RT Book, Section A1 Buse, John B. A1 Polonsky, Kenneth S. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Wood, Lawrence D.H. SR Print(0) ID 2295570 T1 Chapter 78. Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar Nonketotic Coma, and Hypoglycemia T2 Principles of Critical Care, 3e YR 2005 FD 2005 PB The McGraw-Hill Companies PP New York, NY SN 9780071416405 LK accesssurgery.mhmedical.com/content.aspx?aid=2295570 RD 2021/03/05 AB Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic coma (HHNC), and hypoglycemia are life-threatening disorders of glucose metabolism.Altered glucose metabolism should be considered in the differential diagnosis of all patients with mental status changes, neurologic deficits, and severe illness.Therapy of DKA and HHNC requires replacement of deficits of fluids, electrolytes, and insulin.Mixed-anion-gap acidosis and hyperosmolarity are encountered often in the same patient.Continuous insulin therapy is essential in DKA.In DKA and HHNC, careful physical examination and laboratory follow-up with a flow sheet make it possible to prevent the disastrous consequences of aggressive therapy—cerebral edema, pulmonary edema, hypoglycemia, hypokalemia, and hyperchloremic metabolic acidosis.A search for the underlying cause of metabolic decompensation is required.Therapy of hypoglycemia requires immediate establishment and maintenance of modest hyperglycemia (glucose concentration above 100 mg/dL or 5.5 mmol/L).