Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome.

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) are life-threatening acute metabolic complications of diabetes mellitus. Although there are some important differences, the pathophysiology, the presenting clinical challenge, and the treatment of these metabolic derangements are similar. Each of these complications can be seen in type 1 or type 2 diabetes, although DKA is usually seen in patients with type 1 diabetes and HHNS in patients with type 2 disease. The clinical management of these syndromes involves careful evaluation and correction of the metabolic and volume status of the patient, identification and treatment of precipitating and comorbid conditions, a smooth transition to a long-term treatment regimen, and a plan to prevent recurrence.

[1]  P. Li,et al.  Acute renal failure (ARF) caused by rhabdomyolysis due to diabetic hyperosmolar nonketotic coma: a case report and literature review. , 1992, Renal failure.

[2]  M. Rowley,et al.  GAD Antibody Negative NIDDM in Adult Black Subjects with Diabetic Ketoacidosis and Increased Frequency of Human Leukocyte Antigen DR3 and DR4: Flatbush Diabetes , 1994, Diabetes.

[3]  S. Westphal,et al.  The occurrence of diabetic ketoacidosis in non-insulin-dependent diabetes and newly diagnosed diabetic adults. , 1996, The American journal of medicine.

[4]  H. E. Martin,et al.  The fluid and electrolyte therapy of severe diabetic acidosis and ketosis; a study of twenty-nine episodes (twenty-six patients). , 1958, The American journal of medicine.

[5]  T. Kreulen,et al.  Human splanchnic metabolism during diabetic ketoacidosis. , 1977, Metabolism: clinical and experimental.

[6]  W. Hagopian,et al.  Immunogenetic analysis suggests different pathogenesis for obese and lean African-Americans with diabetic ketoacidosis. , 1999, Diabetes care.

[7]  U. Keller,et al.  Prevention of Hypophosphatemia by Phosphate Infusion During Treatment of Diabetic Ketoacidosis and Hyperosmolar Coma , 1980, Diabetes.

[8]  A. Kitabchi,et al.  Diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma. , 1988, The Medical clinics of North America.

[9]  U. Keller,et al.  Treatment of diabetic ketoacidosis and non-ketotic hyperosmolar diabetic coma. , 1992, Bailliere's clinical endocrinology and metabolism.

[10]  A. Kitabchi,et al.  Low-dose insulin therapy in diabetic ketoacidosis: fact or fiction? , 1989, Diabetes/metabolism reviews.

[11]  E. Zawada.  Metabolic considerations in the approach to diabetic hypertensive patients. , 1989, The American journal of medicine.

[12]  R. Goldberg,et al.  Factors in the Pathogenesis of Experimental Nonketotic and Ketoacidotic Diabetic Stupor , 1973, Diabetes.

[13]  J. Connors.  Insulin therapy in diabetic ketoacidosis. , 1977, Annals of internal medicine.

[14]  J. Assal,et al.  Metabolic Effects of Sodium Bicarbonate in Management of Diabetic Ketoacidosis , 1974, Diabetes.

[15]  R. Sherwin,et al.  Effect of Diabetes Mellitus and Insulin on the Turnover and Metabolic Response to Ketones in Man , 1976, Diabetes.

[16]  G. Eknoyan,et al.  Phosphate therapy in diabetic ketoacidosis. , 1982, Archives of internal medicine.

[17]  A. Risse,et al.  Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application. , 1999, Diabetes care.

[18]  G. Eknoyan,et al.  Plasma acid-base patterns in diabetic ketoacidosis. , 1982, The New England journal of medicine.

[19]  M. Siperstein.  Diabetic ketoacidosis and hyperosmolar coma. , 1992, Endocrinology and metabolism clinics of North America.

[20]  P. Davidson,et al.  Reduction in Severe Hypoglycemia With Long-Term Continuous Subcutaneous Insulin Infusion in Type I Diabetes , 1996, Diabetes Care.

[21]  P. Watkins.  The effect of ketone bodies on the determination of creatinine. , 1967, Clinica chimica acta; international journal of clinical chemistry.

[22]  A. Wright,et al.  Persisting Mortality in Diabetic Ketoacidosis , 1993, Diabetic medicine : a journal of the British Diabetic Association.

[23]  Y. Okuda,et al.  Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. , 1996, The Journal of clinical endocrinology and metabolism.

[24]  H. Lebovitz,et al.  Therapy for Diabetes Mellitus and Related Disorders , 1994 .

[25]  M. Nattrass,et al.  Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. , 1984, British medical journal.

[26]  A. Kitabchi,et al.  A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis. , 1983, The Journal of clinical endocrinology and metabolism.

[27]  F. Féry,et al.  Ketone body production and disposal: effects of fasting, diabetes, and exercise. , 1989, Diabetes/metabolism reviews.

