Diabetic ketoacidosis physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with diabetic ketoacidosis (DKA) may usually appear [[cachexic]], [[diaphoretic]] or [[Obtundation|obtunded]]. Physical examination of patients with DKA is usually remarkable for [[hypothermia]], [[hypotension]], [[tachycardia]], [[tachypnea]], [[Kussmaul breathing|kussmaul breathing pattern]], [[acanthosis nigricans]], [[nausea]], [[vomiting]] and [[abdominal]] pain.


==Physical Examination==
==Physical Examination==


=== Appearance of the Patient ===
=== Appearance of the Patient ===
Patient may look thin, cachectic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis.
Patient may look thin, [[cachexic]], ill-appearing, [[diaphoretic]], [[Disorientation|disoriented]] or [[Obtundation|obtunded]] due to severe [[hyperglycemia]] and [[ketosis]].<ref name="urlHyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK279052/ |title=Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf |format= |work= |accessdate=}}</ref>


=== Vital Signs ===
=== Vital Signs ===
* Hypothermia<ref name="pmid102402">{{cite journal |vauthors=Gale EA, Tattersall RB |title=Hypothermia: a complication of diabetic ketoacidosis |journal=Br Med J |volume=2 |issue=6149 |pages=1387–9 |year=1978 |pmid=102402 |pmc=1608617 |doi= |url=}}</ref>
* [[Hypothermia]]<ref name="pmid102402">{{cite journal |vauthors=Gale EA, Tattersall RB |title=Hypothermia: a complication of diabetic ketoacidosis |journal=Br Med J |volume=2 |issue=6149 |pages=1387–9 |year=1978 |pmid=102402 |pmc=1608617 |doi= |url=}}</ref>
* Hypotension<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>
* [[Hypotension]]<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>
* Tachycardia<ref name="pmid17308209" />
* [[Tachycardia]]<ref name="pmid17308209" />
* Tachypnea<ref name="pmid22127748">{{cite journal |vauthors=Rosenbloom AL |title=The management of diabetic ketoacidosis in children |journal=Diabetes Ther |volume=1 |issue=2 |pages=103–20 |year=2010 |pmid=22127748 |pmc=3138479 |doi=10.1007/s13300-010-0008-2 |url=}}</ref>
* [[Tachypnea]]<ref name="pmid22127748">{{cite journal |vauthors=Rosenbloom AL |title=The management of diabetic ketoacidosis in children |journal=Diabetes Ther |volume=1 |issue=2 |pages=103–20 |year=2010 |pmid=22127748 |pmc=3138479 |doi=10.1007/s13300-010-0008-2 |url=}}</ref>
* Kussmaul breathing may be present in severe DKA<ref name="urlAlternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text">{{cite web |url=https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-2-41 |title=Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department &#124; Diabetology & Metabolic Syndrome &#124; Full Text |format= |work= |accessdate=}}</ref>
* [[Kussmaul breathing]] may be present in severe DKA<ref name="urlAlternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text">{{cite web |url=https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-2-41 |title=Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department &#124; Diabetology & Metabolic Syndrome &#124; Full Text |format= |work= |accessdate=}}</ref>
* Weak pulse due to dehydration
* Weak [[pulse]] due to [[dehydration]]


