Crisis Convergence: Emergency Responses in ARDS Complicated by Diabetic Ketoacidosis


Authors : Aruna Rajeswari Balaprakash Bhavani

Volume/Issue : Volume 9 - 2024, Issue 9 - September


Google Scholar : https://tinyurl.com/4kua84ca

Scribd : https://tinyurl.com/42n8ncxa

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP039

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : The intersection of Acute Respiratory Distress Syndrome (ARDS) and Diabetic Ketoacidosis (DKA) represents a critical challenge in emergency care, requiring a comprehensive and coordinated strategy. This paper delves into the complex relationship between these conditions, highlighting their shared pathophysiological mechanisms and the distinct challenges posed by their simultaneous occurrence. The paper emphasizes the importance of collaborative efforts among multidisciplinary teams—including intensivists, pulmonologists, and endocrinologists—to enhance emergency response strategies. Additionally, it explores the prognosis and long-term outcomes, advocating for personalized care approaches in managing these multifaceted cases. Finally, the paper discusses future research directions and potential advancements to improve emergency response and patient outcomes for those affected by both ARDS and DKA.

Keywords : ARDS, Acute Respiratory Distress Syndrome, DKA, Diabetic Ketoacidosis, Interdisciplinary Collaboration, Diagnosis, Treatment Strategies, Prognosis, Future Research Directions.

References :

