Diabetic ketoacidosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Physical Examination
Appearance of the Patient
Patient may look thin, cachectic, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and ketosis.
Vital Signs
- Hypothermia[1]
- Hypotension[2]
- Tachycardia[2]
- Tachypnea
- Kussmaul breathing may be present in severe DKA[3]
- Weak pulse due to dehydration
Skin
HEENT
Neck
Lungs
- Rales/crackles due to pulmonary edema (in case of complication of DKA) or pneumonia (in cases where infection is a precipitating cause)[4]
Heart
- S1 normal
- S2 normal
- Prolonged QT interval[5]
- U wave (hypokalemia)[6]
- Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia[7]
Abdomen
- Nausea
- Vomiting
- Abdominal pain
Back
- Not significant
Genitourinary
- Polyuria
Extremities
- Muscle atrophy
- Cold extremities
Neuromuscular
- Hemianopia
- Hemiparesis
- Seizures
- ↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
- ↑ 2.0 2.1 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.
- ↑ "Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department | Diabetology & Metabolic Syndrome | Full Text".
- ↑ 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.