Clinical Characteristics Associated with the Development of Diabetic Ketoacidosis in Patients with Type 2 Diabetes

Objective This study analyzed the clinical and laboratory parameters that might influence the clinical outcomes of patients with type 2 diabetes who develop diabetic ketoacidosis (DKA), which has not been well investigated. Methods We reviewed the clinical and laboratory data of 158 patients who were hospitalized due to DKA between January 2006 and June 2019 and compared the data of patients stratified by the type of diabetes. In addition, the patients with type 2 diabetes were subdivided according to age, and their clinical and laboratory findings were evaluated. Results Patients with type 2 diabetes had a longer symptom duration associated with DKA, higher body mass index (BMI), and higher C-peptide levels than those with type 1 diabetes (p＜0.05). Among patients with type 2 diabetes, elderly patients (≥65 years old) had a longer duration of diabetes, higher frequency of DKA onset under diabetes treatment, higher effective osmolarity, lower BMI, and lower urinary C-peptide levels than nonelderly patients (＜65 years old) (p＜0.05). A correlation analysis showed that age was significantly negatively correlated with the index of insulin secretory capacity. Conclusion Patients with DKA and type 2 diabetes had a higher BMI and insulin secretion capacity than those with type 1 diabetes. However, elderly patients with type 2 diabetes, unlike younger patients, were characterized by a lean body, impaired insulin secretion, and more frequent DKA development while undergoing treatment for diabetes.     

Interstitial Pulmonary Edema in Children and Adolescents with Diabetic Ketoacidosis

The acute complications of diabetic ketoacidosis in children and adolescents are well recognized but not completely understood. Clinical studies have focused primarily on brain edema. We have investigated the prevalence and course of interstitial pulmonary edema in patients with severe diabetic ketoacidosis all of whom had uneventful clinical courses. High resolution computed tomography scans of the lungs were analyzed by determining the Hounsfield attenuation level and then converting to physical density values. All seven patients had evidence of interstitial pulmonary edema on the first scan, which was performed within 1 h of hydration and prior to receiving insulin; six of the seven patients had increased pulmonary density 6–8 h into treatment, and all had complete resolution of the interstitial changes at discharge. Our study suggests that subclinical interstitial pulmonary edema may be a frequent occurrence in children and adolescents with severe diabetic ketoacidosis and may very well be present prior to treatment. The study also supports the philosophy of cautious rehydration and the close monitoring of children and adolescents with diabetic ketoacidosis until a more complete understanding of this pathophysiologic event is achieved.     

Characteristics and Outcomes of Injured Older Adults After Hospital Admission

OBJECTIVES: To describe the seriously injured adult population aged 65 and older; compare the differences in injury characteristics and outcomes in three subgroups aged 65 to 74, 75 to 84, and 85 and older; and identify predictors of death, complications, and hospital discharge destination. DESIGN: Retrospective secondary analysis of data from the Queensland Trauma Registry (QTR) using all patients aged 65 and older admitted from 2003 through 2006. SETTING: Data from 15 regional and tertiary hospitals throughout Queensland, Australia. PARTICIPANTS: Six thousand sixty‐nine patients: 2,291 (37.7%) aged 65 to 74, 2,265 (37.3%) aged 75 to 84, and 1,513 (24.9%) aged 85 and older. MEASUREMENTS: Outcome variables included mortality, complications, and discharge destination (usual residence, rehabilitation, nursing home, convalescence). Predictive factors incorporated demographic details, injury characteristics, and acute care factors. RESULTS: Hospital survival was 95.0%, with a median length of hospital stay of 8 days (interquartile range 5–15), and 33.8% of cases with a major injury developed a complication. Predictors of death included older age, male sex, admission to the intensive care unit (ICU), greater Injury Severity Score (ISS), injury caused by a fall, and two or more injuries; those who had surgery were less likely to die. Predictors of complications included ICU admission, older age, longer hospital stay, and two or more injuries. Predictors of discharge to a nursing home included older age, greater ISS, longer hospital stay, and injury caused by a fall, among others. CONCLUSION: Older adults with severe injuries are at risk of poor outcomes. These findings suggest opportunities for improving geriatric trauma care that could lead to better outcomes.     

Self-neglect in Older Adults: a Primer for Clinicians

Self-neglect in older adults is an increasingly prevalent, poorly understood problem, crossing both the medical and social arenas, with public health implications. Although lacking a standardized definition, self-neglect is characterized by profound inattention to health and hygiene. In light of the aging demographic, physicians of all specialties will increasingly encounter self-neglectors. We outline here practical strategies for the clinician, and suggestions for the researcher. Clinical evaluation should include attention to medical history, cognition, function, social networks, psychiatric screen and environment. The individual’s capacity is often questioned, and interventions are case-based. More research is needed in basic epidemiology and risk factors of the problem, so that targeted interventions may be designed and tested. The debate of whether self-neglect is a medical versus societal problem remains unresolved, yet as health sequelae are part of the syndrome, physicians should be part of the solution.     

Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes

Background/Objectives

Whereas opiate prescribing patterns have been well described in outpatient and emergency department settings, they have been less defined in hospitalized older adults. The objective was to describe patterns of opiate prescribing and associated outcomes in hospitalized older adults.

Design

Retrospective cohort study.

Setting

Tertiary care facility.

Participants

Hospitalized medical patients aged 65 and older (N = 9,245; mean age 80.3, 55.2% female, 72.3% white, 90.8% non‐Hispanic).

Measurements

Opiate exposure and duration of action, concurrent use of potentially inappropriate medications (PIMs), adverse events, discharge disposition, length of stay (LOS), and 30‐day readmissions.

Results

There was no difference in sex, race, ethnicity, or Charlson Comorbidity Index between opiate exposure groups. Participants who had never received opiates had a significantly shorter mean LOS than prior and new opiate users (5.2, 6.8, 7.7 days; P < .001) and were more likely to be discharged home (88.6%, 82.8%, 82.5%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 25.0%, 22.3%; P < .001). Participant who had never been exposed to opiates had a significantly shorter mean LOS than those receiving short‐ and long‐acting opiates (5.2, 7.3, 8.6 days; P < .001) and were more likely to be discharged home (88.6%, 82.6%, 82.4%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 27.7%, 28.9%; P < .001).

Conclusion

Opiate use is widespread during hospitalization and is associated with significant negative clinical outcomes and quality metrics. There is an urgent need to develop innovative pain management alternatives to opiate use.     

ICU糖尿病酮症酸中毒的护理方法与应用效果

目的 研究在ICU糖尿病酮症酸中毒患者中应用ICU全面护理干预的临床应用作用.方法 该文参考抽签法对2018年9月—2019年9月期间收治的60例ICU糖尿病酮症酸中毒患者实施分组比对,每组30例,参照组开展常规护理干预,实验组开展ICU全面护理干预,比对分析两组临床护理差异.结果 实验组ICU糖尿病酮症酸中毒患者护理...     

小儿糖尿病酮症酸中毒临床急救措施与护理研究

目的 研究小儿糖尿病酮症酸中毒的临床急救措施与护理方法.方法 选取2017年12月—2019年12月期间内该院收治的60例小儿糖尿病酮症酸中毒患儿,先随机抽取出30例设为A组,实施常规护理,将剩余的30例设为B组,开展综合护理,护理后,对两组患儿的血糖指标与护理满意度进行比较分析.结果 治疗后,B组患儿的空腹血糖(9....     

A Remarkable Elevation in the Procalcitonin Levels Due to Diabetic Ketoacidosis in a Hemodialysis Patient

Procalcitonin (PCT), a marker of the inflammatory response during infections, can be elevated by diabetic ketoacidosis (DKA). A male patient in his 50s with diabetic nephropathy on hemodialysis presented with vomiting and a reduced level of consciousness and was diagnosed with DKA. His PCT level was markedly elevated, but bacterial cultures (blood, urine, and stool) were negative. The PCT level decreased after DKA improvement. In this patient, DKA probably enhanced the PCT levels. As DKA can increase the PCT levels, an elevation of the PCT levels in DKA patients may not be indicative of infectious diseases, and non-infectious causes of DKA should therefore be considered.     

Diabetic Ketoacidosis Presenting with Pseudonormoglycemia in a 15-Year-Old Girl with Type 1 Diabetes Mellitus

Pseudonormoglycemic diabetic ketoacidosis (DKA) is a rare condition and has been reported only in a few adult patients. We present a 15-year-old girl with a 9-year history of type 1 diabetes who presented with euglycemic and extreme hypertriglyceridemia. The acidosis and hypertriglyceridemia resolved with intravenous insulin therapy and rehydration. Hyperlipidemia was the apparent cause of pseudonormoglycemia in this patient. The findings in the present case demonstrate that also in children, DKA can rarely occur without abnormal blood glucose levels. Assessment of the acid-base status, urinary glucose, and ketone readings is therefore important in all diabetic patients who are unwell at admission and have normal glucose levels. In such patients, hyperlipidemia may cause pseudonormoglycemia. An awareness of this rare treatable life-threatening condition is important. Conflict of interest:None declared.     

Persisting Mortality in Diabetic Ketoacidosis

An overall hospital mortality rate of 3.9% was found in 929 episodes of diabetic ketoacidosis treated in single centre over a 21-year period. The mortality rate in the first half of the survey (4.4%) was not significantly different from that in the second half of the survey (3.4%). Six deaths in patients under 50 years of age occurred in the first half, but only one death under 50 years occurred in the second half of the survey. The number of deaths from a metabolic cause where no other illness was identified also fell from nine (43% of deaths) in the first half to five (33% of deaths) in the second half of the study (not significant). The remaining deaths were due to concurrent illness, mainly myocardial infarction and serious infections. Many of the residual deaths occurred in elderly patients with such medical illness in addition to the ketoacidosis. It may, therefore, prove difficult to reduce mortality further in diabetic ketoacidosis.     

糖尿病酮症酸中毒30例临床分析

目的探讨糖尿病酮症酸中毒(DKA)的诱因及抢救方法,提高对DKA的治愈率,减少病死率。方法对我院近5年收治的30例DKA患者进行临床分析,分析诱因及治疗方法。结果30例DKA中1型糖尿病(T1DM)14例,2型糖尿病(T2DM)15例,类固醇性糖尿病1例,T1DM引起DKA大多数无诱因,少数是停用胰岛素而诱发。T2DM引起DKA最常见的诱因是感染,类固醇性糖尿病是激素和静脉滴注葡萄糖注射液引起,采用小剂量胰岛素持续静脉滴注及积极纠正水电解质紊乱,加强抗感染治疗,疗效满意,30例患者抢救成功。结论积极防治诱因,综合治疗,合理使用抗生素是防治DKA的关键。     

First Evaluation of P Dispersion and Tp-e Parameters in Electrocardiograms of Children with Diabetic Ketoacidosis

Objective:Diabetic ketoacidosis (DKA) is an important complication of type 1 diabetes mellitus. We aimed to evaluate the effect of metabolic disorders of DKA on electrocardiography (ECG) parameters in children.Methods:This study was performed between December 2018 and March 2020 and included 39 children with DKA and 40 healthy children. Three ECGs (one before and two after treatment) were obtained from the patient group. P-wave dispersion (Pd), QT dispersion (QTd), QTc dispersion (QTcd), Tp-e intervals, and the ratios of Tp-e/QT and Tp-e/QTc were measured electrocardiographically. ECG parameters from children with DKA and healthy controls were compared statistically.Results:The mean age of the patient group was 10.50±4.12 years. There was no significant difference in terms of age, gender, weight, height and body mass index between patients and controls. In the patient group, a statistically significant increase was found in Pd, QTd and QTcd in the initial ECG compared to the second and third ECGs. Also, when the first and third ECGs were compared, a significant increase in Tp-e and Tp-e/QT was evident in the first ECG. There was a significant difference in the values of Pd, QTd, QTcd, Tp-e and Tp-e/QT in the first ECGs, obtained before DKA treatment, and those values obtained from the control group.Conclusion:This is the first article evaluating Pd and Tp-e parameters in children with DKA. Cardiac arrhythmia risk markers were increased in children with DKA compared to controls. Therefore, clinicians should be aware of the possibility of developing new arrhythmias during DKA treatment.     

Health Literacy and Cognitive Performance in Older Adults

OBJECTIVES: To study the relationship between health literacy and memory and verbal fluency in older adults.
DESIGN: Cross-sectional cohort.
SETTING: Twenty senior centers and apartment buildings in New York, New York.
PARTICIPANTS: Independently living, English- and Spanish-speaking adults aged 60 and older (N=414).
MEASUREMENTS: Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The associations between S-TOFHLA scores and immediate and delayed recall (Wechsler Memory Scale II), verbal fluency (Animal Naming), and global cognitive function (Mini-Mental State Examination, MMSE) were modeled using multivariable logistic and linear regression.
RESULTS: Health literacy was inadequate in 24.3% of participants. Impairment of immediate recall occurred in 20.4%; delayed recall, 15.0%; verbal fluency, 9.9%; and MMSE, 17.4%. Abnormal cognitive function was strongly associated with inadequate health literacy: immediate recall (adjusted odds ratio (AOR)=3.44, 95% confidence interval (CI)=1.71–6.94, P <.001), delayed recall (AOR=3.48, 95% CI=1.58–7.67, P =.002), and verbal fluency (AOR=3.47, 95% CI=1.44–8.38, P =.006). These associations persisted in subgroups that excluded individuals with normal age-adjusted MMSE scores.
CONCLUSION: Memory and verbal fluency are strongly associated with health literacy, independently of education and health status, even in those with subtle cognitive dysfunction. Reducing the cognitive burden of health information might mitigate the detrimental effects of limited health literacy in older adults. Research that examines the effect of materials modified to older adults' cognitive limitations on health literacy and health outcomes is needed.     

静脉血气分析用于ICU糖尿病酮症酸中毒患者预后判断中的价值评价

目的研究将静脉血气分析用于ICU糖尿病酮症酸中毒患者预后判断中的效果。方法选该院ICU糖尿病酮症酸中毒60例,在患者发病的48 h内给使用静脉血气分析,在15 d后,依据患者的实际情况,将存活的31例患者作为试验组,将死亡的29例患者作为对照组,比较相关指标差异。结果试验组的PCO2、HCO3-、BE与对照组相比,均有较为明显的下降(P<0.05);而试验组与对照组的PO2与pH值在数据上无明显的变化(P>0.05);两组患者PO2、PCO2、pH值、HCO3-、BE与APACHEⅡ评分呈正相关。结论在ICU糖尿病酮症酸中毒患者中,BE水平的高低决定APACHEⅡ评分的高低,有利于对该疾病的诊断。