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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 25, 2015; 6(8): 1009-1023
Published online Jul 25, 2015. doi: 10.4239/wjd.v6.i8.1009
Respiratory failure in diabetic ketoacidosis
Nikifor K Konstantinov, Mark Rohrscheib, Emmanuel I Agaba, Richard I Dorin, Glen H Murata, Antonios H Tzamaloukas
Nikifor K Konstantinov, University of New Mexico School of Medicine, Albuquerque, NM 87122, United States
Mark Rohrscheib, Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87122, United States
Emmanuel I Agaba, Division of Nephrology, Department of Medicine, University of Jos Medical School, Jos, Plateau State 930001, Nigeria
Richard I Dorin, Section of Endocrinology, Medicine Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuq-uerque, NM 78108, United States
Glen H Murata, Section of Informatics, Medicine Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuq-uerque, NM 78108, United States
Antonios H Tzamaloukas, Section of Nephrology, Medicine Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuq-uerque, NM 78108, United States
Richard I Dorin, Glen H Murata, Antonios H Tzamaloukas, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Author contributions: Konstantinov NK reviewed the literature, contributed to the writing of the report and constructed its figure; Rohrscheib M, Agaba EI, Dorin RI and Murata GH made critical changes in the manuscript; Tzamaloukas AH conceived the report and reviewed the literature; Konstantinov NK wrote the biggest part of the paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonios H Tzamaloukas, MD, MACP, Section of Nephrology, Medicine Service (111C), Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro, SE, Albuquerque, NM 87108 United States. antonios.tzamaloukas@va.gov
Telephone: +1-505-2651711 Fax: +1-505-2566443
Received: August 26, 2014
Peer-review started: August 27, 2014
First decision: December 17, 2014
Revised: January 8, 2015
Accepted: May 26, 2015
Article in press: May 27, 2015
Published online: July 25, 2015
Abstract

Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include deficits of potassium, magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema. Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system, pre-existing respiratory or neuromuscular disease and miscellaneous other conditions. Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA.

Keywords: Diabetic ketoacidosis, Respiratory failure, Hypokalemia, Hypomagnesemia, Hypophosphatemia, Pulmonary edema, Adult respiratory distress syndrome, Pneumonia, Neuromuscular disease

Core tip: Despite progress in its management, diabetic ketoacidosis (DKA) continues to cause significant morbidity and mortality. One of the conditions aggravating the course of DKA and causing several deaths is respiratory failure, which can be detected at presentation or, more frequently during the course of treatment of DKA. Several risk factors for respiratory failure in DKA are preventable. Early recognition and management of these risk factors, as well as early recognition of respiratory failure have the potential to improve both morbidity and mortality resulting from DKA.