It is a serious complication in diabetics with extremely high blood glucose levels, severe dehydration and low level of consciousness. It usually occurs in patients with type 2 diabetes (non-insulin-dependent).
It is triggered by infections, serious illnesses, kidney problems, medicines that reduce the effect of insulin, or stopping insulin. Dehydration and advanced age favour its onset.
Symptoms are progressive and may develop over several weeks. The most common are dryness of the skin and mucous membranes, extreme thirst and decreased consciousness to coma. It may be accompanied by fever, nausea, weight loss and seizures.
It is diagnosed clinically by interview, physical examination and blood tests. Compared with diabetic ketoacidosis, the presence of ketones in the urine is very rare.
As for treatment, it is important to treat the cause. This must be done in a health centre, ensuring correct hydration by endovenous serum therapy and insulin administration to correct high glucose levels.
This is a medical emergency with a mortality rate of 40%.
- Irl B Hirsch, MD. Michael Emmett, MD. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis. UpToDate. Sep 15, 2016.
- Irl B Hirsch, MD. Michael Emmett, MD. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis. UpToDate. Jul 05, 2016.
- Irl B Hirsch, MD. Michael Emmett, MD. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment. UpToDate. Dec 07, 2015.
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- Savage MW, Dhatariya KK, Kilvert A, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011; 28:508.
- Nyenwe EA, Kitabchi AE. Evidence-based management of hyperglycemic emergencies in diabetes mellitus. Diabetes Res Clin Pract 2011; 94:340.
