Diabetic Hyperglycemic Emergencies: A Systematic Approach (Pharmacology CME) | Digest
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Diabetic Hyperglycemic Emergencies: A Systematic Approach (Pharmacology CME)

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Points and Pearls Excerpt

  • Both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are usually triggered by a precipitating cause: infection, infarction, infant on board (pregnancy), dietary indiscretion, and insulin deficiency. (The “five Is.”)
  • In DKA, the pH is typically < 7.3, anion gap > 10, serum bicarbonate < 18 mEq/L, and with both elevated urine and serum ketones.
  • In HHS there is typically no ketosis and a normal anion gap, but serum osmolality > 320 mOsm/kg.
  • In most adult cases of DKA, fluid deficit is estimated to be 3 to 6 L; in HHS, the deficit is 9 to 12 L.
  • Provide volume resuscitation before starting insulin therapy, as it will decrease hyperglycemia 35 to 70 mg/dL, even without insulin.

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Publication Information
Authors

H. Evan Dingle, MD; Corey Slovis, MD, FACP, FACEP, FAAEM, FAEMS

Peer Reviewed By

Melissa Parsons, MD, FACEP; Camiron Pfennig-Bass, MD, MHPE

Publication Date

February 1, 2020

CME Expiration Date

February 1, 2023   

Pub Med ID: 31978294

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Publication Information
Authors

H. Evan Dingle, MD; Corey Slovis, MD, FACP, FACEP, FAAEM, FAEMS

Peer Reviewed By

Melissa Parsons, MD, FACEP; Camiron Pfennig-Bass, MD, MHPE

Publication Date

February 1, 2020

CME Expiration Date

February 1, 2023

Pub Med ID: 31978294

Get Permission

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