Diabetic ketoacidosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Patients with diabetic ketoacidosis (DKA) may usually appear cachexic, diaphoretic or obtunded. Physical examination of patients with DKA is usually remarkable for hypothermia, hypotension, tachycardia, tachypnea, kussmaul breathing pattern, acanthosis nigricans, nausea, vomiting and abdominal pain.
Physical Examination
Appearance of the Patient
Patient may look thin, cachexic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis.[1]
Vital Signs
- Hypothermia[2]
- Hypotension[3]
- Tachycardia[3]
- Tachypnea[4]
- Kussmaul breathing may be present in severe DKA[5]
- Weak pulse due to dehydration
Skin
- Cutaneous infection (non-healing ulcer)[6]
- Xerosis[6]
- Hair loss[6]
- Acanthosis nigricans in type 2 diabetics[7]
- Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics[8]
- Eruptive xanthomas in type 2 diabetics[9][6]
- Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)[6]
- Vitiligo[6]
- Diabetic bullae[10][6]
HEENT
- Cranial nerve mononeuropathies of third, fourth, sixth, and seventh cranial nerves affecting ocular movements[11]
- Necrotizing (malignant) otitis externa (black escar)[12]
Lungs
- Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)[13]
Heart
- S1 normal
- S2 normal
- Prolonged QT interval[14]
- U wave (hypokalemia)[15]
- Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia[16]
Abdomen
Genitourinary
Extremities
Neuromuscular
References
- ↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ 3.0 3.1 3.2 3.3 Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.
- ↑ Rosenbloom AL (2010). "The management of diabetic ketoacidosis in children". Diabetes Ther. 1 (2): 103–20. doi:10.1007/s13300-010-0008-2. PMC 3138479. PMID 22127748.
- ↑ "Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text".
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Duff M, Demidova O, Blackburn S, Shubrook J (2015). "Cutaneous manifestations of diabetes mellitus". Clin Diabetes. 33 (1): 40–8. doi:10.2337/diaclin.33.1.40. PMC 4299750. PMID 25653473.
- ↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
- ↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
- ↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
- ↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
- ↑ Skarbez K, Priestley Y, Hoepf M, Koevary SB (2010). "Comprehensive Review of the Effects of Diabetes on Ocular Health". Expert Rev Ophthalmol. 5 (4): 557–577. doi:10.1586/eop.10.44. PMC 3134329. PMID 21760834.
- ↑ Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S (2006). "Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis". Indian J Med Microbiol. 24 (4): 289–91. PMID 17185850.
- ↑ Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH (2015). "Respiratory failure in diabetic ketoacidosis". World J Diabetes. 6 (8): 1009–23. doi:10.4239/wjd.v6.i8.1009. PMC 4515441. PMID 26240698.
- ↑ Kuppermann N, Park J, Glatter K, Marcin JP, Glaser NS (2008). "Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children". Arch Pediatr Adolesc Med. 162 (6): 544–9. doi:10.1001/archpedi.162.6.544. PMID 18524745.
- ↑ Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
- ↑ Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG (2016). "Role of diabetes in heart rhythm disorders". World J Diabetes. 7 (3): 45–9. doi:10.4239/wjd.v7.i3.45. PMC 4733448. PMID 26862372.
- ↑ Umpierrez G, Freire AX (2002). "Abdominal pain in patients with hyperglycemic crises". J Crit Care. 17 (1): 63–7. PMID 12040551.
- ↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
- ↑ Guisado R, Arieff AI (1975). "Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain". Metab. Clin. Exp. 24 (5): 665–79. PMID 805337.
- ↑ Yun C, Xuefeng W (2013). "Association between seizures and diabetes mellitus: a comprehensive review of literature". Curr Diabetes Rev. 9 (4): 350–4. PMID 23590576.