[28]  C. Hawker,et al.  Hypocalcemia, Hypomagnesemia, and Transient Hypoparathyroidism During Therapy with Potassium Phosphate in Diabetic Ketoacidosis , 1979, Diabetes Care.

[29]  R. DeFronzo,et al.  The Effect of Graded Doses of Insulin on Total Glucose Uptake, Glucose Oxidation, and Glucose Storage in Man , 1982, Diabetes.

[30]  R. DeFronzo,et al.  Insulin Resistance in Diabetic Ketoacidosis , 1982, Diabetes.

[31]  V. Murthy,et al.  Serum beta-hydroxybutyrate measurement in patients with uncontrolled diabetes mellitus. , 1999, Archives of internal medicine.

[32]  R. Khardori,et al.  Hyperglycemic hyperosmolar nonketotic syndrome as initial presentation of type 2 diabetes in a young cocaine abuser. , 1999, Diabetes care.

[33]  A. Arieff,et al.  Cerebral edema in diabetic comas. II. Effects of hyperosmolality, hyperglycemia and insulin in diabetic rabbits. , 1974, The Journal of clinical endocrinology and metabolism.

[34]  I. Campbell,et al.  Euglycaemic Diabetic Ketoacidosis , 1973, British medical journal.

[35]  M. Fulop.  The treatment of severely uncontrolled diabetes mellitus. , 1984, Advances in internal medicine.

[36]  W. Waldhäusl,et al.  Severe Hyperglycemia: Effects of Rehydration on Endocrine Derangements and Blood Glucose Concentration , 1979, Diabetes.

[37]  P. Cadnapaphornchai,et al.  Dynamic changes in serum phosphorus levels in diabetic ketoacidosis. , 1985, The American journal of medicine.

[38]  P. Beigelman,et al.  Severe Diabetic Ketoacidosis (Diabetic “Coma”): 482 Episodes in 257 Patients; Experience of Three Years , 1971, Diabetes.

[39]  J. Gerich,et al.  Glucose and ketone body kinetics in diabetic ketoacidosis. , 1983, Clinics in endocrinology and metabolism.

[40]  A. Arieff,et al.  Studies on mechanisms of cerebral edema in diabetic comas. Effects of hyperglycemia and rapid lowering of plasma glucose in normal rabbits. , 1973, The Journal of clinical investigation.

[41]  D. Sapir,et al.  Renal Function and Effects of Partial Rehydration During Diabetic Ketoacidosis , 1981, Diabetes.

[42]  A. Kitabchi,et al.  Bicarbonate therapy in severe diabetic ketoacidosis. , 1986, Annals of internal medicine.

[43]  D. Lorber.  Nonketotic hypertonicity in diabetes mellitus. , 1995, The Medical clinics of North America.

[44]  G. Faich,et al.  The epidemiology of diabetic acidosis: a population-based study. , 1983, American journal of epidemiology.

[45]  T. Wachtel.  The diabetic hyperosmolar state. , 1990, Clinics in geriatric medicine.

[46]  L. Laffel.  Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes , 1999, Diabetes/metabolism research and reviews.

[47]  M. Munshi,et al.  Hyperosmolar Nonketotic Diabetic Syndrome Following Treatment of Human Immunodeficiency Virus Infection With Didanosine , 1994, Diabetes Care.

[48]  M. O'Kane,et al.  Treatment of Diabetic Ketoacidosis Using Normalization of Blood 3-Hydroxybutyrate Concentration as the Endpoint of Emergency Management: A randomized controlled study , 1997, Diabetes Care.

[49]  R. DeFronzo,et al.  Diabetic ketoacidosis. A combined metabolic-nephrologic approach to therapy , 1994 .

[50]  R. DeFronzo,et al.  Regulation of Splanchnic and Peripheral Glucose Uptake by Insulin and Hyperglycemia in Man , 1983, Diabetes.

[51]  H. Tannenbaum,et al.  Lactic acidosis in diabetic patients. , 1976, Archives of internal medicine.

[52]  C. Men,et al.  Non-ketotic hyperglycaemic chorea: a SPECT study. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[53]  R. DeFronzo,et al.  Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. , 1980, The American journal of physiology.

[54]  G. Eknoyan,et al.  Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. Use in patients without extreme volume deficit. , 1989, JAMA.

[55]  J. Jaspan,et al.  Sodium bicarbonate therapy in severe diabetic ketoacidosis. , 1983, The American journal of medicine.

[56]  R. Scott,et al.  Use of Health Services by Diabetic Persons. II. Hospital Admissions , 1985, Diabetes Care.

[57]  J. McGarry,et al.  Regulation of ketogenesis and clinical aspects of the ketotic state. , 1972, Metabolism: clinical and experimental.

