The Journal of Emergency Medicine
Volume 38, Issue 4 , Pages 422-427 , May 2010

Utility of Initial Bolus Insulin in the Treatment of Diabetic Ketoacidosis

  • Nikhil Goyal, MD

      Affiliations

    • Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
    • Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
    • Corresponding Author InformationReprint Address: Nikhil Goyal, md, Department of Emergency Medicine, Henry Ford Health System, 2799 West Grand Boulevard, CFP-2, Detroit, MI 48202
    • ,
  • Joseph B. Miller, MD

      Affiliations

    • Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
    • Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
    • ,
  • Steadman S. Sankey, PHD

      Affiliations

    • Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan
    • ,
  • Usamah Mossallam, MD

      Affiliations

    • Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan

Received 26 January 2007 ,Revised 27 May 2007 ,Accepted 2 November 2007.

References 

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  2. Centers for Disease Control and Prevention. Diabetic ketoacidosis as first-listed diagnosis. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2005;
  3. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001;24:131–153
  4. Kitabchi AE, Haerian H, Rose BD. UpToDate Online 16.1: treatment of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. http://www.uptodate.com/Accessed May 3, 2008
  5. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in diabetes. Diabetes Care. 2004;27(Suppl 1):S94–S102
  6. Dunger DB, Sperling MA, Acerini CL, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics. 2004;113:e133–e140
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  8. Fort P, Waters SM, Lifshitz F. Low-dose insulin infusion in the treatment of diabetic ketoacidosis: bolus versus no bolus. J Pediatr. 1980;96:36–40
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  10. Rosenthal NR, Barrett EJ. An assessment of insulin action in hyperosmolar hyperglycemic nonketotic diabetic patients. J Clin Endocrinol Metab. 1985;60:607–610
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  15. Black AB, Maims M. Diabetic ketosis: a comparison of results of orthodox and intensive methods of treatment based on 170 consecutive cases. Lancet. 1949;253:56–59
  16. Semple PF, White C, Manderson WG. Continuous intravenous infusion of small doses of insulin in treatment of diabetic ketoacidosis. Br Med J. 1974;2:694–698
  17. Genuth SM. Constant intravenous insulin infusion in diabetic ketoacidosis. JAMA. 1973;223:1348–1351
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  19. Soler NG, FitzGerald MG, Wright AD, et al. Comparative study of different insulin regimens in management of diabetic ketoacidosis. Lancet. 1975;2:1221–1224
  20. Burghen GA, Etteldorf JN, Fisher JN, et al. Comparison of high-dose and low-dose insulin by continuous intravenous infusion in the treatment of diabetic ketoacidosis in children. Diabetes Care. 1980;3:15–20
  21. Heber D, Molitch ME, Sperling MA. Low-dose continuous insulin therapy for diabetic ketoacidosis (Prospective comparison with “conventional” insulin therapy). Arch Intern Med. 1977;137:1377–1380
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  24. Sacks HS, Shahshahani M, Kitabchi AE, et al. Similar responsiveness of diabetic ketoacidosis to low-dose insulin by intramuscular injection and albumin-free infusion. Ann Intern Med. 1979;90:36–42
  25. Bratusch-Marrain PR, Komajati M, Waldhausal W. The effect of hyperosmolarity on glucose metabolism. Pract Cardiol. 1985;11:153–163
  26. Ginsberg HN. Investigation of insulin resistance during diabetic ketoacidosis: role of counterregulatory substances and effect of insulin therapy. Metabolism. 1977;26:1135–1146
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  29. Lindsay R, Bolte RG. The use of an insulin bolus in low-dose insulin infusion for pediatric diabetic ketoacidosis. Pediatr Emerg Care. 1989;5:77–79

PII: S0736-4679(08)00042-5

doi: 10.1016/j.jemermed.2007.11.033

The Journal of Emergency Medicine
Volume 38, Issue 4 , Pages 422-427 , May 2010

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