Diabetic Emergencies E-Book

Nikolaos Katsilambros

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 307

Veröffentlichungsjahr: 2011

Beschreibung

The book explores both the clinical presentation of serious diabetic emergencies (like ketoacidosis, hyperosmolar coma, and severe hyper and hypoglycemia) that consultants and hospital staff encounter in practice and the best methods of both managing the emergencies and also administering follow-up guidance/care. All chapters are clearly structured to highlight: definition of emergency; epidemiology; potential causes, diagnosis, clinical management (including problem areas), follow-up management/care; and patient advice.
There are case studies to aid clinical understanding, as well as 5-7 multiple choice questions and several key points/take-home message boxes in every chapter.

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Preface

CHAPTER 1 Diabetic ketoacidosis in adults

Introduction

Definition and classification of DKA in adults

Predisposing factors for DKA

Pathogenesis

Clinical presentation

Laboratory findings

Differential diagnosis

Clinical management

Patient monitoring

Complications

Prevention

Case studies

CHAPTER 2 Diabetic ketoacidosis in childhood and adolescence

Definition of emergency

Potential causes

Epidemiology

Diagnosis

Clinical management

Potential complications—morbidity and mortality

Prevention of recurrent DKA

Patient advice

Case study

CHAPTER 3 Hyperosmolar non-ketotic hyperglycemia

Definition

Epidemiology

Potential causes

Diagnosis

Clinical management

Avoidance of complications

Follow-up management/care

Patient advice

Case studies

CHAPTER 4 Hypoglycemia caused by insulin

Definition of hypoglycemia

Physiology of blood glucose regulation

Hypoglycemia in diabetes

Classification of iatrogenic hypoglycemia

The frequency of iatrogenic hypoglycemia in diabetes

Clinical presentation of hypoglycemia

Predisposing factors for hypoglycemia in insulin-treated patients

Consequences of iatrogenic hypoglycemia

Management of hypoglycemia caused by insulin treatment

Case studies

CHAPTER 5 Hypoglycemia caused by insulin secretagogues

Insulin secretagogues

Prevalence of hypoglycemia caused by insulin secretagogues

Counter-regulation in hypoglycemia in Type 2 diabetes

Symptoms and signs of hypoglycemia in Type 2 diabetes

Treatment

Case studies

CHAPTER 6 Lactic acidosis in diabetes

Introduction

Pathogenesis

Clinical presentation

Classification

Diagnosis

Treatment

Case studies

CHAPTER 7 Management of hyperglycemia in the hospital

Introduction

The importance of in-hospital glycemic control

Management of hyperglycemia in critically ill patients

Management of the non-critically ill hospitalized patient with hyperglycemia

Perioperative management of hyperglycemia

Preoperative period management

Intraoperative period management

Postoperative period management

Treatment of in-hospital hyperglycemia in specific situations

Case studies

CHAPTER 8 Sick-day rules in diabetes

Definition

Epidemiology

Diagnosis

Clinical management

Follow-up management/care

Patient advice

Case studies

Multiple choice questions

Answers to multiple choice questions

Index

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Library of Congress Cataloging-in-Publication Data

Diabetic emergencies : diagnosis and clinical management / Nicholas

Katsilambros ... [et al.].

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-470-65591-7 (pbk. : alk. paper)

ISBN-10: 0-470-65591-7 (pbk. : alk. paper)

 1. Diabetes. 2. Hyperglycemia. 3. Emergencies. I. Katsilambros, Nicholas.

[DNLM: 1. Diabetes Mellitus. 2. Diabetes Complications. 3. Diabetic Ketoacidosis. 4. Emergencies. 5. Hypoglycemia. WK 880]

RC660.D565 2011

616.4'62025–dc22

2011011046

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781119971795; Wiley Online Library 9781119971825; ePub 9781119971801; Mobi 9781119971818

Preface

Diabetes mellitus (DM) comprises a very large chapter, not only of internal medicine but of medicine as a whole. In many countries, the frequency of DM exceeds 10% of the whole population, affecting both genders and all ages. This very common disease not infrequently is accompanied by emergency situations, due both to complications of the disease itself and its treatment. In DM especially, the concept of emergency is potentially tied to the concept of death. For example, a diabetic patient undergoing a moderate-severity operation may have a very bad outcome if his diabetic control during the pre-, peri- and post-operative period is not adequate. The same is true for acute infections and a wide range of other conditions. Acute decompensation of diabetic control can sometimes lead to fatal outcomes in the form of diabetic ketoacidosis or the hyperosmolar hyperglycemic state. Consequently, not only specialists (diabetologists) but also general doctors, internists, surgeons, and other specialty physicians have an obligation to know how to diagnose and deal with such conditions.

For all these reasons it was deemed necessary that this practical book be written for the benefit of both doctors and nurses alike. The writers hope that their by no means easy efforts will be useful in everyday routine practice.

The undersigned expresses his sincere and warmest thanks to all the co-authors of this book, all specialist scientists in this specific field of medicine, for the particular diligence they have shown in dealing with specific chapters.

Many thanks are also expressed to co-author Assistant Professor Konstantinos Makrilakis for his efforts in editing the various chapters of the book and homogenizing them.

Finally, many thanks are expressed to Wiley-Blackwell for their long-standing and fruitful cooperation in publishing this book as well as other previous books concerning DM and metabolic diseases in general.

Professor Nikolaos Katsilambros, MD, PhD, FACP, SCOPE Founding Fellow

October 2011

CHAPTER 1

Diabetic ketoacidosis in adults

Nikolaos Tentolouris, Nikolaos Katsilambros

Introduction

Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus. It is characterized by the triad of hyperglycemia, ketosis, and metabolic acidosis.1 DKA complicates mainly patients with Type 1 diabetes mellitus, where it may be the first manifestation of the disease, and rarely people with Type 2 diabetes.1 A special heterogeneous syndrome of “ketosis-prone diabetes (KPD),” in usually adult patients who may lack the typical clinical phenotype of autoimmune Type 1 diabetes, has recently been identified. While initially the condition was thought to be limited to persons of non-Caucasian ethnicity (African-Americans and Hispanics), its prevalence appears to be increasing worldwide.2 DKA is an emergency situation and hospitalization of the patient is necessary for immediate treatment. Its frequency is reported as 4.8–8.0 episodes per 1000 diabetic patients.3,4 The mortality rate is 2.5–9% and increases along with age, level of consciousness on admission, degree of hyperosmolality and acidosis, as well as severity of azotemia.5,6 In the US, hospitalizations due to DKA reach 100,000 and the cost of treatment has been reported as 1 billion dollars per year.7

Summary Box

DKA is characterized by the triad of hyperglycemia, ketosis, and acidosisDKA complicates mainly Type 1 diabetes

Definition and Classification of DKA in Adults

The criteria for the diagnosis of DKA are shown in Table 1.1.8,9 DKA can be mild, moderate, or severe. It is considered severe when the arterial blood pH is less than 7.0, the concentration of plasma bicarbonate is less than 10 mEq/L, and the anion gap is greater than 12 mEq/L. In severe DKA, the patient is in stupor or in coma. Notably, the severity of DKA does not necessarily coincide with the degree of hyperglycemia.

Table 1.1 Diagnostic criteria for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)

Modified from reference 8 with permission.

*Determination of serum or urine ketone is usually based on a nitroprusside-based reaction.