Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)





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: 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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Feb 28, 2021 | Posted by in EMERGENCY MEDICINE | Comments Off on Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
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