Hyperglycemic Emergencies in Adults

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Hyperglycemic Emergencies in Adults

• Key Messages
• Diabetic ketoacidosis (DKA) and hyperosmolar
  hyperglycemic state (HHS) should be suspected in
  ill patients with diabetes. If either DKA or HHS
  is diagnosed, precipitating factors must be
  sought and treated.

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Hyperglycemic Emergencies in Adults

• Key Messages
• DKA and HHS are medical emergencies that require
  treatment and monitoring for multiple metabolic
  abnormalities and vigilance for complications.
• Ketoacidosis requires insulin administration (0.1
  U/kg/hour) for resolution bicarbonate therapy
  should be considered only for extreme acidosis
  (pH 7.0).

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Hyperglycemic Emergencies in Adults

• 2008 CPG Recommendations
• In patients with DKA, a protocol incorporating
  the principles illustrated in Figure 1 should be
  followed Grade D, Consensus. For HHS, a similar
  protocol can be used however, in this case, the
  plasma glucose level is used to titrate the
  insulin dose Grade D, Consensus.

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Hyperglycemic Emergencies in Adults

• 2008 CPG Recommendations
• In individuals with DKA, IV 0.9 sodium chloride
  should be administered initially at 500 mL/hour
  for 4 hours, then 250 mL/hour for 4 hours Grade
  B, Level 2 (15) with consideration of a higher
  initial rate (12 L/hour) in the presence of
  shock Grade D, Consensus. For persons with a
  HHS, IV fluid administration should be
  individualized based on the patients needs
  Grade D, Consensus.

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Hyperglycemic Emergencies in Adults

• 2008 CPG Recommendations
• In patients with DKA, IV short-acting insulin
  should be administered at an initial dose of 0.1
  U/kg/hour Grade B, Level 2 (19,20). The insulin
  infusion rate should be maintained until the
  resolution of ketosis Grade B, Level 2 (24) as
  measured by the normalization of the plasma anion
  gap Grade D, Consensus. Once the plasma glucose
  concentration reaches 14.0 mmol/L, IV dextrose
  should be started to avoid hypoglycemia Grade D,
  Consensus.