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Diabetic Ketoacidosis and Hyperosmolar Coma

Diabetic Ketoacidosis and Hyperosmolar Coma is a topic covered in the Harrison's Manual of Medicine.

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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 23-1.

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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Loscalzo, Joseph, et al., editors. "Diabetic Ketoacidosis and Hyperosmolar Coma." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623153/all/Diabetic_Ketoacidosis_and_Hyperosmolar_Coma.
Diabetic Ketoacidosis and Hyperosmolar Coma. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623153/all/Diabetic_Ketoacidosis_and_Hyperosmolar_Coma. Accessed April 18, 2019.
Diabetic Ketoacidosis and Hyperosmolar Coma. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623153/all/Diabetic_Ketoacidosis_and_Hyperosmolar_Coma
Diabetic Ketoacidosis and Hyperosmolar Coma [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 18]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623153/all/Diabetic_Ketoacidosis_and_Hyperosmolar_Coma.
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TY - ELEC T1 - Diabetic Ketoacidosis and Hyperosmolar Coma ID - 623153 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623153/all/Diabetic_Ketoacidosis_and_Hyperosmolar_Coma PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -