This chapter will review the American Diabetes Association Practice Guidelines on diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
Introduction
DKA and HHS are the two most serious acute complications of diabetes.
Diagnosis criteria ( table 6.1 )
Table 6.1
Diagnostic Criteria for DKA and HHS
Adapted from Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care . 2009;32(7):1335–1343 and Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic crises: diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar state (HHS). In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext [Internet]. South Dartmouth, MA: MDText.com , Inc.; 2000. Available from: https://www-ncbi-nlm-nih-gov.easyaccess1.lib.cuhk.edu.hk/books/NBK279052/ . Updated May 17, 2018.
| NORMAL | DKA | HHS | |||
| MILD | MODERATE | SEVERE | |||
| Plasma glucose (mg/dL) | 140–180 | >250 | >250 | >250 | >600 |
| Arterial pH | 7.38–7.44 | 7.25–7.30 | 7.00 to <7.24 | <7.00 | >7.30 |
| Serum bicarbonate (mEq/L) | 24–32 | 15–18 | 10 to <15 | <10 | >18 |
| Urine ketones a | Negative | Positive | Positive | Positive | Small |
| Serum ketones | Negative | Positive | Positive | Positive | Small |
| Effective serum osmolality (mOsm/kg) | 285–295 | Variable | Variable | Variable | >320 |
| Anion gap | <12 | >10 | >12 | >12 | Variable |
| Mental status | Alert | Alert | Alert/Drowsy | Stupor/Coma | Stupor/Coma |
DKA , Diabetic ketoacidosis; HHS , Hyperosmolar hyperglycemic state
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