diabetic%20ketoacidosis%20-and-%20hyperosmolar%20hyperglycemic%20state
DIABETIC KETOACIDOSIS & HYPEROSMOLAR HYPERGLYCEMIC STATE
Diabetic ketoacidosis is characterized by having blood glucose >13.9 mmol/L, arterial pH <7.3 in adults or venous pH <7.3 in pediatrics, bicarbonate <15 mEg/L, moderate ketonuria or ketonemia and anion gap >14.
Hyperosmolar hyperglycemic state in adults is described as having blood glucose >33.3 mmol/L, arterial pH >7.3, bicarbonate >15 mEq/L, mild ketonuria or ketonemia, effective serum osmolality >320 mOsm/kg and variable anion gap.
Hyperosmolar hyperglycemic state in pediatric patients has blood glucose >33.3 mmol/L, venous pH >7.3, bicarbonate >15 mEq/L and altered mental status or severe dehydration.

Diabetic%20ketoacidosis%20-and-%20hyperosmolar%20hyperglycemic%20state Diagnosis

Evaluation

Diagnostic Criteria for diabetic ketoacidosis (DKA)

  • Blood glucose >13.9 mmol/L (>250 mg/dL)
  • Arterial pH <7.3 in adults or venous pH <7.3 in pediatrics
  • Bicarbonate <15 mEq/L
  • Moderate ketonuria or ketonemia
  • Anion gap >12

Diagnostic Criteria for hyperosmolar hyperglycemic state (HHS) in Adults

  • Blood glucose >33.3 mmol/L (>600 mg/dL)
  • Arterial pH >7.3
  • Bicarbonate >15 mEq/L
  • Mild ketonuria or ketonemia
  • Effective serum osmolality >320 mOsm/kg
  • Anion gap variable

Diagnostic Criteria for HHS in Pediatrics

  • Blood glucose >33.3 mmol/L (>600 mg/dL)
  • Venous pH >7.3
  • Bicarbonate >15 mEq/L
  • Altered mental status or severe dehydration

Classification

Classification of Diabetic Ketoacidosis

  • Mild DKA presents without alteration in sensorium, > 250 mg/dL plasma glucose, arterial pH 7.25-7.30, 15-18 mEq/L serum bicarbonate, presence of serum & urine ketones, & >10 anion gap
  • Moderate DKA presents w/ or without alteration in sensorium or drowsiness, >250 mg/dL plasma glucose, arterial pH 7-<7.24, 10-<15 mEq/mL serum bicarbonate, presence of serum & urine ketones, & >12 anion gap
  • Severe DKA presents w/ stupor or coma, >250 mg/dL plasma glucose, arterial pH <7, <10 mEq/L serum bicarbonate, presence of serum & urine ketones, & >12 anion gap

History

  • History of polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain (in DKA)
  • Dehydration
  • Weakness

Physical Examination

  • Altered mental status or sensoria clouding to coma (more frequent in HHS)
  • Poor skin turgor, dry axilla & oral mucosa, Kussmaul respirations (in DKA), low jugular venous pressure, tachycardia, hypotension, shock

Laboratory Tests

  • Serum glucose
  • Blood urea nitrogen (BUN)/creatinine
  • Serum ketones
  • Electrolytes (anion gap)
  • Serum osmolality
    • Effective osmolality = (2 × Na) + (glucose/18) 
  • Urinalysis
  • ECG &/or chest X-ray (CXR), if indicated
  • Urine ketones by dipstick
  • Arterial blood gas
  • CBC w/ differential
  • Urine, blood & throat culture
  • Glycosylated hemoglobin (HbA1c)
  • Nitroprusside testing
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
11 May 2020
This second issue revisits the impact EMPA-REG OUTCOME had on clinical practice and helps readers discover how it gives life back to patients through its cardiovascular indication. Learn how it was approved and the possible mechanisms for its cardiovascular benefits.
Pearl Toh, 15 Oct 2020
Cycling was associated with reduced risk for both all-cause and cardiovascular (CV) mortality in people with diabetes, according to a study presented at EASD 2020 Meeting — suggesting that cycling could be encouraged as an activity to prevent deaths in this population who are known to have a higher mortality risk than the general public.
Elaine Soliven, 15 Oct 2020

Higher levels of exercise appear to be associated with a lower risk of all-cause mortality in adults with type 2 diabetes (T2D) compared with no exercise at all, according to a study presented at EASD 2020.

Elvira Manzano, 12 Oct 2020
Taking regular hot baths may have a positive impact on glycaemia, blood pressure (BP), and body weight among Japanese patients with type 2 diabetes(T2D), according to a real-world study touted as the first to analyse the effect of heat therapy in T2D.