[58]  C. Sakakura,et al.  A case of hyperosmolar nonketotic coma occurring during chemotherapy using cisplatin for gallbladder cancer. , 1999, Hepato-gastroenterology.

[59]  N. Ruderman,et al.  Inhibition of muscle acetoacetate utilization during diabetic ketoacidosis. , 1974, The American journal of physiology.

[60]  R. Matz,et al.  Uncontrolled Diabetes Mellitus in Adults: Experience in Treating Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma with Low-Dose Insulin and a Uniform Treatment Regimen , 1983, Diabetes Care.

[61]  M. Haymond,et al.  Cerebral Edema Complicating Therapy for Diabetic Ketoacidosis , 1976, Diabetes.

[62]  P. Grant,et al.  Does hypernatraemia promote thrombosis? , 1985, Thrombosis research.

[63]  P. Hamblin,et al.  Deaths associated with diabetic ketoacidosis and hyperosmolar coma, 1973–1988 (for editorial comment, see page 427; see also page 444) , 1989, The Medical journal of Australia.

[64]  R. Eaton,et al.  Metabolic and clinical significance of ketosis. , 1982, Special topics in endocrinology and metabolism.

[65]  R. Eaton,et al.  Dose response to insulin in man: differential effects on glucose and ketone body regulation. , 1977, The Journal of clinical endocrinology and metabolism.

[66]  A. Arieff,et al.  NONKETOTIC HYPEROSMOLAR COMA WITH HYPERGLYCEMIA: CLINICAL FEATURES, PATHOPHYSIOLOGY, RENAL FUNCTION, ACID-BASE BALANCE, PLASMA-CEREBROSPINAL FLUID EQUILIBRIA AND THE EFFECTS OF THERAPHY IN 37 CASES , 1972, Medicine.

[67]  H. J. Köhler,et al.  Cessation of insulin infusion at night-time during CSII-therapy: comparison of regular human insulin and insulin lispro. , 2009, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[68]  D. Armanini,et al.  Hyperosmolar nonketotic coma at the onset of Type I diabetes in a child , 1997, Journal of endocrinological investigation.

[69]  R. Silliman,et al.  Prognostic Factors in the Diabetic Hyperosmolar State , 1987, Journal of the American Geriatrics Society.

[70]  J. Goodwin,et al.  Characteristics of Diabetic Ketoacidosis in Older versus Younger Adults , 1992, Journal of the American Geriatrics Society.

[71]  N. Peden,et al.  Diabetic Ketoacidosis During Long-Term Treatment with Continuous Subcutaneous Insulin Infusion , 1984, Diabetes Care.

[72]  N. Bohannon.  Large phosphate shifts with treatment for hyperglycemia. , 1989, Archives of internal medicine.

[73]  M. Burge,et al.  Short-term fasting is a mechanism for the development of euglycemic ketoacidosis during periods of insulin deficiency. , 1993, The Journal of clinical endocrinology and metabolism.

[74]  S. Gupta,et al.  Severe non-ketotic hyperosmolar coma--intensive care management. , 1998, European journal of anaesthesiology.

[75]  L. Groop,et al.  Metabolic Effects of Low-Dose Insulin Therapy on Glucose Metabolism in Diabetic Ketoacidosis , 1988, Diabetes.

[76]  P. Marsden,et al.  Quantitative Analysis of Glucose Loss During Acute Therapy for Hyperglycemic Hyperosmolar Syndrome , 1986, Diabetes Care.

[77]  R. Berris,et al.  Metabolic studies in diabetic acidosis; the effect of the administration of sodium phosphate. , 1948, Archives of internal medicine.

[78]  J. McGarry,et al.  The metabolic derangements and treatment of diabetic ketoacidosis. , 1983, The New England journal of medicine.

[79]  L. Groop,et al.  Glucose and free fatty acid metabolism in non-insulin-dependent diabetes mellitus. Evidence for multiple sites of insulin resistance. , 1989, The Journal of clinical investigation.

[80]  Y. Berthiaume,et al.  Cerebral hypoxia from bicarbonate infusion in diabetic acidosis. , 1980, The Journal of pediatrics.

[81]  E. Marliss,et al.  Altered redox state obscuring ketoacidosis in diabetic patients with lactic acidosis. , 1970, The New England journal of medicine.

[82]  R. Matz.  Management of the hyperosmolar hyperglycemic syndrome. , 1999, American family physician.

[83]  R. Carey,et al.  Determinants of glucose and ketoacid concentrations in acutely hyperglycemic diabetic patients. , 1984, The American journal of medicine.

[84]  C. Sprung,et al.  Relation of colloid osmotic pressure to arterial hypoxemia and cerebral edema during crystalloid volume loading of patients with diabetic ketoacidosis. , 1982, Annals of internal medicine.