Chapter 25: Diabetic Ketoacidosis and Hyperosmolar Coma
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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.
DKA | HHS | |
---|---|---|
Glucose,a mmol/L (mg/dL) | 13.9–33.3 (250–600) | 33.3–66.6 (600–1200)c |
Sodium, meq/L | 125–135 | 135–145 |
Potassium,a meq/L | Normal to ↑b | Normal |
Magnesiuma | Normalb | Normal |
Chloridea | Normal | Normal |
Phosphatea | Normal to ↓b | Normal |
Creatinine, µmol/L (mg/dL) | Slightly ↑ | Moderately ↑ |
Osmolality (mosmol/mL) | 300–320 | 330–380 |
Plasma ketonesa | ++++ | ± |
Serum bicarbonate,a meq/L | <15 meq/L | Normal to slightly ↓ |
Arterial pH | 6.8–7.3 | >7.3 |
Arterial PCO2,a mmHg | 20–30 | Normal |
Anion gapa [Na – (Cl + HCO3)], meq/L | ↑ | Normal to slightly ↑ |
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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.
DKA | HHS | |
---|---|---|
Glucose,a mmol/L (mg/dL) | 13.9–33.3 (250–600) | 33.3–66.6 (600–1200)c |
Sodium, meq/L | 125–135 | 135–145 |
Potassium,a meq/L | Normal to ↑b | Normal |
Magnesiuma | Normalb | Normal |
Chloridea | Normal | Normal |
Phosphatea | Normal to ↓b | Normal |
Creatinine, µmol/L (mg/dL) | Slightly ↑ | Moderately ↑ |
Osmolality (mosmol/mL) | 300–320 | 330–380 |
Plasma ketonesa | ++++ | ± |
Serum bicarbonate,a meq/L | <15 meq/L | Normal to slightly ↓ |
Arterial pH | 6.8–7.3 | >7.3 |
Arterial PCO2,a mmHg | 20–30 | Normal |
Anion gapa [Na – (Cl + HCO3)], meq/L | ↑ | Normal to slightly ↑ |
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