RT Journal Article
SR Electronic
T1 Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 859
OP 866
VO 168
IS 7
A1 Jean-Louis Chiasson
A1 Nahla Aris-Jilwan
A1 Raphaël Bélanger
A1 Sylvie Bertrand
A1 Hugues Beauregard
A1 Jean-Marie Ékoé
A1 Hélène Fournier
A1 Jana Havrankova
YR 2003
UL http://www.cmaj.ca/content/168/7/859.abstract
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.