=== Skin ===
=== Skin ===
* Cutaneous infection (non-healing ulcer)<ref name="pmid25653473">{{cite journal |vauthors=Duff M, Demidova O, Blackburn S, Shubrook J |title=Cutaneous manifestations of diabetes mellitus |journal=Clin Diabetes |volume=33 |issue=1 |pages=40–8 |year=2015 |pmid=25653473 |pmc=4299750 |doi=10.2337/diaclin.33.1.40 |url=}}</ref>
* [[Cutaneous]] infection (non-healing [[ulcer]])<ref name="pmid25653473">{{cite journal |vauthors=Duff M, Demidova O, Blackburn S, Shubrook J |title=Cutaneous manifestations of diabetes mellitus |journal=Clin Diabetes |volume=33 |issue=1 |pages=40–8 |year=2015 |pmid=25653473 |pmc=4299750 |doi=10.2337/diaclin.33.1.40 |url=}}</ref>
* Xerosis<ref name="pmid25653473" />
* [[Xerosis]]<ref name="pmid25653473" />
* Hair loss<ref name="pmid25653473" />
* Hair loss<ref name="pmid25653473" />
* Acanthosis nigricans in type 2 diabetics<ref name="urlChapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138874 |title=Chapter 151. Diabetes Mellitus and Other Endocrine Diseases &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>  
* [[Acanthosis nigricans]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="urlChapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138874 |title=Chapter 151. Diabetes Mellitus and Other Endocrine Diseases &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>  
* Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics<ref name="urlChapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138766 |title=Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>
* [[Diabetic dermopathy]] (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics<ref name="urlChapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatricks Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical">{{cite web |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138766 |title=Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors &#124; Fitzpatrick's Dermatology in General Medicine, 8e &#124; AccessMedicine &#124; McGraw-Hill Medical |format= |work= |accessdate=}}</ref>
* Eruptive xanthomas in type 2 diabetics<ref name="pmid10815049">{{cite journal |vauthors=Paron NG, Lambert PW |title=Cutaneous manifestations of diabetes mellitus |journal=Prim. Care |volume=27 |issue=2 |pages=371–83 |year=2000 |pmid=10815049 |doi= |url=}}</ref><ref name="pmid25653473" />
* Eruptive [[xanthomas]] in [[Diabetes mellitus type 2|type 2 diabetics]]<ref name="pmid10815049">{{cite journal |vauthors=Paron NG, Lambert PW |title=Cutaneous manifestations of diabetes mellitus |journal=Prim. Care |volume=27 |issue=2 |pages=371–83 |year=2000 |pmid=10815049 |doi= |url=}}</ref><ref name="pmid25653473" />
* Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)<ref name="pmid25653473" />
* [[Necrobiosis lipoidica]] (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)<ref name="pmid25653473" />
* Vitiligo<ref name="pmid25653473" />
* [[Vitiligo]]<ref name="pmid25653473" />
* Diabetic bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref><ref name="pmid25653473" />
* Diabetic bullae<ref name="pmid12170881">{{cite journal |vauthors=Ferringer T, Miller F |title=Cutaneous manifestations of diabetes mellitus |journal=Dermatol Clin |volume=20 |issue=3 |pages=483–92 |year=2002 |pmid=12170881 |doi= |url=}}</ref><ref name="pmid25653473" />


=== HEENT ===
=== HEENT ===
*Cranial nerve mononeuropathies of third, fourth, sixth, and seventh cranial nerves affecting ocular movements<ref name="pmid21760834">{{cite journal |vauthors=Skarbez K, Priestley Y, Hoepf M, Koevary SB |title=Comprehensive Review of the Effects of Diabetes on Ocular Health |journal=Expert Rev Ophthalmol |volume=5 |issue=4 |pages=557–577 |year=2010 |pmid=21760834 |pmc=3134329 |doi=10.1586/eop.10.44 |url=}}</ref>
*[[Cranial nerves|Cranial nerve]] [[mononeuropathies]] of [[Oculomotor nerve palsy|third]], [[Fourth (trochlear) nerve palsy|fourth]], [[Sixth nerve palsy|sixth]], and [[Facial nerve palsy|seventh]] [[cranial nerves]] affecting [[ocular]] movements<ref name="pmid21760834">{{cite journal |vauthors=Skarbez K, Priestley Y, Hoepf M, Koevary SB |title=Comprehensive Review of the Effects of Diabetes on Ocular Health |journal=Expert Rev Ophthalmol |volume=5 |issue=4 |pages=557–577 |year=2010 |pmid=21760834 |pmc=3134329 |doi=10.1586/eop.10.44 |url=}}</ref>
*Necrotizing (malignant) otitis externa (black escar)<ref name="pmid17185850">{{cite journal |vauthors=Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S |title=Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis |journal=Indian J Med Microbiol |volume=24 |issue=4 |pages=289–91 |year=2006 |pmid=17185850 |doi= |url=}}</ref>
*[[Malignant otitis externa|Necrotizing (malignant) otitis externa]] (black escar)<ref name="pmid17185850">{{cite journal |vauthors=Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S |title=Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis |journal=Indian J Med Microbiol |volume=24 |issue=4 |pages=289–91 |year=2006 |pmid=17185850 |doi= |url=}}</ref>
 
