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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It also occurs in type 2 diabetes under conditions of extreme stress, such as serious infection, trauma, cardiovascular or other emergencies, and, less often, as a presenting manifestation of type 2 diabetes, a disorder called ketosis-prone type 2 diabetes Acta Paediatr ; When this occurs, subcutaneous insulin therapy can be started. The American journal of emergency medicine ; 5: Barriers to improving diabetes care for blacks.

Miles and Joseph N. Am Fam Physician ; Am J Gastroenterol ; During follow up, blood should be drawn every h for determination of serum electrolytes, glucose, blood urea nitrogen, creatinine, osmolality, and venous pH. The annual incidence of DKA from population-based studies is estimated to range from 4 to 8 episodes per 1, patient admissions with diabetes 2. In ketoacidosis, leukocytosis is attributed to stress and maybe correlated to elevated levels of cortisol and norepinephrine In this condition the plasma becomes milky and lipemia retinalis may be visible in physical examination Diabetic ketoacidosis and hyperosmolar nonketotic state.

Postgrad Med J ; Showing of 83 references.

Hyperglycemic crises in adult patients with diabetes.

Moreover, there is a tendency to hypoglycemia rather than hyperglycemia with isopropyl alcohol injection 96 Patients with low normal or low serum potassium concentration on admission have severe total-body potassium crisees and require careful cardiac monitoring and more vigorous potassium replacement because treatment lowers potassium further and can provoke cardiac dysrhythmia. Skip to search form Skip to main content.


Diabetes in urban African-Americans. Because lactic acidosis is more common in patients with diabetes than in nondiabetic persons and because elevated lactic acid levels may occur in severely volume-contracted patients, plasma lactate should be measured on admission.

In patients who are hypernatremic or hyperglcemic, 0. There is no evidence that phosphate therapy is necessary in treatment for better outcome of DKA Active use of cocaine: Management of adult diabetic ketoacidosis.

Generally, 20—30 mEq potassium in each liter of infusion fluid is sufficient to maintain a serum potassium concentration within the normal range.

Prospective randomized studies have failed to show any beneficial effect of phosphate replacement on the clinical outcome in DKA 4667and overzealous phosphate therapy can cause severe hypocalcemia 46 Acid-base problems in diabetic ketoacidosis. Serum lipid levels in hyperosmolar non-ketotic diabetic coma.

Hyperglycemic Crises in Adult Patients With Diabetes

Insulin secretion in diabetes mellitus. The case for venous rather than arterial blood gases in diabetic ketoacidosis. In addition, an earlier report of pituitary gigantism was presented with two episodes of DKA with complete resolution of diabetes after pituitary apoplexy From This Paper Figures, tables, and afa from this paper.

Maletkovic J, Drexler A. Tohoku J Exp Med ; 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.


Increased levels of glucagon, catecholamines and vrises with concurrent insulinopenia stimulate gluconeogenic enzymes, especially phosphoenol pyruvate carboxykinase PEPCK 19 Additionally, DKA has to be distinguished from other causes of high anion gap metabolic acidosis including lactic acidosis, advanced chronic renal failure, as well as ingestion of drugs such as salicylate, methanol and ethylene glycol.

Ketogenesis Excess catecholamines coupled with insulinopenia promote triglyceride breakdown lipolysis to free fatty acids FFA and glycerol. Manitol infusion and mechanical ventilation are suggested for treatment of cerebral edema The Journal of pediatrics ; The lactic acid is transported to the liver in the Cori cycle where it serves as a carbon skeleton for gluconeogenesis Active use of cocaine: There were no differences in length of hospital stay, total amount of insulin needed for resolution of hyperglycemia or ketoacidosis, or in the incidence of hypoglycemia among treatment groups.

Therefore, in patients with pH between 6.

Impact of a hyperglycemic crises protocol.

Disease severity scores are not, but precipitating cause is, predictive of prolonged hospital stays in patients with DKA Despite total-body potassium depletion, mild-to-moderate hyperkalemia is common in patients with hyperglycemic crises. There are no randomized controlled studies that evaluated safe and effective strategies in the treatment of HHS The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA.

Hyperglycemif in the emergency department therapeutics.