Feb 11 2019

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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Insulin deficiency, hypertonicity, and increased catabolism all contribute to the movement of phosphate out hyperblycemic cells. Therefore, elevated pancreatic enzymes may not be reliable for the diagnosis of pancreatitis in the DKA setting.

Hyperglycemic crises in adult patients with diabetes.

Pediatr Diabetes ; 2: Addressing health problems in the African American and other minority communities requires explicit recognition of the fact that these populations are probably quite diverse in their behavioral responses to diabetes Arch Iranian Med ; 8: The severity of DKA is classified as mild, moderate, or severe based on the severity of metabolic acidosis blood pH, bicarbonate, and ketones and the presence of altered mental status 4.

Patients with DKA and vomiting may have relatively normal plasma bicarbonate levels and close to normal pH.

Hyperglycemic crises in adult patients with diabetes: Severe dehydration, older age, and the presence of comorbid conditions in patients with HHS account for the higher mortality in these patients Differential diagnosis Not all patients with ketoacidosis have DKA. Resolution of HHS is associated with normal osmolality and regain of normal mental status. Phosphate Therapy There is no evidence that phosphate therapy is necessary in treatment for better outcome of DKA Potassium Therapy Although total-body potassium is depleted, mild to moderate hyperkalemia frequently seen in patients with DKA is due to acidosis and insulinopenia.


Potassium Despite total-body potassium depletion, mild-to-moderate hyperkalemia is hyperglycfmic in patients with hyperglycemic crises. The prognosis of both conditions is substantially worsened at hypeeglycemic extremes of age in the presence of coma, hyperglycdmic, and severe comorbidities 14812 View this chapter in Endotext.

Am J Emerg Med ; Randomized controlled studies in patients with DKA have shown that insulin therapy is effective regardless of the route of administration The temporal relationship between endogenously secreted stress hormones and metabolic decompensation in diabetic man. A serum lipase determination may be beneficial in the differential diagnosis of pancreatitis; however, lipase could also be elevated in DKA in the absence of pancreatitis Kaminska ES, Pourmotabbed G.

Acta Paediatr ; A Possible Cause of Insulin Resistance. Cerebral edema has also been reported in patients with HHS, with some cases of mortality Review Diabetic ketoacidosis and hyperglycemic hyperosmolar state.

Impact of a hyperglycemic crises protocol.

Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Neurologic manifestations of diabetic comas: Arch Intern Med ; Induction of hypocalcemia and hypomagnesemia by phosphate therapy. A study in adolescents with type 1 diabetes suggests that some of the risk factors for DKA include higher HbA1c, uninsured children and psychological problems Laleh Razavi NematollahiAbbas E.

Patients who received intravenous insulin attained an immediate pharmacologic level of insulin concentration.

It should be emphasized that urinary losses of water and electrolytes are also need to be considered. Vital Health Stat 13 ; Margareat ThatcherDavid A. Total body sodium loss can result in contraction of extracellular fluid volume and signs of intravascular volume depletion. This consensus statement will outline precipitating factors and recommendations for the diagnosis, treatment, and prevention of DKA and HHS in adult subjects. Pediatr Hypefglycemic ; 7: Headache is the earliest clinical manifestation of cerebral edema.


The key diagnostic feature in DKA is the elevation in circulating hyeprglycemic blood ketone concentration. J Crit Care ; Predisposing factors for the diabetic hyperosmolar state.

Paramount in this effort is improved education regarding sick day management, which includes the following:. Phosphate administration may result in hypocalcemia when used in high dose hypsrglycemic, National Center for Biotechnology InformationU.

Diabetes Metab Rev ; 3: The mainstay in the treatment of DKA involves the administration of regular insulin via continuous intravenous infusion or by frequent subcutaneous or intramuscular injections 456 Abdominal pain hyperylycemic patients with hyperglycemic crises.

Pseudonormoglycemia 44 and pseudohyponatremia 45 may occur in DKA in the presence of severe chylomicronemia. More recently, basal-bolus regimens crisee basal glargine and detemir and rapid-acting insulin analogs lispro, aspart, or glulisine have been proposed as a more physiologic insulin regimen in patients with type 1 diabetes.

Role of glucagon and other hormones in development of diabetic ketoacidosis.

Lever E, Jaspan JB. Unrecognized false-positive ketones from drugs containing free-sulfhydryl group s.