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World J Diabetes. Jan 15, 2019; 10(1): 16-22
Published online Jan 15, 2019. doi: 10.4239/wjd.v10.i1.16
Effects of diabetic ketoacidosis in the respiratory system
Alice Gallo de Moraes, Salim Surani
Alice Gallo de Moraes, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Salim Surani, Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Corpus Christy, TX 78412, United States
Author contributions: All authors have contributed to the conception, design and review of the manuscript; Gallo de Moraes A has been also involved in literature review and drafting of the manuscript.
Conflict-of-interest statement: None of the authors have any conflict of interest or financial disclosures.
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/
Corresponding author: Alice Gallo de Moraes, MD, FACP, Assistant Professor, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. gallodemoraes.alice@mayo.edu
Telephone: +1-507-7742416
Received: August 24, 2018
Peer-review started: August 24, 2018
First decision: October 5, 2018
Revised: November 8, 2018
Accepted: December 12, 2018
Article in press: December 13, 2018
Published online: January 15, 2019
Processing time: 145 Days and 8.8 Hours
Abstract

Diabetes affects approximately 30 million persons in the United States. Diabetes ketoacidosis is one of the most serious and acute complications of diabetes. At the time of presentation and during treatment of diabetic ketoacidosis (DKA), several metabolic and electrolyte derangements can ultimately result in respiratory compromise. Most commonly, hypokalemia, hypomagnesemia and hypophosphatemia can eventually lead to respiratory muscles failure. Furthermore, tachypnea, hyperpnea and more severely, Kussmaul breathing pattern can develop. Also, hydrostatic and non-hydrostatic pulmonary edema can occur secondary to volume shifts into the extracellular space and secondary to increased permeability of the pulmonary capillaries. The presence of respiratory failure in patients with DKA is associated with higher morbidity and mortality. Being familiar with the causes of respiratory compromise in DKA, and how to treat them, may represent better outcomes for patients with DKA.

Keywords: Diabetes ketoacidosis; Respiratory physiology; Mechanical ventilation; metabolic acidosis; Hyperventilation; Kussmaul breathing; Respiratory failure

Core tip: Several electrolyte and metabolic derangements associated with diabetic ketoacidosis (DKA) and its treatment can affect the respiratory system. Since respiratory failure in DKA is associated with increased morbidity and mortality, the recognition and treatment of those derangements have the potential to improve outcomes in DKA.