  1. Darrat, M., Gilmartin, B., Kennedy, C., & Smith, D. (2021, July 1). Acute respiratory distress syndrome in a case of diabetic ketoacidosis requiring ECMO support. Endocrinology, Diabetes & Metabolism Case Reports. https://doi.org/10.1530/edm-20-0192
  2. Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017, August 10). Acute Respiratory Distress Syndrome. The New England Journal of Medicine. https://doi.org/10.1056/nejmra1608077
  3. Acute pulmonary edema in juvenile diabetic ketoacidosis. (1997, December 1). PubMed. https://doi.org/10.1002/(sici)1099-0496(199712)24:6
  4. Janz, D. R., & Ware, L. B. (2014, December 1). Approach to the Patient with the Acute Respiratory Distress Syndrome. Clinics in Chest Medicine. https://doi.org/10.1016/j.ccm.2014.08.007
  5. Chang, L., & Li, J. (2014, September 1). Role of genetic factors in the development of acute respiratory distress syndrome. Journal of Translational Internal Medicine. https://doi.org/10.4103/2224-4018.141831
  6. Horiya, M., Anno, T., Shigemoto, R., Koyama, K., Kawasaki, F., Tomoda, K., Kaku, K., & Kaneto, H. (2022, March 25). Acute respiratory distress syndrome triggered by marked cytokine storm in a subject with diabetic ketoacidosis. Medicine. https://doi.org/10.1097/md.0000000000029119
  7. Carroll, P. A., & Matz, R. (1982, November 1). Adult Respiratory Distress Syndrome Complicating Severely Uncontrolled Diabetes Mellitus: Report of Nine Cases and a Review of the Literature. Diabetes Care. https://doi.org/10.2337/diacare.5.6.574
  8. Leonard, R., Asplin, C. M., McCormick, C. V., & Hockaday, T. D. R. (1983, March 5). Acute respiratory distress in diabetic ketoacidosis: possible contribution of low colloid osmotic pressure. The BMJ. https://doi.org/10.1136/bmj.286.6367.760
  9. Breidbart, S., Singer, L. P., St Louis, Y., & Saenger, P. (1987, November 1). Adult respiratory distress syndrome in an adolescent with diabetic ketoacidosis. The Journal of Pediatrics. https://doi.org/10.1016/s0022-3476(87)80256-1
  10. Koves, I. H., Leu, M. G., Spencer, S., Popalisky, J., Drummond, K., Beardsley, E., Klee, K. M., & Zimmerman, J. J. (2014, September 1). Improving Care for Pediatric Diabetic Ketoacidosis. Pediatrics. https://doi.org/10.1542/peds.2013-3764
  11. Pavić, I., Drinković, D. T., Galić, S., & Putarek, N. R. (2018, January 1). Acute Respiratory Distress Syndrome in a Four-Year-Old Boy with Diabetic Ketoacidosis – Case Report. Acta Clinica Croatica. https://doi.org/10.20471/acc.2018.57.03.24
  12. Wolfsdorf, J. I., Allgrove, J., Craig, M. E., Edge, J., Glaser, N., Jain, V., Lee, W. W., Mungai, L. N. W., Rosenbloom, A. L., Sperling, M. A., & Hanås, R. (2014, July 12). Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes. https://doi.org/10.1111/pedi.12165
  13. Swenson, K. E., & Swenson, E. R. (2021, October 1). Pathophysiology of Acute Respiratory Distress Syndrome and COVID-19 Lung Injury. Critical Care Clinics. https://doi.org/10.1016/j.ccc.2021.05.003
  14. Mumme, L. E. (n.d.). Diabetic Ketoacidosis: Pathophysiology and Treatment. Scholars Crossing. https://digitalcommons.liberty.edu/kabod/vol2/iss1/3/
  15. Gosmanov, A. R., & Kitabchi, A. E. (2018, April 28). Diabetic Ketoacidosis. Endotext - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK279146/#:~:text=Insulin%20deficiency%2C%20increased%20insulin%20counter,underlie%20the%20pathophysiology%20of%20DKA.
  16. De Moraes, A. G., & Surani, S. (2019, January 15). Effects of diabetic ketoacidosis in the respiratory system. World Journal of Diabetes. https://doi.org/10.4239/wjd.v10.i1.16
  17. Kayina, C. A., Maitra, S., Anand, R., Ray, B. R., Baidya, D. K., & Subramaniam, R. (2020, December 16). SARS-CoV-2 Infection Presenting with Hyperglycemia and Ketosis: A Case Series of Three Diabetic Patients. Indian Journal of Critical Care Medicine. https://doi.org/10.5005/jp-journals-10071-23595
  18. Lizzo, J. M., Goyal, A., & Gupta, V. (2023, July 10). Adult Diabetic Ketoacidosis. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560723/
  19. Konstantinov, N. K., Rohrscheib, M., Agaba, E. I., Dorin, R. I., Murata, G. H., & Tzamaloukas, A. H. (2015, January 1). Respiratory failure in diabetic ketoacidosis. World Journal of Diabetes. https://doi.org/10.4239/wjd.v6.i8.1009
  20. Diamond, M., Peniston, H. L., Sanghavi, D. K., & Mahapatra, S. (2024, January 31). Acute Respiratory Distress Syndrome. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK436002/
  21. Professional, C. C. M. (n.d.). Kussmaul Breathing. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/24593-kussmaul-breathing
  22. Ghimire, P., & Dhamoon, A. S. (2023, August 8). Ketoacidosis. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK534848/
  23. Tang, P. (2023, December 7). Acute Respiratory Failure - All There Is To Know | Read more. Pinson & Tang. https://www.pinsonandtang.com/resources/acute-respiratory-failure-know/
