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Hyperglycemic diabetic emergencies practice guidelines kundavaram paul prabhakar abhilash, current medical issues Hướng dẫn Xử trí cơn tăng đường huyết cấp cứu trong đái tháo đường
27/4/2019 Hyperglycemic diabetic emergencies: Practice guidelines :Kundavaram Paul Prabhakar Abhilash, Current Medical Issues PRACTICE GUIDELINES Year : 2017 | Volume : 15 | Issue : | Page : 208 210 Hyperglycemic diabetic emergencies: Practice guidelines Kundavaram Paul Prabhakar Abhilash Department of Accident and Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India Correspondence Address: Kundavaram Paul Prabhakar Abhilash Department of Accident and Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu India Abstract Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with Type diabetes, but it is not uncommon in some patients with Type diabetes Fluid resuscitation, insulin administration, potassium administration, and correction of the underlying precipitating cause constitute the four pillars of treatment Hyperglycemic hyperosmolar state (HHS) is classically seen in elderly patients with Type diabetes Although less common than diabetic ketoacidosis, HHS is associated with a higher mortality rate How to cite this article: Abhilash KP Hyperglycemic diabetic emergencies: Practice guidelines.Curr Med Issues 2017;15:208-210 How to cite this URL: Abhilash KP Hyperglycemic diabetic emergencies: Practice guidelines Curr Med Issues [serial online] 2017 [cited 2019 Apr 27 ];15:208-210 Available from: http://www.cmijournal.org/text.asp?2017/15/3/208/212375 Full Text Introduction Diabetes mellitus is a common metabolic disorder which may present to the emergency department with life-threatening emergencies Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state/coma (HHS) are two common diabetic emergencies which can be managed with optimal fluid and blood glucose management along with optimization of electrolyte imbalances and treatment of the cause This article discusses practical and concise guidelines for the diagnosis and management of these conditions that can be applied in almost any kind of hospital setting Diabetic Ketoacidosis www.cmijournal.org/printarticle.asp?issn=0973-4651;year=2017;volume=15;issue=3;spage=208;epage=210;aulast=Abhilash 1/5 27/4/2019 Hyperglycemic diabetic emergencies: Practice guidelines :Kundavaram Paul Prabhakar Abhilash, Current Medical Issues DKA is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with Type diabetes, but it is not uncommon in some patients with Type diabetes It may be the first manifestation of diabetes in many patients with Type diabetes [1],[2] Clinical features The most common early symptom of DKA is an insidious increase in polydipsia and polyuria Malaise, generalized weakness, fatigability, altered sensorium, and associated symptoms of infections may also be seen Patients would be extremely dehydrated with a fluid deficit of at least 5–6 L.[2],[3] Precipitating cause Look for any precipitating cause and address itThe common precipitating causes (the five Is) are as follows: Insulin – nonadherence to use of insulinInfection/inflammationIschemia/infarction (myocardial infarction/stroke)Intra-abdominal process – pancreatitis, cholecystitis, appendicitis, splenic injury, ischemic bowelIatrogenic – steroid use Diagnostic triad The three features that form a triad that is diagnostic of DKA are: High plasma sugar level (>250 mg%)Ketosis: Urine ketones positive (2+ or 3+ Remember that ketone 1+ positive is a common finding and does not mean ketosis)Acidosis: Serum bicarbonate