Diabetic Ketoacidosis, Hyperosmolar Nonketotic States, and Stress-Induced Hyperglycemia

  • Paul Ellis Marik


Diabetic ketoacidosis (DKA) remains a major problem of uncontrolled diabetes with significant morbidity and mortality. In the pathogenesis of ketoacidosis, relative insulin deficiency and counterregulatory hormone excess lead to overproduction and underutilization of glucose, resulting in hyperglycemia. Increased lipolysis leads to excessive formation of ketone bodies, which accumulate to produce a metabolic acidosis. Insulin therapy promotes a reversal of these metabolic derangements by suppressing hepatic production of both glucose and ketones, in addition to increasing glucose utilization and ketone body clearance. Common precipitating factors include discontinuation of insulin therapy (noncompliance), infections, myocardial ischemia, and emotional stress.


Blood Glucose Insulin Infusion Diabetic Ketoacidosis Insulin Administration Capillary Blood Glucose 
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Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Paul Ellis Marik
    • 1
  1. 1.Critical Care MedicineMercy Hospital of PittsburghPittsburghUSA

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