Med Clin North Am. May;(3) doi: / Management of Hyperglycemic Crises: Diabetic Ketoacidosis and. For the diagnosis of ketoacidosis, the ADA guidelines recommend that .. Hyperglycemic crises in adult patients with diabetes. Diabetes. Introduction. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nal crisis, trauma and, possibly, continuous subcutaneous insulin infusion (CSII).

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It also provides a simple method for calculating anion gap and serum osmolality.

Serum lipid levels in hyperosmolar non-ketotic diabetic coma. Effects of free fatty acid availability, glucagon excess and insulin deficiency on ketone body production in postabsorptive man. National Diabetes Statistics Report: Bicarbonate therapy in severe diabetic ketoacidosis. Diabetes Res Clin Pract.

Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.

UK Perspective The UK guideline recommends adjustment of insulin infusion depending on the rate of fall of glucose 3. Recommendations are made to change fluids according to osmolality.

Successful treatment of DKA and HHS requires correction of dehydration, hyperglycemia, and electrolyte imbalances; identification of comorbid precipitating events; and above all, frequent patient monitoring. Acta Paediatr ; Guisado R, Arieff AI. Venous pH should be assessed every 2 hours until the pH rises to 7.


The exact etiology of this non-specific leukocytosis is not known. Regulation of ketogenesis and the renaissance of carnitine palmitoyltransferase. Hyperglycemic afa in diabetes mellitus: More recently, it has been proposed that consciousness level in adolescents with DKA was related to the severity of acidosis pH and not to a blood glucose levels The initial laboratory evaluation of patients with suspected DKA or HHS should include determination of plasma glucose, blood urea nitrogen, hypergljcemic creatinine, serum ketones, electrolytes with calculated anion gaposmolality, urinalysis, urine ketones by dipstick, arterial blood gases, and complete blood count with differential.

Felig P, Wahren J. Diabetic acidosis with initial hypokalemia.

A comprehensive history of HHS was described in full detail in a review by Pasquel and Umpierrez [ 44 ]. Phosphorus deficiency and hypophosphatemia. Intracerebral crises during treatment of diabetic ketoacidosis. The events leading to hyperglycemia and ketoacidosis are depicted in Fig.

Turn recording back on. An 8-year study in schools and private practices. Induction of hypocalcemia and hypomagnesemia by phosphate therapy.

Acromegaly presenting with diabetic ketoacidosis. FFA, free fatty acid.

Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.

Several studies on serum osmolarity and mental alteration have established a positive linear relationship between osmolarity, pH and mental obtundation This is in part because a serum chloride is neither routinely reported as part of the blood gas analysis, nor reports of electrolyte concentrations. Cocaine use also is associated with recurrent DKA 45 An exemplary mentor and clinical researcher.


The rate of decline of blood glucose concentration and the mean duration of treatment until correction of ketoacidosis were similar among patients treated with subcutaneous insulin analogs every 1 or 2 h or with intravenous regular insulin.

Dhatariya KK, Vellanki P. In these papers, the authors reported the severe hyperglycemia accompanied by osmotic diuresis but without ketonuria. The UK guidelines suggest several ways of calculating serum osmolality, which do not include blood urea nitrogen levels.

The reasons for dividing DKA presentation into different levels of severity are multifactorial. In addition, the use of 0. Diabetes in urban African-Americans. Hyperamylasemia in diabetic ketoacidosis: Age-Adjusted DKA hospitalization rate per 1, persons with diabetes and in-hospital case-fatality rate, United States, — 4. Support Center Support Center. The differences in the guidelines are with choice of fluid with respect to sodium concentrations and timing of insulin initiation.