Diagnosis and Management of Hyperglycemic Crises: Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State

Key Points

  • DKA and HHS are life-threatening emergencies.

  • Management involves

    • Attention to precipitating cause

    • Fluid and electrolyte management

    • Insulin therapy

    • Patient monitoring

    • Prevention of metabolic complications during recovery

    • Transition to long-term therapy

  • Patient education and discharge planning should aim at prevention of recurrence.

Suggested Reading

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Devi R, Selvakumar G, Clark L, Downer C, Braithwaite SS. A dose-defining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises. Diabetes Manage. 2011;1:397-412.

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Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-1343.

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Mudaliar S, Mohideen P, Deutsch R, et al. Intravenous glargine and regular insulin have similar effects on endogenous glucose output and peripheral activation/deactivation kinetic profiles. Diabetes Care. 2002;25:1597-1602.

Muir AB, Quisling RG, Yang MC, Rosenbloom AL. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes Care. 2004;27:1541-1546.

Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks. Arch Intern Med. 1997;157:669-675.

Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. 2006;144:350-357.

Wrenn KD, Slovis CM, Minion GE, Rutkowski R. The syndrome of alcoholic ketoacidosis. Am J Med. 1991;91:119-128.