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 Ketoacidosis & Hyperosmolar Hyperglycemic State References

  1. American Diabetes Association. Tests of glycemia in diabetes. Diabetes Care. 2002 Jan;25(Suppl 1):S97-S99
  2. Bosnak M, Dikici B, Dogru O, et al. Somatostatin therapy in the management of resistant diabetic ketoacidosis. Diabetes Care. 2002 Mar;25(3):629-630. PMID: 11874963
  3. Chiasson JL, Aris-Jilwan N, Belanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. CMAJ. 2003 Apr;168(7):859-866. PMID: 12668546
  4. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008 Sep;32(Suppl 1):S65-S70
  5. Delany MF, Zisman A, Kettyle WM. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Endocrinol Metab Clin North Am. 2000 Dec;29(4):683-705. PMID: 11149157
  6. Kitabchi AE, Umpierrez GE, Murphy MB, et al; American Diabetes Association. Hyperglycemic crises in diabetes. Diabetes Care. 2004 Jan;27(Suppl 1):S94-S102. PMID: 14693938
  7. Kitabchi AE, Umpierrez GE, Murphy M, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006 Dec;29(12):2739-2748. PMID: 17130218
  8. Edge JA. BSPED Recommended DKA guidelines 2009. Oxford. 2009 Nov:001-11
  9. Wolsdorf J, Craig M, Daneman D, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes. 2009 Sep;10(Suppl 12):118-133. PMID: 19754623
  10. Savage MW, Dhatariya KK, Kilvert A, et al, for the Joint British Diabetes Societies. Diabetes UK position statement and care recommendations. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011 May;28(5):508-515. PMID: 21255074
  11. Wolfsdorf J, Craig M, Daneman D, et al. Diabetic ketoacidosis. In: Hanas R, Donaghue K, Klingensmith G, et al. Global IDF/ISPAD guideline for diabetes in childhood and adolescence. International Diabetes Federation; 2011:70-81.
  12. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  13. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  14. Joint British Diabetes Societies Inpatient Care Group. The management of diabetic ketoacidosis in adults. http://www.bsped.org.uk/clinical/docs/dkamanagementofdkainadultsmarch20101.pdf. Mar 2010
  15. Goguen J, Gilbert J. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee clinical practice guidelines hyperglycemic emergencies in adults. Can J Diabetes. 2013;37(Suppl 1):S72-S76. doi: 10.1016/j.jcjd.2013.01.023. Accessed 31 Mar 2014.
  16. Malaysian Endocrine & Metabolic Society. Clinical practice guidelines on management of type 2 diabetes mellitus. 5th edition. MEMS. http://www.mems.org.my. 2015. Accessed 08 Dec 2015.
  17. Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014;7:255-264. doi: 10.2147/DMSO.S50516. PMID: 25061324
  18. Kitabachi AE, Hirsch IB, Emmett M. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: clinical features, evaluation and diagnosis. UpToDate. www.uptodate.com. 2014.
  19. Kitabachi AE, Hirsch IB, Emmett M. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: treatment. UpToDate. www.uptodate.com. 2015.
  20. Kitabachi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335-1343. doi: 10.2337/dc09-9032. PMID: 19564476
  21. Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016 Apr;12(14):222-232. doi: 10.1038/nrendo.2016.15. PMID: 26893262.
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