Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are two of the most serious acute complications of diabetes. These disorders can occur in both type 1 and type 2 diabetes. Hyperglycemic crises in adult patients with diabetes. Thirty years of personal experience in hyperglycemic crises. Declining death rates from hyperglycemic crisis among adults with diabetes, u. There was a decline in mortality from 2000 to 2014 across all age groups and both sexes with largest absolute decrease among persons aged. Overview of the diabetic ketoacidosis dka hyperglycemic.
Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Pdf management of hyperglycemic crises in patients with. Thirty years of personal experience in hyperglycemic. The mortality rate in patients with diabetic ketoacidosis dka is hyperglycemic.
Kitabchi and guillermo e umpierrez and john m miles and joseph n. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic crises. Management involves attention to precipitating cause fluid and electrolyte management insulin therapy patient monitoring prevention of metabolic complications during recovery transition to longterm therapy patient education and discharge planning should aim at prevention of recurrence. Diagnostic features of hyperosmolar hyperglycemic state hhs kitabchi ae, umpierrez ge, murphy mb, et al. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in.
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Hyperglycemic crises in patients with diabetes mellitus. Which conditions increase the risk of hyperosmolar. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic. Figure 2 from hyperglycemic crises in adult patients with. National data shows a decline in death related to both hyperglycemic crises with and absolute decline of 529 deaths in the period of 1990 to 2010 2. In the setting of severe volume deficit and shock, and in the absence of cardiac compromise, patients should receive 0. Adapted with permission from kitabchi ae, umpierrez ge, murphy mb, barrett ej, kreisberg ra, malone ji, et al. N hyperglycemic crises in adult patients with diabetes. Hyperosmolar hyperglycemic state is a relatively common, lifethreatening endocrine emergency that is reported in all age groups,1 but it most frequently affects older patients with type 2 diabetes. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Kitabchi ae, umpierrez ge, fisher jn, murphy mb, stentz fb.
Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious acute metabolic complications of diabetes. A persons breath may develop a specific fruity smell. Diabetic ketoacidosis and hyperglycemic hypersmolar state. Information updated from kitabchi ae, umpierrez ge, miles jm, et al.
Dec 21, 2019 ada hyperglycemic crises 2009 pdf diabetes care. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths. Kitabchi and others published hyperglycemic crises. Hyperglycemic crises in adult patients with diabeteskitabchi and associates. The mortality rate for dka and hyperglycemic crises has been falling over the years figure 1b. Diabetic ketoacidosis dka, and hyperglycemic hyperosmolar state hhs. Kitabchi ae, umpierrez ge, murphy mb, kreisberg ra. The terms hyperglycemic hyperosmolar nonketotic coma and hyperglycemic hyperosmolar nonketotic state have been replaced with the term hyperglycemic hyperosmolar state hhs to reflect the. Hyperglycemic crises knowledge for medical students and. Hyperglycemic crises in adult patients with diabetes diabetes care. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Hyperglycemic crises in adult patients with diabetes abbas e. Mental status and ph and serum bicarbonate levels help clinicians determine the extent of disease severity, classifying patients as having mild, moderate, or severe dka table 4.
Information updated from kitabchi ae, umpierrez ge, miles jm, fisher jn. Strength of recommendation labels are based on kitabchi ae, umpierrez ge, murphy mb, barrett ej, kreisberg ra, malone ji, et al. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Hyperglycemic crises in cancer patients american diabetes. May 03, 2020 some of these drugs trigger the development of hyperglycemic crises by causing a reversible deficiency in insulin action or insulin secretion e. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs find, read and cite all the. These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of their pathogenesis and more uniform agreement about their diagnosis and treatment. Risk factors for hyperglycemic crisis ushersmith et al. Most patients with dka have autoimmune type 1 diabetes. Hyperosmolar hyperglycemic state symptoms, diagnosis and.
Aug 16, 2019 ada hyperglycemic crises 2009 pdf diabetes care. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. Contributes to less than 1% of all diabetesrelated admissions. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes.
The mortality rate in patients with diabetic ketoacidosis dka is hyperglycemic state hhs still remains high. Dka most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to dka under stressful conditions such as trauma, surgery or infections. Aug 22, 2019 ada hyperglycemic crises 2009 pdf diabetes care. The authors report no actual or potential conflict of interest in relation to this article. They are found to occur simultaneously in up to of cases overlap syndrome of hyperosmolar ketoacidosis. Hyperglycemic crisis journal of emergency medicine. May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus.
Hyperglycemic crises in diabetic adults 2742 d iabetes c are, volume 29, number 12, d ecember 2006 figure 2 protocol for the management of adult patients with dka. Volume depletion may be difficult to assess in the form of poor skin turgor in older patients. Hyperglycemic crises in adult patients with diabetes ncbi. May 06, 2019 ada hyperglycemic crises 2009 pdf diabetes care. Management of hyperglycemic crises in patients with diabetes. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or. Occurs most commonly in older patients with type 2 diabetes. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Mar 10, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the two most serious hyperglycemic emergencies in patients with diabetes mellitus.
Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality. Hyperosmolar hyperglycemic state criteria bmj best practice. These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of their pathogenesis and more uniform agreement about their. Hyperosmolar hyperglycemic state history and exam bmj. A consensus statement from the american diabetes association. Hyperosmolar hyperglycemic state treatment algorithm. D iabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes. Assessment of the buccal mucosa for dryness is more informative in these patients. Treatment of diabetic ketoacidosis dkahyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management emergency medicine. Pdf hyperglycemic crises in adult patients with diabetes.
Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs cause major morbidity and significant mortality in patients with diabetes mellitus. Hyperglycemic crises in adult patients with diabetes diabetes care 2009 jul. Key points dka and hhs are lifethreatening emergencies. Hyperosmolar hyperglycemic state winchester hospital. Increasing evidence indicates that the hyperglycemia in patients with hyperglycemic crises is associated with a severe inflammatory state characterized by an elevation of proinflammatory cytokines tumor necrosis factor. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths 9. Table 1 outlines the diagnostic criteria for dka and hhs. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Aug 05, 2019 ada hyperglycemic crises 2009 pdf diabetes care.
Hyperosmolar hyperglycemic state bmj best practice. Fisher, md 1 d iabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhsarethetwomostseriousacute. A consensus statement from the american diabetes association diabetes care july 2009 vol. Hyperglycemic crisis, which includes diabetic ketoacidosis and hyperglycemic hyperosmolar state, is a common diagnosis in high acuity hospital. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum.
931 383 435 1460 379 1119 1415 395 221 1572 674 541 400 1081 678 943 376 974 1143 1617 1478 507 430 1122 1257 155 1465 409 463 847 904 1169 304 1189 863 215 980 666 1335 67 520 1438