=== Neck ===
* Not significant
=== Lungs ===
=== Lungs ===
*Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)<ref name="pmid26240698">{{cite journal |vauthors=Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH |title=Respiratory failure in diabetic ketoacidosis |journal=World J Diabetes |volume=6 |issue=8 |pages=1009–23 |year=2015 |pmid=26240698 |pmc=4515441 |doi=10.4239/wjd.v6.i8.1009 |url=}}</ref>
*[[Rales/Crackles|Rales/crackles]] due to [[pulmonary edema]] (in case of complication of DKA) or [[pneumonia]] (in cases where infection is a precipitating cause)<ref name="pmid26240698">{{cite journal |vauthors=Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH |title=Respiratory failure in diabetic ketoacidosis |journal=World J Diabetes |volume=6 |issue=8 |pages=1009–23 |year=2015 |pmid=26240698 |pmc=4515441 |doi=10.4239/wjd.v6.i8.1009 |url=}}</ref>


=== Heart ===
=== Heart ===
* S1 normal
* [[Heart sounds|S1]] normal
* S2 normal
* [[Heart sounds|S2]] normal
* Prolonged QT interval<ref name="pmid18524745">{{cite journal |vauthors=Kuppermann N, Park J, Glatter K, Marcin JP, Glaser NS |title=Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children |journal=Arch Pediatr Adolesc Med |volume=162 |issue=6 |pages=544–9 |year=2008 |pmid=18524745 |doi=10.1001/archpedi.162.6.544 |url=}}</ref>
* Prolonged [[QT interval]]<ref name="pmid18524745">{{cite journal |vauthors=Kuppermann N, Park J, Glatter K, Marcin JP, Glaser NS |title=Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children |journal=Arch Pediatr Adolesc Med |volume=162 |issue=6 |pages=544–9 |year=2008 |pmid=18524745 |doi=10.1001/archpedi.162.6.544 |url=}}</ref>
* U wave (hypokalemia)<ref name="pmid25430801">{{cite journal |vauthors=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM |title=Profound hypokalemia associated with severe diabetic ketoacidosis |journal=Pediatr Diabetes |volume=17 |issue=1 |pages=61–5 |year=2016 |pmid=25430801 |pmc=4896141 |doi=10.1111/pedi.12246 |url=}}</ref>
* [[The U Wave|U wave]] ([[hypokalemia]])<ref name="pmid25430801">{{cite journal |vauthors=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM |title=Profound hypokalemia associated with severe diabetic ketoacidosis |journal=Pediatr Diabetes |volume=17 |issue=1 |pages=61–5 |year=2016 |pmid=25430801 |pmc=4896141 |doi=10.1111/pedi.12246 |url=}}</ref>
* Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia<ref name="pmid26862372">{{cite journal |vauthors=Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG |title=Role of diabetes in heart rhythm disorders |journal=World J Diabetes |volume=7 |issue=3 |pages=45–9 |year=2016 |pmid=26862372 |pmc=4733448 |doi=10.4239/wjd.v7.i3.45 |url=}}</ref>
* [[Cardiac arrhythmia]] ([[Atrial fibrillation]] and [[Ventricular arrhythmias|ventricular arrhythmia]]<ref name="pmid26862372">{{cite journal |vauthors=Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG |title=Role of diabetes in heart rhythm disorders |journal=World J Diabetes |volume=7 |issue=3 |pages=45–9 |year=2016 |pmid=26862372 |pmc=4733448 |doi=10.4239/wjd.v7.i3.45 |url=}}</ref>


