Current diagnosis and treatment of hyperglycemic emergencies.
Diabetic ketoacidosis and hyperosmolar hyperglycemic state are the most feared complications of uncontrolled diabetes seen in emergency medicine. The treatment of both conditions must be tailored to individual patients and relies on aggressive fluid resuscitation, insulin replacement, and electrolyte management. Emergency medicine providers must address the underlying causes and monitor for complications of therapy. Improved understanding of the underlying pathophysiology and application of evidence-based guidelines have significantly improved prognosis and decreased mortality. The purpose of this article is to review the diagnosis, presentation, and emergency department management of diabetic ketoacidosis and hyperosmolar hyperglycemic state with an emphasis on current management and treatment guidelines.
CAQ Sports Medicine, Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: bcorwell@som.umaryland.edu.
Brian
B
Corwell
Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
Brandi
B
Knight
Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
Laura
L
Olivieri
Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
George C
GC
Willis
D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D004630:Emergencies; D004636:Emergency Service, Hospital; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood*
D007004:Hypoglycemic Agents; D007328:Insulin
Diabetic ketoacidosis (DKA); Electrolyte management; Hyperglycemic crisis; Hyperosmolar hyperglycemic state (HHS); Insulin therapy