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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DKA can be qda as mild, moderate, or severe based on the severity of metabolic acidosis and the presence of altered mental status Ketoacidosis in pancreatectomized man. 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 should be reviewed with patients periodically.
Ketoacidosis as the primary manifestation of acromegaly. A recent prospective randomized study reported that a bolus dose of insulin is not necessary if patients receive an hourly insulin infusion of 0. Effects of free fatty acid availability, glucagon excess and insulin deficiency on ketone body production in postabsorptive man. Efficacy of low-dose insulin therapy for severely obtunded patients uyperglycemic diabetic ketoacidosis.
Economic impact of diabetic ketoacidosis in a multiethnic indigent population: View this chapter in Endotext.
In addition, resources should be directed toward the education of primary care providers and school personnel so that they can identify signs and symptoms of uncontrolled diabetes and so that new-onset diabetes can be diagnosed at an earlier time.
Ketonemia is further is maintained by the reduced liver clearance of ketone bodies in DKA.
Close follow up is very important, as it has been shown that three-monthly visits to the endocrine clinic will reduce the number of ER admission for DKA Blood Coagul Fibrinolysis ; Diabetes Metab Res Rev ; On the other hand, development of HHS is insidious and may occur over days to weeks It may also occur in patients with known diabetes and in very young adults usually under 20 years of age Elevated levels of pro-inflammatory cytokines and lipid peroxidation markers, as well as procoagulant criwes such as plasminogen activator inhibitor-1 PAI-1 and C-reactive protein CRP have been demonstrated in DKA.
Because lactic acidosis is more common in patients with diabetes than in nondiabetic persons and because elevated lactic acid levels may occur in severely criaes patients, plasma lactate should be measured on admission.
Hyperosmolarity and acidosis in diabetes mellitus: Acid-base problems in diabetic ketoacidosis. The use of home glucose-ketone meters may allow early recognition of impending ketoacidosis, which may help to guide insulin therapy at home and, possibly, may prevent hospitalization for DKA. Most recently, two new classes of medications have emerged as triggers for DKA. Ketosis-prone type 2 diabetes in patients crisss sub-Saharan African origin: The choice of fluid for further repletion depends on the hydration status, serum electrolyte levels, and urinary output.
Bicarbonate therapy has been associated with some adverse effects, such as hypokalemiadecreased tissue oxygen uptake and cerebral edemaand delay in the resolution of ketosis Prophylactic use of heparin, if there is no gastrointestinal hemorrhage, should be considered.
A study that investigated the optimum route of insulin therapy in DKA demonstrated hyperglycemci the time for resolution of DKA was identical in patients who received regular insulin via intravenous, intramuscular, or subcutaneous routes The underlying defects in DKA and HHS are 1 reduced net effective action of circulating insulin as a result of decreased insulin secretion DKA or ineffective action of insulin in HHS2 elevated levels of counter regulatory hormones: Phosphate depletion in DKA is universal but on admission, like the potassium, it may xda low, normal or high The maximal rate of phosphate replacement generally regarded as safe to treat severe hypophosphatemia is 4.
Patients with known diabetes may be given insulin at the dose they were receiving before the onset of hyperglycemic crises. It must be emphasized that successful treatment of DKA and HHS requires frequent monitoring of patients rcises the above goals by clinical and laboratory parameters.
Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. Differences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis.
Hyperglycemic Crises in Adult Patients With Diabetes
Hyoerglycemic of Health and Human Services; Glucose and ketone body kinetics in diabetic ketoacidosis. Insulin therapy, correction of acidosis, and volume expansion decrease serum potassium concentration. J Crit Care ; Valdmanis Diabetes care Data adapted from ref. Fatal olanzapine-induced hyerglycemic ketoacidosis. Randomized controlled studies in patients with DKA have shown that insulin therapy is effective regardless of the route of administration Diabetes in urban African-Americans.
Hyperglycemic Crises in Adult Patients With Diabetes
Factors that may lead to insulin omission in younger patients include fear of weight gain with improved metabolic control, fear of hypoglycemia, rebellion against authority, and stress of chronic disease. The anion gap is calculated by subtracting the sum of chloride and bicarbonate concentration from the sodium concentration: Diabetic ketoacidosis with intracerebral complications.
In addition, new-onset type 1 diabetes or discontinuation of insulin in established type 1 diabetes commonly leads to the development of DKA. Studies in diabetic and pancreatectomized patients have demonstrated the cardinal role of hyperglucagonemia and insulinopenia in the genesis of DKA Umpierrez G, Freire AX. To prevent recurrence of hyperglycemia or ketoacidosis during the transition period to subcutaneous insulin, it hypervlycemic important to allow an overlap of 1—2 h between discontinuation of intravenous insulin and the administration of subcutaneous insulin.