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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Hyperglycemic crises in adult patients with diabetes.

Department of Health and Human Services; The AKA patients seldom present with hyperglycemia Proinflammatory cytokines in response to insulin-induced hypoglycemic stress in healthy subjects. Hypothermia in diabetic acidosis. Other provoking factors include myocardial infarction, cerebrovascular accidents, pulmonary embolism, pancreatitis, alcohol aa illicit drug use Table 1.

Symptoms and signs of cerebral edema are variable and include onset of headache, gradual deterioration in level of consciousness, seizures, sphincter incontinence, pupillary changes, papilledema, bradycardia, elevation in blood pressure, and respiratory arrest J Am Geriatr Hypfrglycemic ; Particularly important in this regard is captopril, an angiotensin converting enzyme inhibitor prescribed for the treatment of hypertension and diabetic nephropathy.

Nephrol Dial Transplant ; 29 Suppl 2: Insulin therapy, correction of acidosis, and volume expansion decrease serum potassium concentrations. The common clinical presentation of DKA and HHS is due to hyperglycemia and include polyuria, polyphagia, polydipsia, weight loss, weakness, and physical signs of intravascular volume depletion, such as dry buccal mucosa, sunken eye balls, poor skin turgor, tachycardia, hypotension and shock in severe cases.

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

The initial laboratory evaluation of patients include determination of plasma glucose, blood urea nitrogen, creatinine, electrolytes with calculated anion gaposmolality, serum and urinary ketones, and urinalysis, as well as initial arterial blood gases and a complete blood count with a differential. Incidence of DKA Figure 1b. Diabetes Mellitus Search for additional papers on this topic. National Diabetes Statistics Report: This article has been cited by other articles in PMC.


Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Phosphate Therapy There is no evidence that phosphate therapy is necessary in treatment for better outcome of DKA Adair R GosmanovM.

These ketone bodies have been shown to affect vascular integrity and permeability, leading to edema formation Diabetes Metab Syndr Obes ; 7: Cerebral edema has also been reported in patients with HHS, with some cases of mortality Measurement of serum salicylate and blood methanol level may be helpful. During treatment of DKA, hyperglycemia is corrected faster than ketoacidosis. Syndromes of ketosis-prone diabetes mellitus.

Impact of a hyperglycemic crises protocol.

Arch Intern Med ; Further evaluation is necessary if this complaint does not resolve with resolution of dehydration and metabolic acidosis. Serum potassium concentration may be elevated because of an extracellular shift of potassium caused by insulin deficiency, hypertonicity, and acidemia Diabetic ketoacidosis in children.

Until recently, treatment algorithms recommended the administration of an initial intravenous dose of regular insulin 0. Elvira O GosmanovaM. Finally, patients with diabetes insipidus presenting with severe polyuria and dehydration, who are subsequently treated with free water in hypervlycemic form of intravenous dextrose water, can have hyperglycemia- a clinical picture that can be confused with HHS 98 Table 5. J Pediatr ; However, the long-term impact of uncontrolled diabetes and its economic burden could be more significant because it can contribute to various complications.

Unrecognized false-positive ketones from drugs containing free-sulfhydryl group s.

National Center for Biotechnology InformationU. Although relative insulin deficiency is clearly present in HHS, endogenous insulin secretion reflected by C-peptide levels appears to be greater than in DKA, where it is negligible Table 2.

Hyperglycemic crises in adult patients with diabetes.

The choice of fluid for further repletion depends on the hydration status, serum electrolyte levels, and urinary output. Treatment of patients with mild and moderate DKA with subcutaneous rapid-acting insulin analogs every 1 or 2 h in non—intensive care unit ICU settings has been shown to be as safe and effective as the treatment with intravenous regular insulin in the ICU 60 Subclinical brain swelling in children during treatment of diabetic ketoacidosis.


Severe hypothermia, if present, is a poor prognostic sign Clin Endocrinol Metab ; Recently, one case report has shown that a patient with diagnosed acromegaly may present with DKA as the primary manifestation of the disease Occasionally, the entire symptomatic presentation may evolve or develop more acutely, and the patient may present with DKA with no prior clues or symptoms.

Characterization of creatinine error in ketotic patients. Physical findings may include poor skin turgor, Kussmaul respirations in DKAtachycardia, and hypotension.

Despite total-body potassium depletion, mild-to-moderate hyperkalemia is common in patients with hyperglycemic crises. The goals of therapy in patients with hyperglycemic crises include: Schaapveld-DavisAna L. 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 secretion in diabetes mellitus. Therefore, the initial fluid therapy is directed toward expansion of intravascular volume and securing adequate urine flow. FisherMD 1. Vomiting is a common clinical hypfrglycemic in DKA and hyperglycemlc to a loss of hyperglycemuc ions in gastric content and the development of metabolic alkalosis. This is an important point as persistent decrease in plasma HCO3- concentration should not be interpreted as a sign of continuous DKA if ketosis and hyperglycemia are resolving.

In patients who are hypernatremic or eunatremic, 0.