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 2021/12/07
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).