Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

Aidar R Gosmanov, Elvira O. Gosmanova, Abbas E. Kitabchi, Kenneth R Feingold, Bradley Anawalt, Marc R Blackman, Alison Boyce, George Chrousos, Emiliano Corpas, Wouter W de Herder, Ketan Dhatariya, Kathleen Dungan, Johannes Hofland, Sanjay Kalra, Gregory Kaltsas, Nitin Kapoor, Christian Koch, Peter Kopp, Márta Korbonits, Christopher S Kovacs, Wendy Kuohung, Blandine Laferrère, Miles Levy, Elizabeth A McGee, Robert McLachlan, Maria New, Jonathan Purnell, Rakesh Sahay, Frederick Singer, Mark A Sperling, Constantine A Stratakis, Dace L Trence, Don P Wilson, Aidar R Gosmanov, Elvira O. Gosmanova, Abbas E. Kitabchi, Kenneth R Feingold, Bradley Anawalt, Marc R Blackman, Alison Boyce, George Chrousos, Emiliano Corpas, Wouter W de Herder, Ketan Dhatariya, Kathleen Dungan, Johannes Hofland, Sanjay Kalra, Gregory Kaltsas, Nitin Kapoor, Christian Koch, Peter Kopp, Márta Korbonits, Christopher S Kovacs, Wendy Kuohung, Blandine Laferrère, Miles Levy, Elizabeth A McGee, Robert McLachlan, Maria New, Jonathan Purnell, Rakesh Sahay, Frederick Singer, Mark A Sperling, Constantine A Stratakis, Dace L Trence, Don P Wilson

Excerpt

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of DKA and HHS. Critical components of the hyperglycemic crises’ management include coordinating fluid resuscitation, insulin therapy, and electrolyte replacement along with the continuous patient monitoring using available laboratory tools to predict the resolution of the hyperglycemic crisis. Understanding and prompt awareness of potential special situations such as DKA or HHS presentation in the comatose state, possibility of mixed acid-base disorders obscuring the diagnosis of DKA, and risk of brain edema during therapy are important to reduce the risks of complications without affecting recovery from hyperglycemic crisis. Identification of factors that precipitated DKA or HHS during the index hospitalization should help prevent subsequent episode of hyperglycemic crisis. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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