Azoulay et al identified findings associated with an underlying infection in patients admitted to the intensive care unit (ICU) with diabetic ketoacidosis. The authors are from Saint-Louis Teaching Hospital and Paris 7 University in Paris.


Patient selection: adults admitted to the ICU in diabetic keotacidosis


Findings associated with underlying infection:

(1) female gender

(2) neurologic symptoms (disorientation, altered level of consciousness, stupor, coma) on admission

(3) failure of ketonuria to clear within 12 hours of admission


Of the patients with infection as the cause for diabetic ketoacidosis:

(1) About half of the infections were urinary tract infections, with E. coli as the most common cause. This may explain the association with female gender.

(2) The other leading pathogen was Staphylococcus aureus.


Sometimes the presence of an infection will be obvious, but it may be occult or it may be overshadowed by the ketoacidosis. The possibility of an underlying infection should be considered in any patient with ketoacidosis requiring admission to the ICU.


Sites to screen for an occult infection:

(1) urinary tract

(2) lung

(3) paranasal sinuses, dental or other ENT site

(4) intra-abdominal, including gallbladder

(5) bone

(6) skin or soft tissue


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