Chapter 25: Diabetic Ketoacidosis and Hyperosmolar Coma

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute complications of diabetes mellitus (DM). DKA is seen primarily in individuals with type 1 DM and HHS in individuals with type 2 DM. Both disorders are associated with absolute or relative insulin deficiency, volume depletion, and altered mental status. The metabolic similarities and differences in DKA and HHS are summarized in Table 25-1.

TABLE 25-1: Laboratory Values in DKA and HHS (Representative Ranges at Presentation)
Glucose,a mmol/L (mg/dL)13.9–33.3 (250–600)33.3–66.6 (600–1200)c
Sodium, meq/L125–135135–145
Potassium,a meq/LNormal to ↑bNormal
PhosphateaNormal to ↓bNormal
Creatinine, µmol/L (mg/dL)Slightly ↑Moderately ↑
Osmolality (mosmol/mL)300–320330–380
Plasma ketonesa++++±
Serum bicarbonate,a meq/L<15 meq/LNormal to slightly ↓
Arterial pH6.8–7.3>7.3
Arterial PCO2,a mmHg20–30Normal
Anion gapa [Na – (Cl + HCO3)], meq/LNormal to slightly ↑
aLarge changes occur during treatment of DKA.
bAlthough plasma levels may be normal or high at presentation, total-body stores are usually depleted.
cLarge changes occur during treatment.
Abbreviations: DKA, diabetic ketoacidosis; HHS, hyperglycemic hyperosmolar state.

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