Challenges in management of diabetic ketoacidosis in hemodialysis patients, case presentation and review of literature

Publication date: Available online 28 June 2019Source: Diabetes & Metabolic Syndrome: Clinical Research & ReviewsAuthor(s): Ayman Aly Seddik, Alaaeldin Bashier, Amna Khalifa Alhadari, Fakhryia AlAlway, Hind Hassan Alnour, Azza Abdulaziz Bin Hussain, Andrew Frankel, Mohammed Jaffer RaileyAbstractChronic kidney disease is associated with accumulation of uremic toxins that increases insulin resistance which will lead to blunted ability to suppress hepatic gluconeogenesis and reduce peripheral utilization of insulin. CKD patients fail to increase insulin secretion in response to insulin resistance because of acidosis, 1,25 vitamin D deficiency, and secondary hyperparathyroidism. Hemodialysis causes further fluctuations in glycemic control due to alterations in insulin secretion, clearance and resistance. DKA is uncommon in hemodialysis patients because of the absence of glycosuria and osmotic diuresis which accounts for most of the fluid and electrolyte losses seen in DKA, anuric patients may be somewhat protected from dehydration and shock, although still subject to hyperkalemia and metabolic acidosis. However, substantial volume loss can still occur due to a prolonged decrease in oral intake or increased insensible water losses related to tachypnoea and fever. There is no current guidelines for the management of diabetic ketoacidosis in anuric hemodialysis patients considering their differences than general population. In this review article we reviewed the literature and came ...
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research