Browsing by Author "Ameyaw, Emmanuel"

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    Management of Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar States
    (Journal Gurus, 2024) Mungai, L N Wainaina; Abdalla, Asmahan T Msuya, levina J.; Odongkara, Beatrice; Iroro, Yarhere; Ameyaw, Emmanuel; Bodieu, Adele Chetcha; Majaliwa, Edna Siima; Mandilou, Steve Vassili Missambou; Omondi, Vincent O.; Hanas, Ragnar; Abdullah, Mohamed
    The global rise in diabetes mellitus prevalence has implications for Africa, with diabetic ketoacidosis (DKA) being its most severe acute complication. In Sub-Saharan Africa, DKA rates at first diagnosis among children and adolescents range from 24%-82% constituting 76% of paediatric endocrine admissions. DKA and hyperglycaemic hyperosmolar state (HHS) result in significant morbidity and mortality. Yet, healthcare disparities and unique issues such as severe malnutrition challenge African Management in Africa. Methodology: Diagnosis criteria for DKA include symptoms like polyuria, polydipsia, and weight loss combined with hyperglycaemia (>11 mmol/L), venous pH <7.3, and ketonemia (blood ß-hydroxybutyrate ≥3 mmol/L) or significant Ketonuria. Emergency management prioritizes restoring circulation, obtaining relevant laboratory samples, and initiating fluid and insulin therapy. Special attention is given to unique considerations, like administering oral rehydration solution (ORS) without IV fluids or handling severe malnutrition with RESOMAL. Treatment: Fluid therapy involves administering deficit replacement plus maintainance. Based on clinical conditions, potassium is added, and bicarbonate is reserved for severe cases. Insulin, vital for treatment, is introduced an hour after fluid therapy. Monitoring for cerebral oedema, especially in high-risk groups, is critical. Following the acute treatment phase, preventative measures are underscored to mitigate recurrence. For HHS, a subset of patients with particular diagnostic criteria, including elevated plasma glucose (>33.3 mmol/L) and higher pH levels, management focuses on restoring volume, renal perfusion, and a steady decline in serum sodium concentration and osmolality. The approach diverges from DKA regarding fluid volume, insulin timing, and monitoring specifics. Conclusion: Effective diagnosis and Management of DKA and HHS are pivotal in the African context, considering healthcare limitations and unique challenges. Guidelines that consider these intricacies ensure comprehensive care for affected individuals.