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.
No studies are available on the use of phosphate in the treatment of HHS. Hypoxemia may be related to the reduction in colloid osmotic pressure that leads to accumulation of water in lungs and decreased lung compliance.
A prospective comparison of alkaline picrate methods with an enzymatic method.
Hyperchloremic acidosis is caused by the loss of large amounts of ketoanions, which are usually metabolized to bicarbonate during the evolution of DKA, and excess infusion of chloride containing fluids during treatment Differential diagnosis Not all patients with ketoacidosis have DKA.
Miles 3 Mayo Clinic, Rochester, Minnesota. Umpierrez G, Freire Drises. The procoagulant and inflammatory states may be due to nonspecific jyperglycemic of stress and may partially explain the association of hyperglycemic crises with a hypercoagulable state Br Med J ; 2: 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.
It may also occur in patients with known diabetes and in very young adults usually under 20 years of age The admission serum sodium is usually low because of the osmotic flux of water from the intracellular to the extracellular space in the presence of hyperglycemia.
Cocaine use also is associated with recurrent DKA 45 Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis? However, total body potassium deficit is usually present from urinary potassium losses due to osmotic diuresis and ketone excretion.
Hyperglycemic crises in diabetes mellitus: An increased or even normal serum sodium concentration in the presence of hyperglycemia indicates a rather profound degree of free water loss.
Burden of hospitalizations primarily due to uncontrolled diabetes: Enhanced subclinical coagulation activation during diabetic ketoacidosis. The AKA patients seldom present with hyperglycemia Bicarbonate therapy The hyperlgycemic of bicarbonate in DKA is controversial 62 because most experts believe that during the treatment, as ketone bodies decrease there will be adequate bicarbonate except in severely acidotic patients.
Resolution of HHS is associated with normal osmolality and regain of normal mental status.
There are no randomized controlled studies that evaluated safe and effective strategies in the treatment of HHS The mainstay in the treatment of DKA involves the administration of regular insulin via continuous intravenous infusion or by frequent subcutaneous or intramuscular injections 456 Fatal cerebral oedema in adult diabetic ketoacidosis.
Hyperosmolarity and acidosis in diabetes mellitus: The use of bicarbonate in treatment of DKA remains controversial. Thrombotic conditions and disseminated intravascular coagulation may contribute to the morbidity and mortality of hyperglycemic emergencies Furthermore, in 3 separate studies in which cases of DKA were evaluated, serum osmolality was also the most important determinant of mental status changes The maximal rate of phosphate replacement generally regarded as safe to treat severe hypophosphatemia is 4.
From This Paper Figures, tables, and topics from this paper. Kaminska ES, Pourmotabbed G. Despite the excessive water loss, the admission serum sodium tends to be low.
Impact of a hyperglycemic crises protocol.
Hosp Pract ; The common clinical presentation of DKA and HHS is due to hyperglycemia and include polyuria, polyphagia, polydipsia, weight hypeerglycemic, 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.
Hyperglycemic crises in adult patients with diabetes.
Elderly individuals with new-onset diabetes particularly residents of chronic care facilities or individuals with known diabetes who become hyperglycemic and are unaware of it or are unable to take fluids when necessary are at risk for HHS 10 It is based on a previous technical review 4 and more recently published peer-reviewed articles sincewhich should cirses consulted for further information.
The incidence of DKA in the US continues to increase and it accounted for abouthospitalizations in Figure 1a and, most recently, in forhospitalizations 34. Diabetes in urban African-Americans.
Hyperglycemic Crises in Adult Patients With Diabetes
Severe dehydration, older age, and the presence of comorbid conditions in patients with HHS account for the higher mortality in these patients Medicine Baltimore ; Diabetic ketoacidosis in obese African-Americans. Hyperglycemi in pancreatectomized man. Acetoacetate and beta-hydroxybutyrate differentially regulate endothelin-1 and vascular endothelial growth factor in mouse brain microvascular endothelial cells.