Abstract
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two serious acute complications of diabetes that require immediate medical attention. Patients with DKA present with hyperglycemia, ketonemia, and anion gap metabolic acidosis. Patients with HHS present with extreme hyperglycemia, increased osmolality, and severe dehydration. Some patients share features of both conditions. These acute complications can be life threatening and it is critical that the healthcare providers recognize them and provide appropriate clinical care. This chapter reviews the pathophysiology, diagnosis, and treatment of these disorders.
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Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001;24(1):131–53.
van de Werve G, Jeanrenaud B. Liver glycogen metabolism: an overview. Diabetes Metab Rev. 1987;3(1):47–78.
Felig P, Sherwin RS, Soman V, et al. Hormonal interactions in the regulation of blood glucose. Recent Prog Horm Res. 1979;35:501–32.
Barrett EJ, DeFronzo RA, Bevilacqua S, Ferrannini E. Insulin resistance in diabetic ketoacidosis. Diabetes. 1982;31(10):923–8.
Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes. 2004;53(8):2079–86.
Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006;35(4):725–51, viii.
Miles JM, Gerich JE. Glucose and ketone body kinetics in diabetic ketoacidosis. Clin Endocrinol Metab. 1983;12(2):303–19.
Munro JF, Campbell IW, McCuish AC, Duncan LJ. Euglycaemic diabetic ketoacidosis. Br Med J. 1973;2(5866):578–80.
Burge MR, Hardy KJ, Schade DS. Short-term fasting is a mechanism for the development of euglycemic ketoacidosis during periods of insulin deficiency. J Clin Endocrinol Metab. 1993;76(5):1192–8.
Winter SD, Pearson JR, Gabow PA, Schultz AL, Lepoff RB. The fall of the serum anion gap. Arch Intern Med. 1990;150(2):311–3.
Sadjadi SA. A new range for the anion gap. Ann Intern Med. 1995;123(10):807.
Hypernatremic and polyuric states. In the kidney: physiology and pathophysiology: Selain A, Giebisch G (Eds.), Newyork, Raven, 1992, p. 1578.
Yadav D, Nair S, Norkus EP, Pitchumoni CS. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities. Am J Gastroenterol. 2000;95(11):3123–8.
Fulop M, Eder HA. Plasma triglycerides and cholesterol in diabetic ketosis. Arch Intern Med. 1989;149(9):1997–2002.
Fulop M, Eder H. Severe hypertriglyceridemia in diabetic ketosis. Am J Med Sci. 1990;300(6):361–5.
Rumbak MJ, Hughes TA, Kitabchi AE. Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides. Am J Emerg Med. 1991;9(1):61–3.
Kaminska ES, Pourmotabbed G. Spurious laboratory values in diabetic ketoacidosis and hyperlipidemia. Am J Emerg Med. 1993;11(1):77–80.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335–43.
Umpierrez GE, Latif K, Stoever J, et al. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J Med. 2004;117(5):291–6.
Umpierrez GE, Cuervo R, Karabell A, Latif K, Freire AX, Kitabchi AE. Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. Diabetes Care. 2004;27(8):1873–8.
Fisher JN, Kitabchi AE. A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. J Clin Endocrinol Metab. 1983;57(1):177–80.
Winter RJ, Harris CJ, Phillips LS, Green OC. Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med. 1979;67(5):897–900.
Miller DW, Slovis CM. Hypophosphatemia in the emergency department therapeutics. Am J Emerg Med. 2000;18(4):457–61.
Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986;105(6):836–40.
Narins RG, Cohen JJ. Bicarbonate therapy for organic acidosis: the case for its continued use. Ann Intern Med. 1987;106(4):615–8.
Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996;81(1):314–20.
Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984;289(6451):1035–8.
Roberts MD, Slover RH, Chase HP. Diabetic ketoacidosis with intracerebral complications. Pediatr Diabetes. 2001;2(3):109–14.
Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(12):2739–48.
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Lupsa, B.C., Inzucchi, S.E. (2014). Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome. In: Loriaux, L. (eds) Endocrine Emergencies. Contemporary Endocrinology, vol 74. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-697-9_2
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