Cargando…
Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis
AIM: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologis...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645697/ https://www.ncbi.nlm.nih.gov/pubmed/31410042 http://dx.doi.org/10.2147/DMSO.S209938 |
_version_ | 1783437518072446976 |
---|---|
author | Lee, Kiyoung Park, Ie Byung Yu, Seung Hee Kim, Soo-Kyung Kim, So Hun Seo, Da Hea Hong, Seongbin Jeon, Ja Young Kim, Dae Jung Kim, Soo Wan Choi, Cheol Soo Lee, Dae Ho |
author_facet | Lee, Kiyoung Park, Ie Byung Yu, Seung Hee Kim, Soo-Kyung Kim, So Hun Seo, Da Hea Hong, Seongbin Jeon, Ja Young Kim, Dae Jung Kim, Soo Wan Choi, Cheol Soo Lee, Dae Ho |
author_sort | Lee, Kiyoung |
collection | PubMed |
description | AIM: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology. METHODS: This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies. RESULTS: Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05–5.13 mmol/L and 1.02–15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L). CONCLUSIONS: Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA. |
format | Online Article Text |
id | pubmed-6645697 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-66456972019-08-13 Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis Lee, Kiyoung Park, Ie Byung Yu, Seung Hee Kim, Soo-Kyung Kim, So Hun Seo, Da Hea Hong, Seongbin Jeon, Ja Young Kim, Dae Jung Kim, Soo Wan Choi, Cheol Soo Lee, Dae Ho Diabetes Metab Syndr Obes Original Research AIM: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology. METHODS: This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies. RESULTS: Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05–5.13 mmol/L and 1.02–15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L). CONCLUSIONS: Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA. Dove 2019-07-16 /pmc/articles/PMC6645697/ /pubmed/31410042 http://dx.doi.org/10.2147/DMSO.S209938 Text en © 2019 Lee et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Lee, Kiyoung Park, Ie Byung Yu, Seung Hee Kim, Soo-Kyung Kim, So Hun Seo, Da Hea Hong, Seongbin Jeon, Ja Young Kim, Dae Jung Kim, Soo Wan Choi, Cheol Soo Lee, Dae Ho Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title | Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title_full | Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title_fullStr | Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title_full_unstemmed | Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title_short | Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
title_sort | characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645697/ https://www.ncbi.nlm.nih.gov/pubmed/31410042 http://dx.doi.org/10.2147/DMSO.S209938 |
work_keys_str_mv | AT leekiyoung characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT parkiebyung characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT yuseunghee characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT kimsookyung characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT kimsohun characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT seodahea characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT hongseongbin characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT jeonjayoung characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT kimdaejung characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT kimsoowan characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT choicheolsoo characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis AT leedaeho characterizationofvariablepresentationsofdiabeticketoacidosisbasedonbloodketonelevelsandmajorsocietydiagnosticcriteriaanewviewpointontheassessmentofdiabeticketoacidosis |