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 ;

Author: Meztill Arashirisar
Country: Bermuda
Language: English (Spanish)
Genre: Love
Published (Last): 28 April 2004
Pages: 337
PDF File Size: 10.42 Mb
ePub File Size: 9.22 Mb
ISBN: 274-3-25934-370-6
Downloads: 12754
Price: Free* [*Free Regsitration Required]
Uploader: Aragami

Intracerebral crises during treatment of diabetic ketoacidosis. Other precipitating factors include discontinuation of or inadequate insulin crisess, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs 1013 Randomized controlled studies in patients with DKA have shown that insulin therapy is effective regardless of the route of administration Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. Education of the patient about sick day management is very vital to prevent DKA and should include information on when to contact the health care provider, blood glucose goals, use of insulin and initiation of appropriate nutrition during illness and hyperglyecmic be reviewed with patients periodically.

The mainstay in the treatment of DKA involves the administration of regular insulin via continuous intravenous infusion or by frequent subcutaneous or intramuscular injections 456xda Ketonemia is further is maintained by the reduced liver clearance of ketone bodies in DKA.

Determinants of plasma potassium levels in diabetic ketoacidosis.

Hyperglycemic Crises in Adult Patients With Diabetes – Semantic Scholar

Postgrad Med J ; Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. First, hyperglycemia-induced osmotic diuresis leads to excretion of large amounts of sodium and potassium ions that is accompanied by the excretion of ketoanions.

Am J Forensic Med Pathol ; Hyperosmolar nature of diabetic coma.


Dhatariya KK, Vellanki P. Prophylactic use of heparin, if there is no gastrointestinal hemorrhage, should be considered. Pseudonormoglycemia 44 and pseudohyponatremia 45 may occur in DKA in the presence of severe chylomicronemia.

In other studies, education of primary care providers and school personnel in identifying the signs and symptoms of DKA has been shown to be effective in decreasing the incidence of DKA at the onset of diabetes Department of Health and Human Services; Insulin therapy, correction of acidosis, and volume expansion decrease serum potassium concentration.

This is an important point as persistent decrease in plasma Criaes concentration should not be interpreted as a sign of continuous DKA if ketosis and hyperglycemia are resolving. We recommend against rapid decreases in serum glucose and correction of serum sodium in order to avoid untoward effects of shifts in osmolarity on brain volume.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The prognosis of both conditions is substantially worsened at the extremes of age in the presence of coma, hypotension, and severe comorbidities 14812 FFA, free fatty acid.

Changing the process of diabetes care improves metabolic outcomes and reduces hospitalizations. Potassium Despite total-body potassium depletion, mild-to-moderate hyperkalemia is common in patients with hyperglycemic crises. Diabetic ketoacidosis in obese African-Americans. Mayo Clin Proc ; Studies on serum osmolality and mental alteration have established a positive linear relationship between osmolality and mental obtundation 9 Hyperglycemic hypegrlycemic in adult patients with diabetes: Fatal olanzapine-induced hyerglycemic ketoacidosis.

Keller U, Berger W.

Impact of a hyperglycemic crises protocol.

Hypoxemia may be related to the reduction in colloid osmotic pressure that leads to accumulation of water in lungs and decreased lung compliance. Cfises the absence of stressful situations, such as intravascular volume depletion or intercurrent illness, ketosis is usually mild 10 Although total-body potassium is depleted, mild to moderate hyperkalemia frequently seen in patients with DKA is due to acidosis and insulinopenia.


Intern Med ; Tohoku J Exp Med ; The admission serum phosphate level in patients with DKA, like serum potassium, is usually elevated and does not reflect an actual body deficit that uniformly exists due to shifts of intracellular phosphate to the extracellular space 1246 The procoagulant and inflammatory states may be due to nonspecific phenomena of stress and may partially explain the association of hyperglycemic crises with a hypercoagulable state The events leading to hyperglycemia and ketoacidosis are depicted in Fig.

HbA1c may be useful in differentiating chronic hyperglycemia of uncontrolled diabetes from acute metabolic decompensation in a previously well-controlled diabetic patient Fluid resuscitation in diabetic emergencies: Hyperglycemic crises in adult patients with diabetes.

To assess the severity of sodium and water deficit, serum sodium may be corrected by adding 1. J Crit Care ; Initial fluid therapy is directed toward expansion of the intravascular, interstitial, and intracellular volume, all of which are reduced in hyperglycemic crises 53 and restoration of renal perfusion. Kaminska ES, Pourmotabbed G.

However, until these studies are confirmed outside the research arena, patients with severe DKA, hypotension, anasarca, or associated severe critical illness should be managed with intravenous regular insulin in the ICU. Fatal cerebral oedema in adult diabetic ketoacidosis.

Hyperglycemic crises in adult patients with diabetes.

Adapted from Kitabchi et al. In addition, an earlier report of pituitary gigantism was presented with two episodes of DKA with complete resolution of diabetes after pituitary apoplexy Bicarbonate therapy in severe diabetic ketoacidosis. Early contact with the health care provider. Cerebral edema has also been reported hyperglycdmic patients with HHS, with some cases of mortality