Abstract
Purpose of review
To emphasize the pathophysiological and therapeutic approach differences between diabetic ketoacidosis (DK) and hyperosmolar hyperglycemic state (HHS).
Recent findings
This manuscript depicts the different therapeutic protocols and potential complications in DK and HHS based on the best current evidence, in order to improve their management. Novel studies show quite different fluid management between DK and HHS, encouraging bicarbonate avoidance whenever possible.
Summary
Diabetic ketoacidosis is one of the most severe and life-threatening complications in diabetes. Cerebral edema may sometimes appear (less than 1%) as a consequence of DK, and it carries out high morbidity (serious neurocognitive sequelae) and mortality itself. The younger the patient, the higher the risk for developing CE, especially in recently diagnosed patients. This life-threatening complication must be clinically suspected in front of a patient undergoing a DK episode, and treatment should be started as soon as possible.
Other diabetic patients may decompensate with an HHS, which is pathophysiologically different from DK. Indeed patients with DK complication must have a cautious fluid management. On the contrary, HHS should be treated with an aggressive fluid reposition. Pediatric patients undergoing severe DK or HSS should to be admitted to a PICU for monitoring and especial care.
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Acknowledgments
Drs. Rosario Gallagher Norris and Ignacio Piroli for the translation of the manuscript and Dr. Luis Landry for corrections and suggestions are acknowledged.
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Marcela, Z., Ana, F., Solana, P. et al. Neurological Status Deterioration in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State. Curr Treat Options Peds 6, 377–386 (2020). https://doi.org/10.1007/s40746-020-00210-7
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DOI: https://doi.org/10.1007/s40746-020-00210-7