PT  - JOURNAL ARTICLE
AU  - Jean-Louis Chiasson
AU  - Nahla Aris-Jilwan
AU  - Raphaël Bélanger
AU  - Sylvie Bertrand
AU  - Hugues Beauregard
AU  - Jean-Marie Ékoé
AU  - Hélène Fournier
AU  - Jana Havrankova
TI  - Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state
DP  - 2003 Apr 01
TA  - Canadian Medical Association Journal
PG  - 859--866
VI  - 168
IP  - 7
4099  - http://www.cmaj.ca/content/168/7/859.short
4100  - http://www.cmaj.ca/content/168/7/859.full
SO  - CMAJ2003 Apr 01; 168
AB  - DIABETIC KETOACIDOSIS AND THE HYPERGLYCEMIC hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. Insulin deficiency is the main underlying abnormality. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in hyperglycemia, and can also stimulate lipolysis and ketogenesis, resulting in ketoacidosis. Both hyperglycemia and hyperketonemia will induce osmotic diuresis, which leads to dehydration. Clinical diagnosis is based on the finding of dehydration along with high capillary glucose levels with or without ketones in the urine or plasma. The diagnosis is confirmed by the blood pH, serum bicarbonate level and serum osmolality. Treatment consists of adequate correction of the dehydration, hyperglycemia, ketoacidosis and electrolyte deficits.