Diabetes Care. Jul;32(7) doi: /dc Hyperglycemic crises in adult patients with diabetes. Kitabchi AE(1), Umpierrez GE, Miles JM. Impact of a hyperglycemic crises protocol. hyperglycemic crises protocol based upon the American Diabetes Association (ADA) consensus statement. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also known as hyperosmotic hyperglycemic Typical lab characteristics of DKA and HHS · – ADA DKA HHS water deficit · – DKA rapid overview Hyperglycemic crises in adult patients with diabetes. Diabetes Care ;

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Severe metabolic acidosis can lead to impaired myocardial contractility, cerebral vasodilatation and coma, and several gastrointestinal complications There were no differences in length of hospital stay, total amount of insulin needed for resolution of hyperglycemia or ketoacidosis, or in the incidence of hypoglycemia among treatment groups.

Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetic ketoacidosis complicated by generalized venous thrombosis: Patients with DKA and vomiting may have relatively normal plasma bicarbonate levels and close to normal pH.

Transition to subcutaneous insulin Patients with DKA and HHS should be treated with continuous intravenous insulin until the hyperglycemic crisis is resolved. Immunogenetic analysis suggest different pathogenesis between obese and lean African-Americans with diabetic ketoacidosis.

To prevent hypokalemia, potassium replacement is initiated after serum levels fall below 5. Furthermore, muscle glycogen is catabolized to lactic acid via glycogenolysis. Despite total-body potassium depletion, mild-to-moderate hyperkalemia is common in patients with hyperglycemic crises. Measurement of serum salicylate and blood methanol level may be helpful.

Frequent blood glucose monitoring every 1—2 h is mandatory to recognize hypoglycemia because many patients with DKA who develop hypoglycemia during treatment do not experience adrenergic manifestations of sweating, nervousness, fatigue, hunger, and tachycardia. Mayo Clin Proc ; However, patients who received intravenous insulin showed a more rapid decline in blood glucose and ketone bodies in the first 2 hours of treatment. Determinants of plasma potassium levels hyperglycemci diabetic ketoacidosis.


The most common complications of DKA and HHS include hypoglycemia and hypokalemia due to overzealous treatment hyperglycemoc insulin and bicarbonate hypokalemiabut these complications htperglycemic infrequently with current low dose insulin regimens.

Support Center Support Center. Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. J Clin Endocrinol Metab ; Isopropyl alcohol, which is commonly available as rubbing alcohol, can cause considerable ketosis and high serum osmolar gap without metabolic acidosis.

In contrast, a higher than calculated PCO2 level signifies additional respiratory acidosis and can be seen in zda with underlying chronic lung disease.

Acetone metabolism in humans hypergpycemic diabetic ketoacidosis. A genetic disease, glucosephosphate dehydrogenase deficiency, has been also linked with ketosis-prone diabetes Moreover, there is a tendency to hypoglycemia rather than hyperglycemia with isopropyl alcohol injection 96 Hyperosmolar nature of diabetic coma.

In patients with chronic kidney disease stagethe diagnosis of DKA could be challenging due hypeeglycemic the presence of concomitant underlying chronic metabolic acidosis or mixed acid-base disorders. It may result from osmotically driven movement of water into the central nervous system when plasma osmolality declines too rapidly during treatment of DKA or HHS. The mortality rate for DKA and hyperglycemic crises has been falling over the years Figure 1b 3.

The goal is to replace half of the estimated water and sodium deficit over a period of hours []. Recent Prog Horm Res ; The rate of insulin discontinuation and a history of poor compliance accounts for more than half of DKA admissions in inner-city and minority populations 974 Induction of hypocalcemia and hypomagnesemia by phosphate therapy.

Abdominal pain in patients with hyperglycemic crises.

Hyperglycemic Crises in Adult Patients With Diabetes

Ann Intern Med ; Phosphate Despite whole-body phosphate deficits in DKA that average 1. Vital Health Stat 13 ; Umpierrez G, Freire AX. These metabolic derangements result from the combination of absolute or relative insulin deficiency and an increase in counterregulatory hormones glucagon, catecholamines, cortisol, and growth hormone. The initial laboratory evaluation of patients with suspected DKA or HHS should include determination of plasma glucose, blood urea nitrogen, serum creatinine, serum ketones, electrolytes with calculated anion gaposmolality, urinalysis, urine ketones by dipstick, arterial blood gases, and complete blood count with differential.


Insulin therapy of diabetic ketoacidosis: The Memphis diabetes continuing hyperlgycemic program. J Pediatr ; It must be emphasized that successful treatment of DKA and HHS requires frequent monitoring of patients regarding the above goals by clinical and laboratory parameters.

Other pitfalls include artificial elevation of serum creatinine due to interference from ketone bodies when a colorimetric method is used Annals of internal medicine ; Subcutaneous use of a fast-acting insulin analog: Efficacy crjses low-dose insulin therapy for severely obtunded patients in diabetic ketoacidosis.

Diabetes care ; 3: The maximal rate of phosphate replacement generally regarded as safe to treat severe hypophosphatemia is 4.

Hyperglycemic crises in adult patients with diabetes.

Treatment with subcutaneous rapid-acting insulin analogs lispro and aspart has been shown to be an effective alternative to the use of intravenous regular insulin in the treatment of DKA.

Sodium-glucose cotransporter 2 SGLT-2 inhibitors canagliflozin, dapagliflozin, and empagliflozin that are used for diabetes treatment have been implicated in the development of DKA in patients with both type 1 and type 2 diabetes New perspectives in the regulation of ketogenesis.

Ketosis-prone diabetes–a new subgroup of patients with atypical type 1 and type 2 diabetes? J Michael Gonzalez-CampoyR.