RESUMO
AIMS: Patients with type 1 diabetes often develop diabetic ketoacidosis (DKA). Reportedly, DKA in type 2 diabetes has higher mortality despite its limited occurrence. The exact clinical characteristics and therapeutic modalities yielding successful outcomes in DKA type 2 diabetes remain unknown. METHODS: This retrospective study compared the clinical features and detailed treatment of consecutive type 1 and type 2 diabetes patients hospitalized with DKA between January 2001 and December 2014. RESULTS: We report on 127 patients with type 1 and 74 patients with type 2 diabetes whose DKA was successfully treated. The most frequent precipitating cause for DKA was infectious disease for patients with type 1 diabetes and consumption of sugar-containing beverages for those with type 2 diabetes. Type 2 diabetes patients showed higher mean plasma glucose levels than those with type 1 diabetes (48.4±21.6, vs. 37.1±16.4mmol/l, P<0.01) and higher serum creatinine, blood urea nitrogen, and hemoglobin levels, which normalized after DKA resolution. Compared with type 1 diabetes patients, those with type 2 diabetes required distinctly higher daily total insulin dosage (35.9±37.0U, vs. 20.2±23.3U, P<0.01), larger replacement fluid volumes (4.17±2.69L, vs. 2.29±1.57L, P<0.01) and greater potassium supplementation (23.9±36.5mEq, vs. 11.2±17.9mEq, P<0.01) to resolve DKA and reduce plasma glucose level to ≤16.7mmol/l. CONCLUSIONS: DKA patients with type 2 diabetes required management with a modified treatment protocol to resolve their profound hyperglycemia and dehydration compared with those with type 1 diabetes.
Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Cetoacidose Diabética/prevenção & controle , Adulto , Idoso , Bebidas/efeitos adversos , Glicemia/análise , Terapia Combinada/efeitos adversos , Doenças Transmissíveis/complicações , Doenças Transmissíveis/fisiopatologia , Desidratação/etiologia , Desidratação/fisiopatologia , Desidratação/prevenção & controle , Desidratação/terapia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/fisiopatologia , Cetoacidose Diabética/terapia , Açúcares da Dieta/efeitos adversos , Progressão da Doença , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção TerciáriaRESUMO
A 12-year-old boy with mental retardation and cerebral palsy developed hyperthermia during dental treatment performed while he was conscious. During the treatment, he was highly excited, and shortly after completion of the procedure, general muscular spasms occurred. His axillary temperature was 41.6 degrees C then. He was transferred to another general hospital and there he was judged to have become afebrile and was discharged. His condition deteriorated during the night, and he was readmitted to the same hospital the following morning. The patient did not respond to the therapy and died from multiple organ failure on the 13th day. It was thought that hyperthermia had led to rhabdomyolysis and DIC. The cause of death is discussed. Hyperthermia in a handicapped patient is not always transient or benign, and can be life threatening.