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So I'm in the MICU this month, and today I admitted FOUR people with DKA. Two of them had cocaine on board. Got me thinking... correlation? Did a quick pubmed search, and found this article which I will post after I'm done typing. I wonder if one should get a UDS (or whatever each hospital calls it) on patients presenting with DKA. But ultimately, it never changes our medical care, especially in the ED (except maybe adding a benzo). We can always do patient education but I am not sure how useful it is... especially in our frequent fliers. Thoughts? Interestingly, the article was published from people at my hospital at Tampa General... perhaps we just have lots of cocaine here!
Q
Arch Intern Med. 1998 Sep 14;158(16):1799-802. Related Articles, Links
Diabetic ketoacidosis associated with cocaine use.
Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE.
Division of General Internal Medicine, University of South Florida College of Medicine, Tampa 33612, USA. [email protected]
BACKGROUND: Multiple risk factors for diabetic ketoacidosis (DKA) have been described, including omission of insulin therapy and clinical conditions known to increase counterregulatory hormones. Recently, substance abuse has been identified in patients with DKA. We observed many cases of DKA in cocaine users, although the association between cocaine use and DKA has not been well described in the medical literature. METHODS: We performed a retrospective case-control study of admissions for DKA in cocaine users and non-user controls in an urban teaching hospital from January 1, 1985, to December 31, 1994. RESULTS: We identified 720 adult admissions for DKA. Twenty-seven cocaine users accounted for 102 admissions (14% of all DKA admissions). The users were compared with 85 nonuser controls who had 154 DKA admissions. Cocaine users had more admissions for DKA (mean, 3.78 vs 1.81; P = .03). Cocaine users were less likely than controls to have an intercurrent illness identified as a precipitating factor for DKA (14.7% vs 33.1%; P<.001) and were more likely to have missed taking insulin prior to admission (45.1% vs 24.7%; P<.001). Although cocaine users had higher serum glucose levels on admission (32.9 mmol/L [593.4 mg/dL] vs 29.5 mmol/L [531.1 mg/dL]; P =.03), no differences in intensity of illness or treatment outcome were detected. CONCLUSIONS: In this preliminary study, cocaine use was found in a significant number of adults admitted with DKA and was associated with more frequent omission of insulin therapy and the absence of precipitating systemic illness. Either because of its association with insulin therapy omission or its effects on counterregulatory hormones, cocaine use should be considered a risk factor for DKA, particularly in patients with multiple admissions.
PMID: 9738609 [PubMed - indexed for MEDLINE]
Q
Arch Intern Med. 1998 Sep 14;158(16):1799-802. Related Articles, Links
Diabetic ketoacidosis associated with cocaine use.
Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE.
Division of General Internal Medicine, University of South Florida College of Medicine, Tampa 33612, USA. [email protected]
BACKGROUND: Multiple risk factors for diabetic ketoacidosis (DKA) have been described, including omission of insulin therapy and clinical conditions known to increase counterregulatory hormones. Recently, substance abuse has been identified in patients with DKA. We observed many cases of DKA in cocaine users, although the association between cocaine use and DKA has not been well described in the medical literature. METHODS: We performed a retrospective case-control study of admissions for DKA in cocaine users and non-user controls in an urban teaching hospital from January 1, 1985, to December 31, 1994. RESULTS: We identified 720 adult admissions for DKA. Twenty-seven cocaine users accounted for 102 admissions (14% of all DKA admissions). The users were compared with 85 nonuser controls who had 154 DKA admissions. Cocaine users had more admissions for DKA (mean, 3.78 vs 1.81; P = .03). Cocaine users were less likely than controls to have an intercurrent illness identified as a precipitating factor for DKA (14.7% vs 33.1%; P<.001) and were more likely to have missed taking insulin prior to admission (45.1% vs 24.7%; P<.001). Although cocaine users had higher serum glucose levels on admission (32.9 mmol/L [593.4 mg/dL] vs 29.5 mmol/L [531.1 mg/dL]; P =.03), no differences in intensity of illness or treatment outcome were detected. CONCLUSIONS: In this preliminary study, cocaine use was found in a significant number of adults admitted with DKA and was associated with more frequent omission of insulin therapy and the absence of precipitating systemic illness. Either because of its association with insulin therapy omission or its effects on counterregulatory hormones, cocaine use should be considered a risk factor for DKA, particularly in patients with multiple admissions.
PMID: 9738609 [PubMed - indexed for MEDLINE]
Thanks guys. If you ever get wasted by a dude in Halo/UT2K4 by the name of EvoDevo.........
