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November 30, 1979, Vol 242, No. 22 >
ARTICLE | November 30, 1979

Prevention of Diabetic Ketoacidosis FREE

David S. Schade, MD; R. Philip Eaton, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131 (Dr Schade).


JAMA. 1979;242(22):2455-2458. doi:10.1001/jama.1979.03300220061032
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References

Absolute deficiency of insulin no longer is considered the principal cause of ketoacidosis. A combination of pathogenic mechanisms includes (1) relative insulin deficiency, (2) stress hormone excess, (3) fasting, and (4) dehydration. Prevention of any one or more of these mechanisms will reverse or lessen the rate of metabolic decompensation. Several important metabolic parameters must be monitored at frequent intervals to permit rational, preventive therapy. The flow sheet to be maintained by the patient should include body weight, temperature, respiratory rate, level of consciousness, degree of ketonuria, and degree of glycosuria. If the patient exhibits decreased mental status, more than 5% loss of body weight, or respirations more than 36/min, hospitalization is indicated.

(JAMA 242:2455-2458, 1979)

REFERENCES

1 +
Beigelman PM:  Severe diabetic ketoacidosis (diabetic "coma"): 428 Episodes in 257 patients; experience of three years . Diabetes 20:490-500, 1971;.
2 +
Report of the National Commission on Diabetes to the Congress of the United States . US Dept of Health, Education, and Welfare publication (NIH) 76-1022, 1975;, vol 3, pt (2) , pp 88-97.
3 +
Schade DS, Eaton RP:  The pathogenesis of diabetic ketoacidosis—A reappraisal . Diabetes Care 2:296-306, 1979;.
4 +
Ginsberg S, Block MB, Mako ME, et al:  Serum insulin levels following administration of exogenous insulin . J Clin Endocrinol Metab 36:1175-1179, 1973;.
5 +
Guerra SMO, Kitabchi AE:  Comparison of the effectiveness of various routes of insulin injection . J Clin Endocrinol Metab 42:869-874, 1976;.
6 +
Schade DS, Eaton RP:  The controversy concerning counter-regulatory hormone secretion: A hypothesis for the prevention of diabetic ketoacidosis? Diabetes 26:596-601, 1977;.
7 +
Gerich JE, Lorenzi M, Bier D, et al:  Effects of physiologic levels of glucagon and growth hormone on human carbohydrate and lipid metabolism . J Clin Invest 57:875-884, 1976;.
8 +
Barnes AJ, Stephen RB, George MM, et al:  Ketoacidosis in pancreatectomized man . N Engl J Med 296:1250-1253, 1977;.
9 +
Barnes AJ, Kohner EM, Bloom SR, et al:  Importance of pituitary hormones in etiology of diabetic ketoacidosis . Lancet 1:1171-1174, 1978;.
10 +
Hockaday TDR, Alberti KGMM:  Diabetic coma . Br J Hosp Med 7:183-198, 1972;.
11 +
Christensen NM:  Plasma norepinephrine and epinephrine in untreated diabetes, during fasting, and after insulin administration . Diabetes 23:1-8, 1974;.
12 +
Sperling MA, Bacon G, Kenny FM, et al:  Cortisol secretion in acidotic and nonacidotic diabetes mellitus . Am J Dis Child 124:690-692, 1972;.
13 +
Asplin CM, Hartog M:  Serum free insulin concentrations during the treatment of diabetic coma and pre-coma with low-dose intramuscular insulin . Diabetologia 13:475-480, 1977;.
14 +
Owen OE, Reichard GA Jr:  Ketone body metabolism in normal, obese and diabetic subjects . Isr J Med Sci 11:560-571, 1975;.
15 +
Saudek CD, Boulter PR, Knopp RH, et al:  Sodium retention accompanying insulin treatment of diabetes mellitus . Diabetes 23:240-246, 1974;.
16 +
Saudek CD, Boulter PR, Arky RA:  The natriuretic effect of glucagon and its role in starvation . J Clin Endocrinol Metab 36:761-765, 1973;.
17 +
Page MM, Alberti KGMM, Greenwood R, et al:  Treatment of diabetic coma with continuous low-dose infusion of insulin . Br Med J 2:687-690, 1974;.
18 +
Baker L, Barcai A, Kaye R, et al:  Beta adrenergic blockade and juvenile diabetes: Acute studies and long-term therapeutic trial . J Pediatr 75:19-29, 1969;.
19 +
Schade DS, Eaton RP, Standefer J:  Modulation of basal ketone body concentration by cortisol in diabetic man . J Clin Endocrinol Metab 47:519-528, 1978;.
20 +
Schade DS, Eaton RP:  Human model for stress-induced ketoacidosis, abstracted . Clin Res 27:50, 1979;.
21 +
Miller PD, Heinig RE, Waterhouse C:  Treatment of alcoholic acidosis . Arch Intern Med 138:67-71, 1978;.
22 +
Munro JF, Campbell IW, McCuish AC, et al:  Euglycaemic diabetic ketoacidosis . Br Med J 2:578-580, 1973;.

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1 +
Beigelman PM:  Severe diabetic ketoacidosis (diabetic "coma"): 428 Episodes in 257 patients; experience of three years . Diabetes 20:490-500, 1971;.
2 +
Report of the National Commission on Diabetes to the Congress of the United States . US Dept of Health, Education, and Welfare publication (NIH) 76-1022, 1975;, vol 3, pt (2) , pp 88-97.
3 +
Schade DS, Eaton RP:  The pathogenesis of diabetic ketoacidosis—A reappraisal . Diabetes Care 2:296-306, 1979;.
4 +
Ginsberg S, Block MB, Mako ME, et al:  Serum insulin levels following administration of exogenous insulin . J Clin Endocrinol Metab 36:1175-1179, 1973;.
5 +
Guerra SMO, Kitabchi AE:  Comparison of the effectiveness of various routes of insulin injection . J Clin Endocrinol Metab 42:869-874, 1976;.
6 +
Schade DS, Eaton RP:  The controversy concerning counter-regulatory hormone secretion: A hypothesis for the prevention of diabetic ketoacidosis? Diabetes 26:596-601, 1977;.
7 +
Gerich JE, Lorenzi M, Bier D, et al:  Effects of physiologic levels of glucagon and growth hormone on human carbohydrate and lipid metabolism . J Clin Invest 57:875-884, 1976;.
8 +
Barnes AJ, Stephen RB, George MM, et al:  Ketoacidosis in pancreatectomized man . N Engl J Med 296:1250-1253, 1977;.
9 +
Barnes AJ, Kohner EM, Bloom SR, et al:  Importance of pituitary hormones in etiology of diabetic ketoacidosis . Lancet 1:1171-1174, 1978;.
10 +
Hockaday TDR, Alberti KGMM:  Diabetic coma . Br J Hosp Med 7:183-198, 1972;.
11 +
Christensen NM:  Plasma norepinephrine and epinephrine in untreated diabetes, during fasting, and after insulin administration . Diabetes 23:1-8, 1974;.
12 +
Sperling MA, Bacon G, Kenny FM, et al:  Cortisol secretion in acidotic and nonacidotic diabetes mellitus . Am J Dis Child 124:690-692, 1972;.
13 +
Asplin CM, Hartog M:  Serum free insulin concentrations during the treatment of diabetic coma and pre-coma with low-dose intramuscular insulin . Diabetologia 13:475-480, 1977;.
14 +
Owen OE, Reichard GA Jr:  Ketone body metabolism in normal, obese and diabetic subjects . Isr J Med Sci 11:560-571, 1975;.
15 +
Saudek CD, Boulter PR, Knopp RH, et al:  Sodium retention accompanying insulin treatment of diabetes mellitus . Diabetes 23:240-246, 1974;.
16 +
Saudek CD, Boulter PR, Arky RA:  The natriuretic effect of glucagon and its role in starvation . J Clin Endocrinol Metab 36:761-765, 1973;.
17 +
Page MM, Alberti KGMM, Greenwood R, et al:  Treatment of diabetic coma with continuous low-dose infusion of insulin . Br Med J 2:687-690, 1974;.
18 +
Baker L, Barcai A, Kaye R, et al:  Beta adrenergic blockade and juvenile diabetes: Acute studies and long-term therapeutic trial . J Pediatr 75:19-29, 1969;.
19 +
Schade DS, Eaton RP, Standefer J:  Modulation of basal ketone body concentration by cortisol in diabetic man . J Clin Endocrinol Metab 47:519-528, 1978;.
20 +
Schade DS, Eaton RP:  Human model for stress-induced ketoacidosis, abstracted . Clin Res 27:50, 1979;.
21 +
Miller PD, Heinig RE, Waterhouse C:  Treatment of alcoholic acidosis . Arch Intern Med 138:67-71, 1978;.
22 +
Munro JF, Campbell IW, McCuish AC, et al:  Euglycaemic diabetic ketoacidosis . Br Med J 2:578-580, 1973;.

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