        • Foster D.W.
        • McGarry J.D.
        The metabolic derangements and treatment of diabetic ketoacidosis.
        N Engl J Med. 1983; 309: 159-169
        • Foster D.W.
        • McGarry J.D.
        Acute complications of diabetes: Ketoacidosis, hyperosmolar coma, lactic acidosis.
        in: DeGroot L.J. Endocrinology. ed 2. WB Saunders, Philadelphia1984: 1439-1453
        • Fulop M.
        • Tawnebaum H.
        • Dreyer N.
        Ketotic hyperosmolar coma.
        Lancet. 1973; 2: 635-639
        • Gerich J.E.
        • Lorenzi M.
        • Bier D.M.
        • et al.
        Prevention of human diabetic ketoacidosis by somatostatin: Evidence for an essential role of glucagon.
        N Engl J Med. 1975; 292: 985-989
        • Ginsberg H.N.
        Investigation of insulin resistance during diabetic ketoacidosis: Role of counter-regulatory substances and effect of insulin therapy.
        Metabolism. 1977; 26: 1135-1146
        • Hale P.J.
        • Crase J.
        • Nattrass M.
        Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis.
        Br Med J. 1984; 289: 1035-1038
        • Hasselstrom L.
        • Wimberley P.D.
        • Nielsen V.G.
        Hypophosphatemia and acute respiratory failure in a diabetic patient.
        Intensive Care Med. 1986; 12: 429-431
        • Katz M.A.
        Hyperglycemia-induced hyponatremia—calculation of expected sodium depression.
        N Engl J Med. 1973; 289: 843-844
        • Keller U.
        Diabetic ketoacidosis: Current views on pathogenesis and treatment.
        Diabetologia. 1986; 29: 71-77
        • Keyes W.G.
        • Heimberg M.
        Influence of thyroid status on lipid metabolism in the perfused rat liver.
        J Clin Invest. 1979; 64: 182-190
        • Kitabchi A.E.
        Low-dose insulin therapy in diabetic ketoacidosis: Fact or fiction?.
        Diabetes Metab Rev. 1989; 5: 337-363
        • Kreisberg R.A.
        Diabetic ketoacidosis: New concepts and trends in pathogenesis and treatment.
        Ann Intern Med. 1978; 88: 681-695
        • Lever E.
        • Jaspan J.B.
        Sodium bicarbonate therapy in severe diabetic ketoacidosis.
        Am J Med. 1983; 75: 263-268
        • Malchoff C.D.
        • Pohl S.L.
        • Kaiser D.L.
        • et al.
        Determinants of glucose and ketoacid concentrations in acutely hyperglycemic diabetic patients.
        Am J Med. 1984; 77: 275-285
        • Matz R.
        Hypothermia in diabetes acidosis.
        Hormones. 1972; 3: 36-41
        • McGarry J.D.
        • Foster D.W.
        Ketogenesis and its regulation.
        Am J Med. 1976; 61: 9-13
        • McGarry J.D.
        • Foster D.W.
        Hormonal control of ketogenesis: Biochemical considerations.
        Arch Intern Med. 1977; 137: 495-501
        • Miles J.M.
        • Haymond M.W.
        • Nissen S.L.
        • et al.
        Effects of free fatty acid availability, glucagon excess, and insulin deficiency on ketone body production in postabsorptive man.
        J Clin Invest. 1983; 71: 1554-1561
        • Morris L.R.
        • Murphy M.B.
        • Kitabchi A.E.
        Bicarbonate therapy in severe diabetic ketoacidosis.
        Ann Intern Med. 1986; 105: 836-840
        • Nayler W.G.
        • Ferrari R.
        • Poole-Wilson P.A.
        • et al.
        A protective effect of mild acidosis on hypoxic heart muscle.
        J Mol Cell Cardiol. 1979; 11: 1053-1071
        • Raskin P.
        • Unger R.H.
        Hyperglucagonemia and its suppression: Importance in the metabolic control of diabetes.
        N Engl J Med. 1978; 299: 433-436
        • Riley Jr, L.J.
        • Cooper M.
        • Narins R.G.
        Alkali therapy of diabetic ketoacidosis: Biochemical, physiologic, and clinical perspectives.
        Diabetes Metab Rev. 1989; 5: 627-639
        • Ruderman N.B.
        • Aoki T.T.
        • Cahill Jr, G.F.
        Gluconeogenesis and its disorders in man.
        Gluconeogenesis: Its Regulation in Mammalian Species. Hanson RW, Mehlman MA. John Wiley & Sons, New York1976: 515-532
        • Sanson T.H.
        • Levine S.N.
        Management of diabetic ketoacidosis.
        Drugs. 1989; 38: 289-300
        • Santeusanio F.
        • Massi-Benedetti M.
        • Angeletti G.
        • et al.
        Glucagon and carbohydrate disorder in a totally pancreatomized man (a study with the aid of an artificial endocrine pancreas.
        J Endocrinol Invest. 1981; 4: 93-96
        • Scott R.S.
        • Brown L.J.
        • Clifford P.
        Use of health services by diabetic persons. II. Hospital Admissions.
        Diabetes Care. 1985; 8: 43-47
        • Schade D.S.
        • Eaton R.P.
        The controversy concerning counter-regulatory hormone secretion: A hypothesis for the prevention of diabetic ketoacidosis?.
        Diabetes. 1977; 26: 596-599
        • Schade D.S.
        • Eaton R.P.
        The regulation of plasma ketone body concentration by counter-regulatory hormones in man. III. Effects of norepinephrine in normal man.
        Diabetes. 1979; 28: 5-10
        • Schade D.S.
        • Woodside W.
        • Eaton R.P.
        The role of glucagon in the regulation of plasma lipids.
        Metabolism. 1979; 28: 874-886
        • ShaFrir E.
        • Bergman M.
        • Felig P.
        The endocrine pancreas: Diabetes mellitus.
        in: Felig P. Baxter J.D. Broadus A.E. Endocrinology and Metabolism. McGraw-Hill, New York1987: 1043-1078
        • Unger R.H.
        • Orci L.
        Glucagon and the A cell: Physiology and pathophysiology.
        N Engl J Med. 1981; 304 (1575-1580): 1518-1524
        • Waldhausl W.
        • Kleinberger G.
        • Korn A.
        • et al.
        Severe hyperglycemia: Effects of rehy dration on endocrine derangements and blood glucose concentration.
        Diabetes. 1979; 28: 577-584
        • Walker M.
        • Marshall S.M.
        • Alberti I.C.G.M.M.
        Clinic?* aspects of diabetic ketoacidosis.
        Diabetes Metab Rev. 1989; 5: 651-663
        • West M.L.
        • Marsden P.A.
        • Singer G.G.
        • et al.
        Quantitative analysis of glucose loss during acute therapy for hyperglycemic hyperosmolar syndrome.
        Diabetes Care. 1986; 9: 465-471
        • Wilson H.K.
        • Keuer S.P.
        • Lea A.S.
        • et al.
        Phosphate therapy in diabetic ketoacidosis.
        Arch Intern Med. 1982; 142: 517-520