title: Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.
abstract: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. Insulin deficiency is the main underlying abnormality. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in hyperglycemia, and can also stimulate lipolysis and ketogenesis, resulting in ketoacidosis. Both hyperglycemia and hyperketonemia will induce osmotic diuresis, which leads to dehydration. Clinical diagnosis is based on the finding of dehydration along with high capillary glucose levels with or without ketones in the urine or plasma. The diagnosis is confirmed by the blood pH, serum bicarbonate level and serum osmolality. Treatment consists of adequate correction of the dehydration, hyperglycemia, ketoacidosis and electrolyte deficits.
authors.affiliation: Division of Endocrinology-Metabolism, Centre hospitalier de l'Université de Montréal, and the Department of Medicine, Université de Montréal, Montréal, QC. jean.louis.chiasson@umontreal.ca
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Chiasson
authors.forename: Nahla
authors.initials: N
authors.lastname: Aris-Jilwan
authors.forename: Raphaël
authors.initials: R
authors.lastname: Bélanger
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bertrand
authors.forename: Hugues
authors.initials: H
authors.lastname: Beauregard
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ekoé
authors.forename: Hélène
authors.initials: H
authors.lastname: Fournier
authors.forename: Jana
authors.initials: J
authors.lastname: Havrankova
mesh_terms: D000137:Acid-Base Imbalance / Q000097:blood; D001639:Bicarbonates / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D003663:Decision Trees; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D003937:Diagnosis, Differential; D005440:Fluid Therapy; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D007328:Insulin / Q000627:therapeutic use; D050356:Lipid Metabolism; D010710:Phosphates / Q000627:therapeutic use; D011188:Potassium / Q000627:therapeutic use; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000097:blood
chemical_list: D001639:Bicarbonates; D001786:Blood Glucose; D007328:Insulin; D010710:Phosphates; D011188:Potassium