=== Abdomen ===
=== Abdomen ===
* Nausea
* [[Nausea]]
* Vomiting
* [[Vomiting]]
* Abdominal pain<ref name="pmid12040551">{{cite journal |vauthors=Umpierrez G, Freire AX |title=Abdominal pain in patients with hyperglycemic crises |journal=J Crit Care |volume=17 |issue=1 |pages=63–7 |year=2002 |pmid=12040551 |doi= |url=}}</ref>
* [[Abdominal]] pain<ref name="pmid12040551">{{cite journal |vauthors=Umpierrez G, Freire AX |title=Abdominal pain in patients with hyperglycemic crises |journal=J Crit Care |volume=17 |issue=1 |pages=63–7 |year=2002 |pmid=12040551 |doi= |url=}}</ref>
 
=== Back ===
* Not significant


=== Genitourinary ===
=== Genitourinary ===
* Polyuria<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>
* [[Polyuria]]<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>


=== Extremities ===
=== Extremities ===
* Muscle cramping<ref name="pmid17549168">{{cite journal |vauthors=Wyatt LH, Ferrance RJ |title=The musculoskeletal effects of diabetes mellitus |journal=J Can Chiropr Assoc |volume=50 |issue=1 |pages=43–50 |year=2006 |pmid=17549168 |pmc=1839979 |doi= |url=}}</ref>
* [[Muscle cramps|Muscle cramping]]<ref name="pmid17549168">{{cite journal |vauthors=Wyatt LH, Ferrance RJ |title=The musculoskeletal effects of diabetes mellitus |journal=J Can Chiropr Assoc |volume=50 |issue=1 |pages=43–50 |year=2006 |pmid=17549168 |pmc=1839979 |doi= |url=}}</ref>
* Cold extremities<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>
* Cold [[extremities]]<ref name="pmid17308209">{{cite journal |vauthors=Kearney T, Dang C |title=Diabetic and endocrine emergencies |journal=Postgrad Med J |volume=83 |issue=976 |pages=79–86 |year=2007 |pmid=17308209 |pmc=2805944 |doi=10.1136/pgmj.2006.049445 |url=}}</ref>


=== Neuromuscular ===
=== Neuromuscular ===
* Hemianopia<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref>
* [[Hemianopia]]<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref>
* Hemiparesis<ref name="pmid805337">{{cite journal |vauthors=Guisado R, Arieff AI |title=Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain |journal=Metab. Clin. Exp. |volume=24 |issue=5 |pages=665–79 |year=1975 |pmid=805337 |doi= |url=}}</ref>
* [[Hemiparesis]]<ref name="pmid805337">{{cite journal |vauthors=Guisado R, Arieff AI |title=Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain |journal=Metab. Clin. Exp. |volume=24 |issue=5 |pages=665–79 |year=1975 |pmid=805337 |doi= |url=}}</ref>
* Seizures<ref name="pmid23590576">{{cite journal |vauthors=Yun C, Xuefeng W |title=Association between seizures and diabetes mellitus: a comprehensive review of literature |journal=Curr Diabetes Rev |volume=9 |issue=4 |pages=350–4 |year=2013 |pmid=23590576 |doi= |url=}}</ref>
* [[Seizures]]<ref name="pmid23590576">{{cite journal |vauthors=Yun C, Xuefeng W |title=Association between seizures and diabetes mellitus: a comprehensive review of literature |journal=Curr Diabetes Rev |volume=9 |issue=4 |pages=350–4 |year=2013 |pmid=23590576 |doi= |url=}}</ref>


==References==
==References==

Latest revision as of 01:04, 24 October 2017

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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

Skin

HEENT

Lungs

Heart

Abdomen

Genitourinary

Extremities

Neuromuscular

References

  1. ↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
  2. ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ "Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text".
  6. ↑ 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.
  7. ↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
  8. ↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
  9. ↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
  10. ↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Umpierrez G, Freire AX (2002). "Abdominal pain in patients with hyperglycemic crises". J Crit Care. 17 (1): 63–7. PMID 12040551.
  18. ↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.

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