  24. Bhutta, B. S., Alghoula, F., & Berim, I. (2022, August 9). Hypoxia. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482316/#:~:text=Hypoxia%20is%20a%20state%20in,in%20the%20blood%20(hypoxemia).
  25. Hashmi, M. F., Modi, P., Basit, H., & Sharma, S. (2023, February 19). Dyspnea. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499965/
  26. Johnson, K., & Ghassemzadeh, S. (2022, December 14). Chest Pain. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470557/
  27. Williams, A. J. (1998, October 31). ABC of oxygen: Assessing and interpreting arterial blood gases and acid-base balance. The BMJ. https://doi.org/10.1136/bmj.317.7167.1213
  28. Acute Respiratory Distress Syndrome (ARDS). (2023, October 2). Yale Medicine. https://www.yalemedicine.org/conditions/ards#:~:text=ARDS%20is%20a%20dangerous%2C%20potentially,oxygen%20to%20dangerously%20low%20levels.
  29. Kitabchi, A. E., Umpiérrez, G. E., Miles, J. M., & Fisher, J. N. (2009, July 1). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care. https://doi.org/10.2337/dc09-9032
  30. Schuller, D., & Schuster, D. P. (2006, September 14). Fluid-Management Strategies in Acute Lung Injury. The New England Journal of Medicine. https://doi.org/10.1056/nejmc061857
  31. Qadir, N., Sahetya, S. K., Munshi, L., Summers, C., Abrams, D., Beitler, J. R., Bellani, G., Brower, R. G., Burry, L., Chen, J. T., Hodgson, C., Hough, C. L., Lamontagne, F., Law, A. C., Papazian, L., Pham, T., Rubin, E., Siuba, M., Telias, I., . . . Fan, E. (2024, January 1). An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.202311-2011st
  32. Vignon, P., Evrard, B., Asfar, P., Busana, M., Calfee, C. S., Coppola, S., Demiselle, J., Géri, G., Jozwiak, M., Martin, G. S., Gattinoni, L., & Chiumello, D. (2020, November 9). Fluid administration and monitoring in ARDS: which management? Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06310-0
  33. Gupta, A., & El-Wiher, N. (2019, January 1). Therapeutic Challenges in Management of Severe Acidosis and Profound Hypokalemia in Pediatric Diabetic Ketoacidosis. Global Pediatric Health. https://doi.org/10.1177/2333794x19840364
  34. Ohshimo, S. (2021, February 6). Oxygen administration for patients with ARDS. Journal of Intensive Care. https://doi.org/10.1186/s40560-021-00532-0
  35. Millar, H. (2023, May 31). What ventilators do and their role in COVID-19. https://www.medicalnewstoday.com/articles/what-is-a-ventilator
  36. Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C., Munshi, L., Walkey, A. J., Adhikari, N. K. J., Amato, M. B. P., Branson, R. D., Brower, R. G., Ferguson, N. D., Gajic, O., Gattinoni, L., Hess, D., Mancebo, J., Meade, M. O., McAuley, D. F., Pesenti, A., Ranieri, V. M., . . . Brochard, L. (2017, May 1). An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.201703-0548st
  37. Recovering from ARDS. (n.d.). https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery
  38. Keddissi, J. I., Youness, H., Jones, K., & Kinasewitz, G. T. (2019, January 1). Fluid management in Acute Respiratory Distress Syndrome: A narrative review. Canadian Journal of Respiratory Therapy. https://doi.org/10.29390/cjrt-2018-016
  39. Diabetic ketoacidosis in pregnancy poses mortality risk - Mayo Clinic. (2023, April 27). https://www.mayoclinic.org/medical-professionals/endocrinology/news/diabetic-ketoacidosis-in-pregnancy-poses-mortality-risk/mac-20546678
  40. Morandi, A., & Canonico, A. E. (2013, October 3). Long-Term Cognitive Impairment after Critical Illness. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa1301372
  41. Lynch, J. P. (2001, February 1). Hospital-Acquired Pneumonia. Chest. https://doi.org/10.1378/chest.119.2_suppl.373s
  42. Peck, T., & Hibbert, K. A. (2019, November 22). Recent advances in the understanding and management of ARDS. F1000Research. https://doi.org/10.12688/f1000research.20411.1

The intersection of Acute Respiratory Distress Syndrome (ARDS) and Diabetic Ketoacidosis (DKA) represents a critical challenge in emergency care, requiring a comprehensive and coordinated strategy. This paper delves into the complex relationship between these conditions, highlighting their shared pathophysiological mechanisms and the distinct challenges posed by their simultaneous occurrence. The paper emphasizes the importance of collaborative efforts among multidisciplinary teams—including intensivists, pulmonologists, and endocrinologists—to enhance emergency response strategies. Additionally, it explores the prognosis and long-term outcomes, advocating for personalized care approaches in managing these multifaceted cases. Finally, the paper discusses future research directions and potential advancements to improve emergency response and patient outcomes for those affected by both ARDS and DKA.

Keywords : ARDS, Acute Respiratory Distress Syndrome, DKA, Diabetic Ketoacidosis, Interdisciplinary Collaboration, Diagnosis, Treatment Strategies, Prognosis, Future Research Directions.

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe