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Diabetic Ketoacidosis l: Introduction01:25

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DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic...
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Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
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First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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Drug-Associated Ketoacidosis: A Comprehensive Disproportionality Analysis Based on the FAERS Database.

Pengqiang Du1, Xiaoyu Chen2, Yinpeng Xu3

  • 1Department of Pharmacy, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.

Diabetes, Obesity & Metabolism
|April 21, 2026
PubMed
Summary
This summary is machine-generated.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors and psychotropic drugs are linked to ketoacidosis. Many drugs lack package insert warnings for this risk, highlighting the need for clinical monitoring.

Keywords:
FAERSdisproportionality analysisketoacidosispharmacovigilance

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Area of Science:

  • Pharmacovigilance
  • Drug Safety
  • Adverse Event Analysis

Background:

  • Ketoacidosis is a serious adverse event requiring vigilant clinical observation.
  • Identifying drugs associated with ketoacidosis is crucial for patient safety.

Purpose of the Study:

  • To identify drugs most strongly associated with drug-induced ketoacidosis using disproportionality analysis.
  • To provide a reference for enhancing clinical medication safety and monitoring.

Main Methods:

  • Utilized the FDA's FAERS database (Q1 2004 - Q2 2025) for adverse event reports.
  • Employed disproportionality analyses (ROR, PRR, IC) and Time-to-Onset (TTO) analysis.
  • Standardized drug names using DrugBank and MedDRA for outcome indicators.

Main Results:

  • Analyzed over 22 million adverse event reports, with 6,977 related to ketoacidosis.
  • Top drugs by report count: metformin, quetiapine, empagliflozin, canagliflozin, dapagliflozin.
  • Significant association found with SGLT2 inhibitors (e.g., dapagliflozin) and psychotropic drugs (e.g., quetiapine).
  • 72% of top ROR drugs lacked ketoacidosis warnings in package inserts.
  • TTO analysis revealed varying onset patterns for different drug classes.

Conclusions:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors and psychotropic drugs are primary risks for ketoacidosis.
  • Undocumented ketoacidosis risks in package inserts necessitate increased clinical attention.
  • Study findings support improved medication monitoring and potential updates to drug labeling.