Strength of recommendation labels are based on kitabchi ae, umpierrez ge, murphy mb, barrett ej, kreisberg ra, malone ji, et al. These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of their pathogenesis and more uniform agreement about their. There was a decline in mortality from 2000 to 2014 across all age groups and both sexes with largest absolute decrease among persons aged. Most patients with dka have autoimmune type 1 diabetes. D iabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are acute and potentially lifethreatening complications of diabetes. Declining death rates from hyperglycemic crisis among adults with diabetes, u. The terms hyperglycemic hyperosmolar nonketotic coma and hyperglycemic hyperosmolar nonketotic state have been replaced with the term hyperglycemic hyperosmolar state hhs to reflect the. Kitabchi and guillermo e umpierrez and john m miles and joseph n. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs. Aug 22, 2019 ada hyperglycemic crises 2009 pdf diabetes care. Hyperglycemic crises in patients with diabetes mellitus. Which conditions increase the risk of hyperosmolar. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2.
Hyperglycemic crises in adult patients with diabetes diabetes care 2009 jul. Diabetic ketoacidosis and hyperglycemic hypersmolar state. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Key points dka and hhs are lifethreatening emergencies. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic. Adapted with permission from kitabchi ae, umpierrez ge, murphy mb, barrett ej, kreisberg ra, malone ji, et al. Overview of the diabetic ketoacidosis dka hyperglycemic. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Mar 10, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are the two most serious hyperglycemic emergencies in patients with diabetes mellitus. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths.
Thirty years of personal experience in hyperglycemic crises. Kitabchi and others published hyperglycemic crises. In the setting of severe volume deficit and shock, and in the absence of cardiac compromise, patients should receive 0. Contributes to less than 1% of all diabetesrelated admissions. Aug 16, 2019 ada hyperglycemic crises 2009 pdf diabetes care.
Kitabchi ae, umpierrez ge, fisher jn, murphy mb, stentz fb. Although they have important differences, they both occur because of lack of insulin effect and can be considered two manifestations of the same underlying mechanism. Diagnostic features of hyperosmolar hyperglycemic state hhs kitabchi ae, umpierrez ge, murphy mb, et al. Hyperosmolar hyperglycemic state is a relatively common, lifethreatening endocrine emergency that is reported in all age groups,1 but it most frequently affects older patients with type 2 diabetes. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic crises. Hyperglycemic crises in adult patients with diabetes diabetes care. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious acute metabolic complications of diabetes. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in. Hyperglycemic crises knowledge for medical students and.
Hyperglycemic crises in adult patients with diabetes abbas e. Risk factors for hyperglycemic crisis ushersmith et al. Hyperglycemic crises in adult patients with diabeteskitabchi and associates. National data shows a decline in death related to both hyperglycemic crises with and absolute decline of 529 deaths in the period of 1990 to 2010 2. Assessment of the buccal mucosa for dryness is more informative in these patients. Diabetic ketoacidosis dka, and hyperglycemic hyperosmolar state hhs. These disorders can occur in both type 1 and type 2 diabetes. Hyperglycemic crises in adult patients with diabetes. Dec 21, 2019 ada hyperglycemic crises 2009 pdf diabetes care. Hyperglycemic crises in adult patients with diabetes ncbi. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs find, read and cite all the. This article is published with open access at abstract.
Increasing evidence indicates that the hyperglycemia in patients with hyperglycemic crises is associated with a severe inflammatory state characterized by an elevation of proinflammatory cytokines tumor necrosis factor. Information updated from kitabchi ae, umpierrez ge, miles jm, fisher jn. The authors report no actual or potential conflict of interest in relation to this article. Hyperosmolar hyperglycemic state symptoms, diagnosis and. Volume depletion may be difficult to assess in the form of poor skin turgor in older patients. Hyperosmolar hyperglycemic state is a lifethreatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or. Table 1 outlines the diagnostic criteria for dka and hhs. Information updated from kitabchi ae, umpierrez ge, miles jm, et al.
Hyperosmolar hyperglycemic state treatment algorithm. The mortality rate in patients with diabetic ketoacidosis dka is hyperglycemic state hhs still remains high. Management involves attention to precipitating cause fluid and electrolyte management insulin therapy patient monitoring prevention of metabolic complications during recovery transition to longterm therapy patient education and discharge planning should aim at prevention of recurrence. Hyperglycemic crisis journal of emergency medicine. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. A consensus statement from the american diabetes association. Hyperosmolar hyperglycemic state bmj best practice.
May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Hyperglycemic crises in cancer patients american diabetes. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Treatment of diabetic ketoacidosis dkahyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Pdf hyperglycemic crises in adult patients with diabetes.
Aug 05, 2019 ada hyperglycemic crises 2009 pdf diabetes care. N hyperglycemic crises in adult patients with diabetes. Hyperosmolar hyperglycemic state criteria bmj best practice. Kitabchi ae, umpierrez ge, murphy mb, kreisberg ra. Hyperosmolar hyperglycemic state hhs, also known as nonketotic hyperglycemic hyperosmolar syndrome nkhs, is characterized by profound hyperglycemia glucose 600 mgdl, hyperosmolality effective serum osmolality.
Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are two of the most serious acute complications of diabetes. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes in spite of major advances in the understanding of their pathogenesis and more uniform agreement about their diagnosis and treatment. May 03, 2020 some of these drugs trigger the development of hyperglycemic crises by causing a reversible deficiency in insulin action or insulin secretion e. Occurs most commonly in older patients with type 2 diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs. A persons breath may develop a specific fruity smell. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Typically, dka presents in type i diabetics while hhs presents in type ii diabetics.
Hyperglycemic crises in diabetic adults 2742 d iabetes c are, volume 29, number 12, d ecember 2006 figure 2 protocol for the management of adult patients with dka. Hyperglycemic crisis, which includes diabetic ketoacidosis and hyperglycemic hyperosmolar state, is a common diagnosis in high acuity hospital. The mortality rate in patients with diabetic ketoacidosis dka is hyperglycemic. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Management of hyperglycemic crises in patients with diabetes. Thirty years of personal experience in hyperglycemic. The mortality rate for dka and hyperglycemic crises has been falling over the years figure 1b. Dka most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to dka under stressful conditions such as trauma, surgery or infections.
May 06, 2019 ada hyperglycemic crises 2009 pdf diabetes care. Figure 2 from hyperglycemic crises in adult patients with. A consensus statement from the american diabetes association diabetes care july 2009 vol. In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths 9. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome management emergency medicine. Pdf management of hyperglycemic crises in patients with. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs cause major morbidity and significant mortality in patients with diabetes mellitus. They are found to occur simultaneously in up to of cases overlap syndrome of hyperosmolar ketoacidosis. Hyperosmolar hyperglycemic state winchester hospital. Fisher, md 1 d iabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhsarethetwomostseriousacute. Mental status and ph and serum bicarbonate levels help clinicians determine the extent of disease severity, classifying patients as having mild, moderate, or severe dka table 4. Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucus membranes, poor skin turgor, hypotension, and, in.