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Stroke and diabetic ketoacidosis – some diagnostic and therapeutic considerations

Authors Jovanovic A, Stolic R, Rasic D, Markovic-Jovanovic S, Peric V

Received 21 December 2013

Accepted for publication 8 January 2014

Published 8 April 2014 Volume 2014:10 Pages 201—204


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Aleksandar Jovanovic,1 Radojica V Stolic,2 Dragisa V Rasic,3 Snezana R Markovic-Jovanovic,4 Vladan M Peric3

1Department of Endocrinology, 2Department of Nephrology, 3Department of Cardiology, 4Department of Pediatrics, University of Pristina–Kosovska Mitrovica, Kosovska Mitrovica, Serbia

Abstract: Cerebrovascular insult (CVI) is a known and important risk factor for the development of diabetic ketoacidosis (DKA); still, it seems that the prevalence of DKA among the patients suffering CVI and its influence on stroke outcome might be underestimated. Diabetic ketoacidosis itself has been reported to be a risk factor for the occurrence of stroke in children and youth. A cerebral hypoperfusion in untreated DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. All these were noted following DKA episodes in children. At least some of these mechanisms may be operative in adults and complicate the course and outcome of CVI. There is a considerable overlap of symptoms, signs, and laboratory findings in the two conditions, making their interpretation difficult, particularly in the elderly and less communicative patients. Serum pH and bicarbonate, blood gases, and anion gap levels should be routinely measured in all type 1 and type 2 diabetics, regardless of symptomatology, for the early detection of existing or pending ketoacidosis. The capacity for rehydration in patients with stroke is limited, and the treatment of the cerebrovascular disease requires intensive use of osmotic and loop diuretics. Fluid repletion may be difficult, and the precise management algorithms are required. Intravenous insulin is the backbone of treatment, although its effect may be diminished due to delayed fluid replenishment. Therefore, the clinical course of diabetic ketoacidosis in patients with CVI may be prolonged and complicated.

Keywords: CVI, type 2 diabetes complications, acid-base disturbances, fluid management

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