Samenvatting
The objective of this manuscript is to review the clinical manifestations, diagnosis and management of diabetic ketoacidosis, one of the most common acute complications of diabetes mellitus. We performed a medline search of the English-language literature using a combination of words (diabetic ketoacidosis, hyperglycemic crises) to identify original studies, consensus statements and reviews on diabetic ketoacidosis published in the past 15 years. Emphasis was placed on clinical manifestations of diabetic ketoacidosis, its diagnosis and treatment.Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that can be life-threatening if not treated properly. Once thought to occur only in patients with type 1 diabetes, diabetic ketoacidosis has also been observed in patients with type 2 diabetes under certain conditions. The basic underlying mechanism for diabetic ketoacidosis is insulin deficiency coupled with elevated levels of counter-regulatory hormones, such as glucagon, cortisol, catecholamines, and growth hormone. Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or precipitated in known patients with diabetes mellitus by many factors, most commonly infection. The management of diabetic ketoacidosis involves careful clinical evaluation, correction of metabolic abnormalities, identification and treatment of precipitating and co-morbid conditions, appropriate longterm treatment of diabetes, and plans to prevent recurrence. Many cases of DKA can be prevented by better access to medical care, proper education, and effective communication with a health care provider during intercurrent illness. Provision of guidelines will also reduce mortality. Resources need to be redirected towards prevention by funding better access to care and educational programs.
Keywords: Diabetes mellitus; ketoacidosis; insulin; fluid management
Résumé
L’objectif de ce manuscrit est de revoir les manifestations cliniques, les diagnostiques et la gestion du diabète kétoacide, l une des complications aigues les plus commune du diabète mellitus. Nous avons exécuté une recherche médline sur la littérature de la langue anglaise utilisant une combinaison des mots (diabète kétoacide, crises hyperglycemique) pour identifier les études originales, les déclarations de consensus, et les revus sur le diabète kétoacide publiés au cours des 15 dernières années. L’accent était placé sur les manifestations cliniques du diabète kétoacide, son diagnostique et son traitement. Le diabète kétoacide (DKA) est une complication aigue du diabète mellitus qui peut être une menace a la vie si mal traité, une fois que la préoccupation n’est dirigée que sur les patients avec le diabète de type 1, le diabète kétoacide a aussi été observé chez les patients de type 2 sous certaines conditions. Le mécanisme de base associé pour le diabète kétoacide est l’insuffisance de l’insuline associé a l’élévation du niveau du régulateur des hormones tel que le glucagon, le cortisol, le catécholamine, et la croissance des hormones. Le diabète kétoacide peut être la phase initiale du diabète mellitus ou précipitée chez les patients connus avec le diabète mellitus par plusieurs facteurs, l’infection la plus commune. La gestion du diabète kétoacide nécessite une évaluation clinique soigneux,la correction des anormalités métaboliques des précipités et les conditions co-morbides,le traitement approprié à long terme du diabète, et les plans de prévention de la réapparition . Plusieurs cas de DKA peuvent être prévenu par un accès meilleurs aux soins médicaux. Une bonne éducation et une communication effective avec des soins de santé appliqués durant la maladie. Les dispositions et les soins vont aussi réduire la mortalité. Les ressources doivent être redirigées vers la prévention par les fonds pour un accès meilleur aux soins et aux programmes éducationnel.
Correspondence: Dr. O.A. Fasanmade, Department of Medicine, Lagos University Teaching Hospital,
PMB 12003, Idi-Araba, Lagos State, Nigeria. Email: ofasanmade@yahoo.com
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