Cetoacidosis diabetica

In Brief
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently andeffectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes ofhyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome.

Diabetic Ketoacidosisand Hyperglycemic Hyperosmolar Syndrome

Guillermo E. Umpierrez, MD, FACP; Mary Beth Murphy, RN, MS, CDE, MBA; and Abbas E. Kitabchi, PhD, MD, FACP, FACE

The two most common life-threateningcomplications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlyingmechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines,cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible for more than100,000 hospital admissions per year in the United States1 and accounts for 4–9% of all hospital discharge summaries among patients with diabetes.1 The incidence of HHS is lower than DKA and accounts for40 years of age and more than 20% were >55 years of age. 3 Many of these adult patients with DKA were classified as
Diabetes Spectrum Volume 15, Number 1, 2002

having type 2 diabetes because 29%of patients were obese, had measurable insulin secretion, and had a low prevalence of autoimmune markers of -cell destruction.4 Treatment of patients with DKA and HHS utilizes significant health care...